More than a thousand dentists have set up shop in Los Algodones. Their patients are mostly Americans who can’t afford the U.S.’s dental care.
“According to Roberto Díaz and Paula Hahn, who run a website about medical tourism called Border CRxing, Los Algodones now has the highest per-capita concentration of dentists in the world: well over a thousand in a population of fifty-five hundred. It’s known as Molar City.
[..] technology has its downsides. The more advanced the imaging system, the more expensive the visit, and the more problems it can find with your teeth. Last year, at a routine checkup in Brooklyn Heights, I mentioned that one of my teeth had been feeling a little sensitive. My dentist spent the next hour searching for the cause: he rapped the tooth with a metal tool, had me chomp down on a stick, and, when I still didn’t feel any pain, sent me to the next room for a panoramic X-ray of my skull. He eventually found a hairline fracture in the tooth’s root. It was so faint that I could hardly see it, even under extreme magnification, but he urged me to get a root canal and an implant for three thousand dollars. I kept the tooth and haven’t felt any pain since.
[..] Eating was meant to be a workout. Chewing raw plants and sinewy meats both strengthened and lengthened the jaw. Without that exercise, our oral growth tends to be stunted. The soft, processed foods we eat offer so little resistance that our jaws end up shorter than they should be, our teeth overcrowded—ninety per cent of us have some misalignment. Early humans didn’t need orthodontia. Their incisors fit together tip to tip, and their wisdom teeth were ten times less likely to be impacted than our own. Their teeth also lasted a lifetime. The food they hunted and foraged wasn’t laced with sugar, so their teeth weren’t infested with bacteria that exude acids that eat through enamel. Our ancestors, for all their lack of flossing, rarely had cavities.
[..] Most of medical history reads like a long, triumphal march: surgeries refined, diseases vanquished, life spans extended. But dental history—in books like “Evolution’s Bite,” by the paleontologist Peter Ungar, or “The Smile Stealers,” by the historian Richard Barnett—always seems to lead backward as well as forward. Agriculture is invented, only to wear down farmers’ teeth with grit from the stones used to mill grain. Food production is industrialized, only to riddle our teeth with cavities. Anesthesia is perfected, only to encourage people to get rid of their imperfect teeth and replace them with less durable implants, crowns, and veneers. And each advance, at least initially, makes dentistry more exclusive, more expensive, more out of reach for the average patient. Hence the crowds at Molar City.
[..] If they’ve made it to Molar City, they’re adventurers of a sort, and the town has become a bargain hunter’s El Dorado. Cut-rate pharmacies, opticians, dermatologists, massage therapists, hair-transplant specialists, and exotic medical practitioners line the streets around the dental clinics, promising deals unheard of back in the U.S.
[..] Good teeth have become a social norm in America. The more money you have, the straighter and whiter they’re expected to be. It wasn’t always so. For centuries, the wealthy had terrible teeth. In the sixteenth century, when sugar first made its way to England in large quantities from Brazil, it was an aristocratic indulgence. By 1700, the country was importing twenty-two million pounds a year, a disproportionate amount of which was consumed by the upper classes. When their teeth rotted, they had no choice but to see a tooth puller or a barber-surgeon—sometimes just a blacksmith with a side gig. If his iron pincers didn’t work, the preferred tool was a pelican: a fearsome-looking device with two hooks to grasp a molar and a lever to wrench it out. In France, the most famous of the tooth pullers, le Grand Thomas, plied his trade on the Pont Neuf, in Paris. He took as his motto “Dentem sinon maxillam”—“The tooth, and if not, the jaw.” [..]
Any neighborhood dentist is capable of miracles nowadays—even root canals can be relatively painless. And more wonders are in development: gene therapies that grow new teeth, stem-cell treatments that coax teeth into filling their own cavities, nanoparticles that loosen teeth so that braces can realign them more easily. But the gap between the best care and the worst has only grown. Less than half of all Americans go to the dentist in any given year, the American Dental Association estimates, and the procedures they most need are the ones they can least afford. In 2019, for example, close to two million emergency-room visits were caused by dental problems; oral cancers alone—often detected too late—kill some twelve thousand Americans a year. Whether by cause or effect, Peter Ungar notes in “Evolution’s Bite,” poor oral health has been linked to Alzheimer’s, diabetes, heart disease, H.I.V., osteoporosis, premature births, sepsis, and a host of other conditions. “As your teeth and gums go, so goes the rest of your body,” he writes. [..]
The line between medicine and cosmetics isn’t always clear when it comes to teeth, and insurance companies have smudged it further. Nancy’s crowns were mostly cosmetic, Billy’s mostly functional, but neither would have been covered by dental insurance. Most policies pay for preventive care, like fillings and teeth cleanings, but not cosmetic work, and major procedures like root canals are largely charged to patients. Dental insurance is the opposite of health insurance: the more serious your condition, the less likely your plan is to pay for it. An abscessed tooth can kill you, but if you can’t afford to get it treated you may have to wait until the infection sends you to an emergency room—at which point your health insurance will kick in. Even if your dental plan does cover it, it will pay only a small part of the cost: reimbursements are usually capped at one to two thousand dollars a year. It’s no wonder more than seventy million Americans don’t have dental insurance—three times as many as lack health insurance.
The more sophisticated our medicine, the more demanding our health standards. We expect medical insurance to cover everything from a balky knee to Ebola. “But there is no established minimum standard for oral health,” Brett Kessler, of the American Dental Association, told me. “If I had mouth cancer, Medicare would pay to remove the tumor but not to replace my teeth. If I have a hip problem, I can get a hip replacement. Why can’t I get a tooth replacement?” This unnatural divide goes back to the beginnings of medicine and dentistry. Physicians insisted on it at first—they didn’t want their work tainted by tooth pullers. Then dentists followed suit: by the late eighteen-hundreds, they had their own schools, offices, and specialized equipment, and little interest in being governed by doctors. In 2010, the Affordable Care Act declared that children up to the age of nineteen have an essential right to dental insurance, but adults were left off the bill. By 2019, eighteen per cent of adults couldn’t afford dental care. Kessler believes that medicine and dentistry should be part of a single health-care system—“It’s time to reconnect the mouth to the body,” he says. But it’s a long-term project: the American Dental Association’s latest strategic initiative is called Oral Health 2050. In the meantime, having healthy teeth will be part right and part privilege, with dentists walking the uneasy line between them.”
Full article, B Bilger, The New Yorker, 2025.7.28