When I was fourteen, I went to a local strip mall with several friends to try on women’s boots at a Belk department store and then to watch The Grudge 2. It was Friday the thirteenth, and we wanted to feel scared.
After the movie, a friend’s mother picked us up outside the Borders bookstore. I remember riding in her car, all of us singing along to the radio, which was playing Snow Patrol’s “Chasing Cars.” (“If I lay here, if I just lay here, would you lie with me and just forget the world?”) My next clear memory is of waking up in the ambulance, my mouth a ruin even if the rest of me felt warm and whole, cushioned in shock. At the hospital, I took one look at my parents—two Chinese immigrants standing inside a hectic Tennessee emergency room, asking after their son’s teeth—and promptly blacked out again. The doctors told me later that the impact of my face against the driver’s seat pushed one incisor into my nose, a tooth they had to surgically retrieve. Two other teeth were recovered from the crash site and couriered to the hospital in a glass of milk. Reinsertion, however, was not an option (too much bone was missing from my maxilla), so I ended that day short three incisors.
The technical phrase for how I lost my front teeth is dental intrusion from sudden facial trauma. My junior year of high school—following a bone graft, the removal of four wisdom teeth, and several stints with partial dentures—I had three titanium posts sunk into my upper jaw. These posts were left to settle in the bone for a few months before a cosmetic dentist capped them with a bridge of ecru falsies.
Few people can tell that my smile is literally fake. Only new dentists in new cities ever comment on the implants. More competitive dentists inform me that whoever placed the implants didn’t do a great job because they left one of the posts unmoored from the bridge. Looking over my X-rays, these dentists zero in on that wandering post, which looks like a small screw, and which sits too close to its neighbor. They tell me not to worry. It’s not a problem they want to deal with, not now at least, this error already lodged inside my mouth.
In Teeth: A Very Short Introduction, the dental scientist Peter Ungar writes that our teeth “mediate” between the world and us, helping to process the wide panoply of things we like to put in our mouths. Given this job description, teeth are incredibly durable, the hardest parts of the human body. When we die, they often serve as stubborn remainders, covered in pits and knobs and subtle striations which trained experts can read like the rings of a tree. In both cop shows and paleontology labs, just one recovered tooth can help create a whole narrative—giving an identity to Jane Doe or divulging the dietary secrets of long-extinct creatures.
After getting my implants, I grew more interested in the stories we like to tell ourselves about teeth. I began to wonder, for one, why dentistry is so distinct from medicine in America. This divide defines not just the separate institutions and insurance policies we use for dentistry and medicine, but also the private ways that people narrate their dental and medical trials. Many of my friends, for instance, claim that teeth are easy to fix and protect. “Just floss some more!” is a common piece of advice doled out when something goes wrong in the mouth, making any toothache all about personal hygiene and thus, laziness. On the other hand, non-oral illnesses are often framed in grandiose terms, as a battle between pathogens and the immune system, or else as “medical mysteries” uncrackable via WebMD. While the body-at-large must be defended and queried like the wild and complicated beast it is, teeth are managed like property. Dentistry figures in our lives as a form of maintenance or, for the bougie, as a form of renovation—the dentist both a groundskeeper and an interior decorator.
Like other forms of property, an orderly mouth is a status symbol, indicating beauty and, increasingly, class. (In 2016, 74 million Americans were living without dental insurance—not all these people already struggle with their dental health, but the chances they might one day are not slight.) Growing up on the outskirts of Appalachia, in health class I was often confronted by stock images of the Mountain Dew-gargling redneck or his freewheeling cousin, the meth addict, their dilapidated dentitions evidence of an aesthetic as well as a moral failing. “Don’t be like this,” the pictures said. “Don’t live this dental story.”
According to the scholar Theodore Ziolkowski, descriptions of teeth have been used by writers to illustrate everything from the decline of a family’s fortunes (Thomas Mann’s Buddenbrooks), to an incestuous desire for one’s cousin (Edgar Allan Poe’s “Berenice”), to the agony of artistic creation (Hans Christian Anderson’s “Auntie Toothache”), to a Russian political prisoner’s guilty memories (Arthur Koestler’s Darkness at Noon), to a priest’s fall from grace (Graham Greene’s The Power and the Glory). In more contemporary literature, one might look to Valeria Luiselli’s The Story of My Teeth, or Zadie Smith’s White Teeth, or even Charles D’Ambrosio’s “Drummond & Son,” which contains a striking moment when a fixer of old typewriters looks inside a broken word-processing machine and re-imagines it via a dental metaphor: “Whenever Drummond opened a machine, he saw a life in the amphitheater of seated type bars, just as a dentist, peering into a mouth for the first time, probably understood something about the person, his age and habits and vices.”
Ziolkowski sorts these dental narratives into two camps: “psychodontia” and “sociodontia.” While psychodontists deploy dental disorders to symbolize the “personal conscience” and psychological pain of their characters, sociodontists style rotting teeth as a metaphor for the breakdown of civil society. As Ziolkowski observes, dental narratives have grown more socially concerned over time: “decaying teeth now represent with increasing frequency society as a whole and not just the esthetic or moral agony of the individual.” This makes sense because, as Ziolkowski argues, “tooth decay varies in direct proportion to the level of civilization.”
Recent dental research seems to corroborate this point. Teeth collected from human remains predating the advent of agriculture are conspicuously cavity-free, and the teeth of modern humans living on hunter-gatherer diets are also less carious (cavity-prone) than the average American smile. What this suggests is probably obvious, that diet matters more than hygiene when it comes to preventing rot. Prehistoric humans were not fastidious tooth brushers, but their diets largely lacked the complex carbohydrates, especially processed sugars, which cavity-causing bacteria love. In other words, dentists may fix our cavities, but they can’t do much about human appetite and the vast network of food production, marketing, and sale which has developed in response to our hungers. The story of a modern mouth may actually be quite simple: From consumption comes decay.
About a year ago, I moved with my boyfriend to China. Our plan was to land in Shanghai and then take the scenic route to Chengdu, where we would start new lives as English teachers. A few weeks into the trip, while hiking in Yading Nature Reserve, I felt a minor pain in my mouth—a light buzz localized to one of my back molars. Trekking through the park, I tongued the tooth whenever it called and tried to focus on the scenery. Snow-covered peaks rose above me. Clear, glacial streams streaked through the meadows. In the mostly coniferous forests, I could see chiru, or Tibetan antelope, moving through the shadows.
Perhaps it was a quirk of the altitude, but everything seemed buffed to a fine sheen that day, the mountains as defined as National Geographic still shots, the trail we walked on straight and bare. My tooth pain grew clearer, too, and I began tapping the offending molar every few seconds with my finger, as if in rebuke. Toothaches often have this infantilizing effect on me. I grub about in my mouth. I bitch to my friends, and if none of that works, I report dutifully to a dentist and ask them to drill the pain away. There in Yading, I felt far removed from that last, failsafe option. My boyfriend took in the pinched look on my face and the little tracks of spittle on my hands. We decided it was time to turn around.
I took the toothache back to Daocheng, a local tourist hub where we had left our luggage that morning. Lying in the hostel bed that night, quietly going crazy from the pain, I compiled a list of oral misdeeds for which I should apologize. The list was not short. I apologized for the oatmeal cookies I hoarded in college and every cigarette I smoked in graduate school. I apologized for booze, though I wasn’t really sure if alcohol—especially in the small quantities I drank—even damaged teeth. I apologized for candy, a pleasure of childhood I had never outgrown, which is to say I apologized for all the hundreds of Tootsie pops I had licked to nothingness and all the Jolly Ranchers I had sucked into brilliant little shivs.
“My mouth is full of decayed teeth and my soul of decayed ambitions,” James Joyce once wrote in a letter to his brother. This statement encapsulates the melodrama of dental disease for me, the way it pairs physical rot with a promise of spiritual or psychological deterioration. Toothaches are unequivocally self-induced, the product of so many wants readily indulged. Pounding about my cranium, a toothache is monotonous and moralizing, a pain which lectures even as it punishes. So I am humbled like Thoreau, who wrote upon accidentally swallowing a loose tooth, that he felt reduced to a “lame and halting piece of manhood.” I am browbeat into feeling guilty for my diet as well as my life, for all the ways I may have been too greedy, all the times I sought too much.
Sleepless in Daocheng, I began to think of myself as budget Veruca Salt from Charlie and the Chocolate Factory, flouncy and perfumed, but compromised at the roots. Like the rest of Mr. Dahl’s sweet tooths, I was getting my just desserts.
By morning, I thought I was in the clear. The pain had peaked in the night and then subsided. I crept to the station and boarded the twelve-hour bus to Kangding, letting myself imagine again the trip ahead of me. Days and nights of alpine smells, lonely horizons, the kind of starlight which both calms and confuses the eye.
But the ache re-formed, sending runners to my ears and the back of my head. Every motion above the neck was accompanied by a spitting nerve in my jaw. Every switchback left me feeling at once nauseous and silly, the American backpacker coming undone as my fellow bus-riders watched and considered. In Notes from the Underground, Dostoyevsky’s narrator thinks of toothache as a “voluptuous pleasure,” a state of physical and mental abasement that brings the sufferer closer to his body. My ache did not feel so revelatory. I felt pathetic, clenching my boyfriend’s hand in a death grip as the bus lurched through another awkward turn, asking the sky for distance from my body—a vacation, however brief, from the constant pinging in my mouth.
By the time the bus deposited us in Kangding, I wasn’t sure if I could continue with the trip. We followed the usual procedures—finding a hostel, looking up potential hikes, buying speckled pears at the market—but it soon seemed prudent to cut our losses and head for Chengdu, where there were dentists to consult. On the way to the airport, I spoke in Chinglish with a woman from Changchun who had lived for a year in Utah, where she had also converted to Mormonism. As the van coasted across the empty passes, the woman told me about a famous love song named for Kangding, which she played for us on her phone. Later, flying towards Chengdu, the song kept drifting in and out of my head, teasing me with images of a curved moon and peaks brushed in white, slippery cloud.
The first dentist office in Chengdu I tried was called Yafei. It was run by Catholics. There were Virgin Mothers ensconced in every alcove. After waiting a few minutes in a long, mauve arcade, I was summoned to see the English-speaking dentist, an Indian expat with a brusque manner. “Does it hurt when I do this?” she asked, knocking my tooth with one of her instruments. I told her yes, it hurt a lot.
The good dentist thought I needed a root canal, but after X-raying my mouth, decided to reverse course. My tooth had apparently had “too much work done” in the past. It wasn’t clear from the X-ray if the tooth needed a root canal or an extraction. Not wanting to act hastily, the dentist suggested I seek a second opinion. She gave me the name of an endodontist at Chengdu’s largest hospital, and I returned to the muggy heart of the city, where I trudged along the sidewalk, longing for something sweet to eat. There was no point running to the hospital right then. Scheduling at such places works on a tight queue system, and all appointments for the day are usually filled by the early morning. I got on a subway train, and then a pedicab, and then the bed in the hotel room, where I spent the rest of the day whimpering into a pillow as my boyfriend tried to narrate the soap operas playing on TV.
The next morning, we arrived at the hospital early, waiting in line to get a pay card and then to gua hao, or collect an appointment number. In China, public dentists work in the same system as any other doctor, and so deal with the same overcrowded and understaffed hospitals which make medicine in China feel like treatment by assembly line. My boyfriend and I followed the general flow of the sick into an airless elevator and then down a long hallway lined with gurneys and off-duty staff. People kept looking at us: the young Chinese-looking man with his laowai companion. I realized I was practicing medical tourism in a country not usually visited for such reasons.
The endodontics ward was set up with two rows of purple recliners, each separated from its neighbor by a divider. I stood in the hallway, peering into the examination room through a long window, watching as the endodontists, who were all women, breezed in to begin another long workday. I was missing very much then the dentist office of my youth, where I opened my mouth and silently listened to hygienists passing gossip as they excavated my plaque or tightened my braces. The women who watched over my young mouth were attentive and kind, but mostly they were competent. Before each visit was finished, a deeply tanned hygienist would recall me from the Sega consoles so the one dentist could perform his inspection. He hemmed and hawed over my teeth, probing at the usual weak spots and grumbling to himself about my latest cavity spree.
Here at the Huaxi endodontics ward, the women were pulling on their face masks and their gloves, their whitest coats and most bored expressions. A designated gatekeeper came to the door. She called many numbers, including mine. I was directed to a chair, where I sat and waited for that familiar falling motion to take me back, my mouth already forming a hungry, hopeful O.
In the end, I left the hospital with a riddle in my mouth. The endodontist looked at my X-rays, furrowed her brows, and sent me to her periodontist friend upstairs, who spent a long time exploring my gums with a sickle probe before also pronouncing my issue undiagnosable. She dismissed me with a parting jab of her hook and a prescription for amoxicillin, asking me to return in a week if the antibiotics hadn’t stopped the pain.
Later online research led me to believe that the ache was caused by an abscess near my tooth’s root, an angry bubble of bacteria and pus which the amoxicillin helped to pop. In the days following my visit to the hospital though, I was unsure what to think. The gums around my molar swelled and extruded pus. I went to look at apartments and started a new job. The pain in my tooth, once the central fact of my Chengdu life, eventually dulled, replaced by long commutes, bad wallpaper, and a sense of unearned calm. Without any clear diagnosis, I was afraid the ache might return. At night, still more sleepless than usual, I lay in bed thinking of holes opening and closing in my jaw.
If an anthropologist in the distant future came across my dental X-rays, what would they think? Would they be able to pinpoint the problem for me, or would they marvel at the crudity of all those fillings, each like a cloudy whiteness in the image? Would they intuit something about the work that had gone into making these teeth the way they are, the years of headgear, braces, and plaster molds that ultimately came to nil? Would they see in my imperfect mouth all the concessions made to the cars which crash in the night and the pieces that stay missing? I’m no specialist, but I think they would infer a lifestyle recognizable to many of the more privileged citizens of my time: a processed, high-carb diet, access to dental care, cavities which were plugged, but which left a trace. More specifically, they would see the implants improperly placed, the middle post nearly diagonal in the bone. They would look at the metal infiltrating the bone, the bone infusing the metal, and theorize that the mouth was where our cyborg natures began.
If nothing else, they’d probably ask why the possessor of this mouth didn’t stop what he was doing, why all the damage control didn’t result in any change to the pattern. Here as well I doubt the answer would be much of a mystery. It’s tedious, controlling one’s appetite. Drunk or depressed, I will probably always take to bed with a bag of Twizzlers or go out with friends to consume in other ways I know to be unwise. I seem committed to such minor rebellions against good sense. Still, my maybe-abscess felt like a reckoning. In the days and weeks after the pain faded, I found myself thinking a lot about accountability. I tried to consider what it would mean to change the story of my teeth, not just with a superficial gesture like buying an electronic toothbrush or investing in expensive mouthwashes, but on the deeper level of habit, of behavior. Maybe the time had come to stop my dependency on dental care and to address the problem at its saccharine source, to think about and meter my consumption in slow but sure ways; to give up the cigarettes, the sodas, the candy; to do the work of controlling my excesses, even if I loathe self-discipline’s earnest, vanilla taste.
In the Coen brothers’s film A Serious Man, a man named Larry who has fallen on hard times pays a visit to his rabbi, seeking insight into what his recent misfortunes might mean. Instead of offering comfort or advice, the rabbi tells the man a story about a local dentist. One day, this dentist found a message chiseled in Hebrew on the backsides of a gentile’s teeth. Help me, save me, the teeth said, and the dentist grew obsessed with understanding what these words might mean. He brought the gentile back for a follow up, suspecting evidence of some deathly disorder. The gentile, however, was fine, leading the dentist to the rabbi, who told him much the same thing he now tells Larry. Maybe our lives are chock full of signs we should follow. Maybe they aren’t. Either way, we have to learn to live with the mystery of it all. “These questions that are bothering you Larry, maybe they are like a toothache,” the rabbi opines. “You feel them for a while, and then they go away.”
When the future socio- and psychodontists come to ask what happened to my teeth, I will try and sum up the story succinctly, as if the action were all past. Scene one: a car crash. In scene two, I get my dental implants and move on with my life, accumulating cavities and fillings, crowns and root canals. My mouth is fixed up, and to the best of my ability, maintained. You could say that something lingers though, a suspicion of flaw, a dream or a nightmare of ruin.
Like Larry, I want to keep feeling the questions my body asks even if I have none of the right answers, even if I suspect that the body is just here to feel itself wearing away. At home, I keep above my desk an orange medicine vial containing the three teeth I lost on Friday the Thirteenth. They are scarily long, these teeth, yellowed and bestial. They have been uprooted, cleaned, misplaced somewhere far from their original context. Even so, looking at the teeth reminds me of fidelity, not trauma, each tooth a message writ small in dentine and enamel and bits of orthodontic glue. We clean and modify and sometimes even shed these narrative devices. For now, however, they remain.
Rumpus original art by Dmitry Samarov.