In the United State, there are 2 classes of dental care.

Many people are getting second class dental care and either they don't know it, or they know it and don't have enough self-esteem to be outraged by the fact that they have been relegated, by economics and other's evaluation of their social status, to second-class biting and chewing ability, and consequently an inferior quality of life - and likely even an reduction of how long they will live.

I spent about a year working as a dental technician. My boss was a dentist. I was a "crown and bridge" person; I made caps and fixed bridges. Every day, dentists would send in impressions they took, of patients' teeth. From the impression, I made a plaster model of the patients' teeth. Then I put the patient's upper and lower model in an articulator -- a device that substitutes for the patient's head. The upper and lower parts of the articulator move apart and together, much like the patient's mouth opens and closes. There it was -- the patient's mouth. The rest of his head was conveniently dispensed with; the patient's dental situation was easy to see.

Why was so much effort applied to supplying me with a superbly detailed model of the patient's mouth? Including in this plaster model of a patient's upper and lower teeth, would be one or more teeth that the dentist had cut down, prepared, to accept a prosthetic crown, a cap. As a crown and bridge person, it was my job to make the caps, and make them to properly fit the teeth that were, hopefully, properly prepared. Not all prepared teeth were prepared as well as other prepared teeth. Some dentists consistently did a better job of preparing teeth, than others. (Some dentists did a better job of taking impressions, too.) Under the supervision of a dentist, I learned how to make caps. Including in learning to make caps, was learning how to judge the quality of each preparation. I learned about how various dentists compared with each other, in the quality of their preparations: what percentage of dentists consistently did good preparations, what percentage did bad; how much the variation was from dentist to dentis; how this would impact on the initial and long-term functioning of the crown in the patient's mouth. I also got lots of plain old gossip, from my boss, about the various dentists who used our services, who sent us impressions from which to make models, and from those, caps and bridges. Where they went to school, how long they had been practicing, what their patients were like, what he thought their motivations were for being the way they were. I also learned alot about economics, social status and social class, in our society, about the assignment of different value and worthiness to different human beings, and how more highly valued humans are cared for better than the less highly valued. How much was this due simply to their earning potential? How much was this due to their comportment and bearing? How much this was due to perceived "class" that was attributed to them by what was known, or thought to be known, about the economic situation they inherited from their progenitors, or about chacteristics it was thought that they inherited?

I saw in detail, how things work. I saw that our society doesn't care too much about the retired elderly, even if they worked hard all their life. Medicare does not pay for any dental care at all. I saw how our society doesn't care too about the disabled. Those disabled, who thru no fault of their own can't produce money as abundantly as perhaps others can -- don't rate the same standard of dental care as those who make a middle class living. They generally get approximately the dental care of 60 years ago, not the dental care that has been the standard of care since before 1950.

If you were retired on a fixed income, and were a lower-middle-income worker before that, who had not accumulated a lot of savings, or who had had a serious illness that depleted their savings - you didn't rate keeping your teeth. They often had Medicaid, and not Medicare, and went to what were unofficially called "Medicaid Mills" -- who told them all their teeth needed to be extracted, and got a few dollars per tooth from Medicaid, to do this. That's right, not matter what condition the patient's tooth was -- it needed to be extracted. That is how they made a living. Why? There was a going rate for extractions that allowed a dentist to make a decent profit. Another rate for root canals. Another rate for caps. Medicaid paid nearly the going rate for extractions. Medicaid paid maybe only 20% of the going rate for all the other procedures it paid for. And for many procedure, it just didn't pay anything.

The rich and upper middle class get class A dentistry and get their teeth saved with a root canal. Their dentist tells them: your tooth can be saved with a root canal, no problem. The lower middle class and poor -- get class B dentistry -- for the exact same tooth situation their dentist tells them "this tooth is beyond repair and needs extraction." Both patients generally simply accept what their dentist says. It either doesn't occur to most of the class B patients that their dentist is lying to them. Or perhaps if it does, they don't want to admit to themselves that they have been consigned to get second-class dental care. Or perhaps they just don't value their teeth the way I value teeth. Maybe they like to eat cream of rice, ice cream, cake, and white bread, and aren't too interested in carrots, almonds, sesame seeds, sugar cane, sweet corn, and apples.

Even if the patient were to say: if I had more money instead of very little or poor insurance or Medicaid, could the tooth be saved, the dentist usually tells them "no." Similarly, it doesn't occur to most class A patients that if they had less money, their dentist would tell them their tooth would need to be extracted. It seems that only a few class B patients are aware that if they had more money they could get better care. These included poor people who are nevertheless well-educated, perhaps people who are poor because they are disabled or elderly, rather than because they are uneducated. 70% of the disabled are unemployed. Apparently these people do NOT generally make waves. Apparently they USUALLY just get the tooth extracted. I appear to be the only one in this situation that gives a damn.

Not only am I acutely aware of the different levels of care after having worked as a dental technician (crowns and bridges) and having my boss point out the medicaid mills that were pulling teeth just to to make money (unnecessarily) and the top-flight dentists who catered to the upper middle class and rich and did a good job of saving teeth. (He also pointed out the good preparations and the poor preparation). But I subsequently spent a good number of hours in the library of a dental school, getting self-educated. If I could get more people to join me I could perhaps slowly change the situation, and get the same level of dental care for all people. I've brought up the subject with many people but it seems to me, that most people in the US really don't care. Not patients, not dentists. I seem to be a rarity -- a patient who knows the difference between good dental work and poor, and even rarer, a patient who gives a damn about which level of care he gets, and others get.

I believe the reason quite a few people in the US get good care is there are quite a few good dentists here who have pride in workmanship, pride in what they do, and refuse to do poor work. They just wouldn't feel good about themselves if they extracted teeth that they knew could be saved. I believe it has little to do with patients demanding it. Unfortunately, they often simply reject patients who can't pay for the good level of care they want to take pride in providing, leaving such patients with no other choice but putting themselves into the hands of dentists who are primarily interested in just making some money, and don't care that they are both (1) extracting teeth that could be saved (1) dishonestly diagnosing such teeth as being unsalvageable, perhaps justifying this to themselves by viewing poverty as a patient "characteristic" that affects the diagnosis. I've spoken to many people about this situation. Many don't want believe there are 2 classes of dentistry. Others don't care and think it is just fine that poor people get teeth extracted that could be saved. They pretend they believe that edentulous mouths and removable dentures are just as good as a fixed bridge and a few good caps. A few unusually well-educated people understand the situation, but none of them seems to be concerned enough to want to do anything to try and change it. Yes I've written to my congressman about it, as well as Hilary Clintion. No response from Ms. Clinton.

It has been suggested, by one dentist that I spoke with, that some patients may value making their pickup truck a whole lot more than the root canal and crown that they could get, if they were to forgo one or 2 monthly payments on their pickup truck

I think patients have a right to make that choice, and denitst have a right to go along with that choice. But in my opinion, for teeth that 75 years ago would have been extracted, the minimum standard of care in this day and age, in many cases, would be s a root canal and a prosthetic crown -- a pfm crown or a crown made of cast precious metal. (A Procera crown or IPS Empress crown would be above the minimum standard of care, and an unnecessary but cosmetically superior solution). I don't understand how anyone can choose a material possession (such as a truck) in preference to a part of their own body, or choose a removable prosthesis in preference to a fixed prosthesis that functions much more like their original body part -- but that is their right

Once you have a tooth extracted, you can never get it back again. Once you sell or even simply lose a pickup truck, you can always get another one. I only wish I had a pickup truck I could sell to use for money to get my teeth fixed.

There have been several studies that show that people who keep their teeth not only report having a better quality of life than those who lose teeth, but actually live longer. One plausible hypothesis that has been put forward to help explain this is that it may be related to ability to maintain a better diet.

Again, once you lose that tooth, it can't be replaced. That's why, in general, I would go thru hell or high water to save a tooth. Of course there would be exceptions, but in general that is what makes sense to me. I suppose part of this is I believe my body is not mine to buy or sell, or alter frivolously. Rather, my opinion is it belongs to the creator, not to me.

It isn't like a root canal and a permanent prosthetic crown is experimental, or cutting edge. It has been the standard of care for over 50 years now. But the cultural attitudes toward teeth seem to be inherited and maintained from those that existed before the development and perfection of the root canal. I see a jagged disconnect here.

120 years ago the standard of care for an inguinal hernia was removal of the testicle and then closure of the inguinal canal. Starting in 1886, after Eduardo Bassini developed his advanced repair, slowly but surely the standard of care became a more complex procedure to re-arrange the layers of tissue in the inguinal region, without first removing the testicle. It is substantially more complex and time-consuming to do a modern hernia repair than to simply remove the testicle and suture up the inguinal canal. Yet the possibility of doing the simpler older repair is almost never even mentioned to male patients with inguinal hernias. Since 1930 or so, it has been a historical curiosity and one that today, most people don't even know about. Certainly, a testicle is not a vital organ like a liver or kidney. You can live without any testicles, and you can have very little loss of quality of life if only one testicle were removed. It is mostly a cosmetic loss. Today, even loss of 2 testicles is mostly cosmetic if only the individual is considered (if ability to reproduce is not taken into account) given the low cost and ready availability of synthetic hormones. Yet general surgeons don't consider trying to save someone's pickup truck by offering inguinal hernia patients the choice to have a simpler, cheaper, testicle-sacrificing operation. That's another reason why my opinion is that the existence of a choice, in re to teeth, is a cultural artifact that reflects cultural views of which body parts are more important than others, and not scientific views of which body parts are more important than others.

Food, including a wide variety of raw fruits and raw vegetables, as well as nuts and seeds, are SO important to my quality of life; they are part of my cultural inheritance, and for over 50 years they have been part of my lifestyle. Eating such a variety, both alone and sharing such food with friends, is what my life has long been all about. As has been discovering new fruits and vegetables, and seeds, and breeding new cultivars. Food is one of the most important aspects of life, if not THE most important, and sharing food with others one of the most important part of human society. And teeth are at the INTERFACE between food and person, between the matter and energy of the environment, and the matter and energy of the human living being. They are where the transformation from non-person to person begins. A such, they are perhaps THE most important appendage of the human body, according to how some people value things, no less important than the arms and legs. We walk -- in order to get to food. As human beings we are mostly about eating, eliminating, and reproducing and socializing. Everything we do revolves around these. And eating STARTS with the Teeth. Not only that, but they are important to socializing too, contributing tremendously to how our smile appears to others.