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  • A close-up look at America's teeth with author Mary Otto

    By Deirdre MacBean, 3M Storyteller

    Blonde girl stands outside of a home in a poor neighborhood

    • Mary Otto is on a mission to talk about teeth. In many ways, it seems she was born to bring us these stories.

      There are almost too many pivotal ‘teeth-related’ events in her life for it to have been chance.

      Mary is a veteran health-care journalist and prize-winning author of the book “Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.” Her decade-long quest to explain to the public why teeth are so important to our overall health – and that bad things can happen to people and communities when society fails to recognize that – began in 2007. It was then, while reporting on poverty and other social issues in Maryland for the Washington Post, that she broke the story to a stunned world of the death of Deamonte Driver. Deamonte was just 12-years old living in Baltimore when he died as a result of complications from dental decay. His underlying tooth infection had gone untreated and spread to his brain while, for a variety of complex reasons ─ ranging from unclear paperwork to lack of available dentists ─ his mother had struggled in vain to find dental care.

    • Portrait of Mary Otto, author of
      Mary Otto, photo credit: Nancy Crampton

      Tragedy sparks policy change

      Mary had been covering Deamonte’s family and its struggles with the dental health system for several weeks before his death. “I’d heard about this child who had ended up in hospital seriously ill from complications of tooth decay. His family was excited, because it looked as though he was recovering, but then suddenly he died,” she remembers.

      “This terribly sad story alerted me to the real implications of the shortage of dental services in the state of Maryland and the rest of the country,” explains Mary. She adds that, by federal estimates, roughly 51 million Americans live in communities that have been designated dental health professional shortage areas.

      She continued to track the ripple effect of Deamonte’s case. Congressional hearings and wide-ranging policy reform led to improvements in access to dental care in underserved communities in Maryland, with innovations such as mobile dental clinics and the use of dental hygienists for basic prevention in schools. Some of these innovations have since been adopted by other states, too.

      Meanwhile, teeth were beginning to play a bigger part in Mary’s world.

      “You know it’s amazing. Everyone’s got a story about teeth,” says Mary. “From nice dinner parties to families waiting long hours in line for free care in volunteer clinics, people all have their dental dramas. Teeth are so intimate, such a part of us, you’d think it might be off limits, but everyone seems to want to talk about them.”

    • “Everyone’s got a story about teeth.” - Mary Otto, author of Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.”

      Teeth are time capsules

      Teeth tell their own stories, too. Mary became fascinated by the deeper significance of teeth to our understanding of human development. During a year-long Knight Science Fellowship at Harvard University, she learned, for instance, about “teeth as time capsules that allow you to explore ancient lives.” According to Tanya Smith, a Harvard paleoanthropologist, layers of tooth enamel are like rings of a tree, with a neonatal line that even marks the time of a person’s birth.

      Stimulated by all these dental discoveries, Mary was soon living surrounded by dental books, boxes of papers and well-thumbed dental treatises, such as the revolutionary surgeon general’s report in 2000, which set out a new agenda for the U.S. dental system, stating that “oral health is a critical component of health and must be included in the provision of health care and the design of community programs.” The author’s words that teeth and other tissues of the mouth and face “represent the very essence of our humanity” were burned into her memory.

      As her interest in teeth approached a self-described obsession, she realized the time was ripe to direct her energy into a book. In 2014, she struck a deal with the New Press, a non-profit publishing house dedicated to producing books that focus on under-represented aspects of American life.

    • Following the toothache

      Mary traveled hundreds of miles from Florida to Alaska to learn from people in the communities where tooth-related pain is most intense – places where care is in short supply, from rural areas to the poor parts of large cities to American Indian reservations.

      Some of her most vivid memories are from making the rounds in a mobile dental clinic, funded and run by the local chapter of the National Dental Association, following the Deamonte Driver case.

      “Watching the little children – so vulnerable, with their beautiful sweet smiles, their fears and their friendliness – it really struck me how precious they are and how oral care is so important to each of their lives,” she remembers.

      This was all too poignant having seen first-hand what happens when teeth are not cared for. At short-term medical and dental clinics, run by the non-profit Remote Area Medical Volunteer Corps (RAM), in states such as Oklahoma and Virginia, Mary witnessed many people with teeth so decayed and so painful that mass extractions were the only solution.

    • Preventive solutions to endemic tooth decay

      Making care accessible in innovative ways is key to preventing situations like this, she believes. “Little kids can’t take themselves to the dental office,” Mary says. “If parents are busy working at low-pay jobs where they can’t take time off or can’t plan ahead because they don’t know their schedule, it becomes very difficult. Parents are facing a variety of challenges from getting gas for their car to juggling several shifts to paying the rent. So, it’s best if you can bring care to children with simple, effective preventive solutions, like fluoride varnishes or sealants, at times that work for the parents.”

      She also points to broader health challenges. “People living in these communities with high rates of chronic disease [including tooth decay] often lack access to healthy food. Maybe their only source can be a local convenience store, stocked with high-calorie, ready-made food, candies and devastatingly destructive sweet drinks like sodas.”

      People who have lacked access to dental care for generations are often less capable of reinforcing good oral health habits in their children, she explains. They tend to fear the system and avoid it, and may even resign themselves to tooth decay. She adds, “I’ve heard many people say things like ‘people in my family have always had bad teeth.’”

    “Watching the little children … it really struck me how precious they are and how oral care is so important to each of their lives.” – Marry Otto

    • While Mary has seen much to distress her, there are also many hopeful signs.

      “I’ve noticed a growing awareness of the importance of oral health to overall health. It’s spread beyond the dental community to the public, as well as community leaders and children’s advocates, like school leaders, physicians and pediatricians, who are seeing the need in children they work with.

      “They’re often working across traditional professional boundaries to provide care,” she says.

      In her view, the plan the surgeon general laid out in 2000 is still valid. Many of his preventive solutions, such as collaboration with other health professionals, community programs such as water fluoridation and provider-based interventions such as the placement of dental sealants, are still being worked on and will be for many years to come. She is encouraged by improvements in people’s understanding of why and how to care for children’s teeth, but she argues that we still have a long way to go.

      “It’s like fastening your seat belt. We just have to make looking after teeth part of the common currency.”

      An expert storyteller herself, Mary encourages all advocates to leverage the power of stories. “Personal stories give a name and a face to these big issues. As humans, we love stories, and they’re really important to us.”

      Visit Why Teeth Matter to read more stories about how tooth decay is impacting children’s lives around the world and the innovative approaches being used to prevent it.