THE MEDICINE

The Monthly (Australia) - - NEWS - Karen Hitch­cock

We spend a lot of time in queues. Peo­ple will wait in line for a seat at a mo­men­tar­ily hip ra­men joint, to se­cure a trickle of govern­ment as­sis­tance or some dis­count Louis Vuit­ton. All day ev­ery day they’re wait­ing for treat­ment out­side hos­pi­tals’ emer­gency de­part­ments. We trade in our time and com­fort for the things we need or re­ally want. The older and richer you are, the less time you will squan­der an­tic­i­pat­ing your turn.

In pri­mary school I spent an in­or­di­nate amount of time queu­ing for things I didn’t want: vac­ci­na­tions, nit inspections, a check-up in the den­tal van.

The Com­mon­wealth-funded van would visit our school a few times each year. A short-tem­pered trainee den­tist and his fe­male as­sis­tant ran it, and there’d be one kid mouth-open in the re­cliner and an­other kid ready in a seat to the side. I copped a lot of pain in that van. One time the den­tist wouldn’t be­lieve that his gi­ant nee­dle had failed to numb the tooth he was drilling, and yelled at me to stop edg­ing down the seat as I tried to es­cape. I ex­pe­ri­enced the most me­morable pain while wait­ing for them to treat my class­mate Patrick. He was only up there for a few min­utes be­fore the as­sis­tant asked him the colour of his tooth­brush. Patrick said it was yel­low. The as­sis­tant sneered, “Is that so? We’re sur­prised you can even re­mem­ber. You do re­alise that your breath smells so bad the den­tist has had to put on a mask?”

The van staff made no ef­fort to dis­guise their ha­tred of this job. They were wheeled out to the free­way sub­urbs, time pres­sured, phys­i­cally cramped, pre­pos­ter­ously young, com­pletely un­su­per­vised and with­out a sin­gle par­ent to thank them. But they had to learn on some­one. Might as well be on those who had no other way to pay ex­cept with a bit of suf­fer­ing. Turns out we were lucky. Born a cou­ple of decades ear­lier and I may have had the lot ex­tracted and re­placed with a set of “low­main­te­nance”, “germ-free” den­tures. If not for free, then per­haps as a 21st birth­day present or “den­tal dowry” (re­as­sur­ance that a fu­ture wife’s teeth wouldn’t send you bank­rupt). At the time of my con­tact with that shak­ily benev­o­lent van, 60% of men and 71% of women over the age of 65 in Aus­tralia were eden­tu­lous. That is, they were com­pletely tooth­less.

Com­pared to the cur­rent state of pub­licly funded den­tal ser­vices in Aus­tralia, the den­tal van sounds as lux­u­ri­ous as cut-price Louis Vuit­ton. If you are poor you can still get free den­tal treat­ment, but you’ll wait up to seven years. We may have been mildly tor­tured and oc­ca­sion­ally hu­mil­i­ated, but that den­tal van prevented a lot of fu­ture trou­ble.

Peo­ple rarely get all their teeth re­moved any­more, and when they do it’s gen­er­ally at their own re­quest. When you’re in a queue that’s seven years long and have a sore tooth, a re­quest for “de­fin­i­tive” treat­ment is hardly sur­pris­ing. Only 14% of Aus­tralian den­tists work in the pub­lic sys­tem. I’ve never met any of them but I com­pletely un­der­stand if they’re in a per­ma­nent bad mood. The ex­clu­sion of den­tal care from Medi­care was sup­ported by den­tal as­so­ci­a­tions wor­ried that govern­ment fund­ing would bring with it govern­ment con­trol. What pro­fes­sion would choose that over the riches avail­able in the free mar­ket?

Both of my daugh­ters had braces fit­ted last year. One had ex­tremely prom­i­nent front teeth caused by a vig­or­ous thumb­suck­ing habit. The other had a mi­nor over­lap­ping of her two front teeth. They saw the or­tho­don­tist – a man with gleam­ing white of­fices, ter­rif­i­cally at­trac­tive as­sis­tants and ex­quis­ite shoes – and he rec­om­mended the braces and three-year pay­ment plan. The braces hurt them for a few days and there­after caused no ma­jor is­sues. But this week they came home from their checkup with their lit­tle cheeks swollen up like a chip­munk’s. Their teeth were so straight by now I’d half ex­pected him to de­clare fur­ther brac­ing un­nec­es­sary. In­stead, he’d in­serted sets of fat me­dieval-look­ing springs: a sched­uled part of the treat­ment I’d ap­par­ently for­got­ten. The girls au­thor­i­ta­tively told me the springs were nec­es­sary to “cor­rect their over­bites”. They no­ticed my scep­ti­cal look and told me – wide-eyed – that if they didn’t get the mi­nor ab­nor­mal­ity fixed they might need “jaw surgery” later on. Then they re­fused din­ner and mis­er­ably took to bed.

I re­mem­bered the hor­ror of be­ing a young girl too in­tensely to have in­sisted my daugh­ters learn to live with buck teeth. Den­tal mal­for­ma­tion has be­come a po­tent sig­ni­fier of poverty and a long list of other un­jus­ti­fi­able as­sump­tions that I’m sorry about but not pre­pared to use my own chil­dren to protest. But to move an en­tire jaw for­ward, to in­flict that kind of pain on a cou­ple of 12-year-olds who looked per­fectly fine? I needed ev­i­dence that the in­ter­ven­tion would pre­vent a se­ri­ous longterm health prob­lem. So, guilt-stricken and con­flicted, I spent a night among the den­tistry jour­nals. The scep­ti­cal look on my face found no rea­son to re­move it­self. There is vir­tu­ally no ev­i­dence that “mal­oc­clu­sion” af­fects the health of the “mas­ti­ca­tory ap­pa­ra­tus” un­less the over­bite is “trau­matic”, the in­cisors self-mu­ti­lat­ing or the teeth wildly im­pacted. The stud­ies even fail to prove any emo­tional ill ef­fects of den­tal ir­reg­u­lar­ity.

Our pri­mary school suf­fer­ing saved our teeth and pro­vided a gen­er­a­tion of den­tists with in­ten­sive train­ing. My daugh­ters’ pain was serv­ing noth­ing more than a fairytale of bite per­fec­tion. In a coun­try where den­tistry costs big dol­lars, chil­dren are lucky if their par­ents can pay. When it comes to orthodon­tics, par­ents should ques­tion ex­actly what it is they’re buy­ing into.

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