Gnashing of Teeth: Dental and mental health in Australia
Published in Verandah Literary & Art Journal, 2021.
I am fourteen, staring up at cold white light. New elastic squeaks across my teeth. Light blue bands, always. The girls at school have stern rules for braces. White turns yellow over time, makes your teeth look filthy. Green looks mossy. Red looks like you’re bleeding from the gums. Blue is safe. The orthodontist has terrible breath. He leans towards me, stale coffee and halitosis. His assistant is older than most. Fifties, perhaps. She smells of Estée Lauder. She wheels in close to be of use, and her breasts brush my cheek. My own mother waits outside, clicking her tongue. The orthodontist tightens the metal on my teeth, sends me away aching, tells me I am very fortunate to have a family who are looking after my smile like this. They never say ‘your teeth’, or ‘your bite’. They always say ‘your smile’. Smile, you lucky thing.
Fifteen years later, in a fluorescent-lit waiting room, I am thumbing through a bad magazine. Teeth, it says, that are aligned without any overlapping or gap are a sign of immense luck. The magazine does not offer advice for the relative luckiness of a smooth bite bought with thousands of dollars of orthodontistry. I think of the cut-grass smell of my father, mowing lawns to buy the wire in my skull. Now, all that is left of it is a single metal bar behind my bottom incisors.
The dental assistant is only half-suppressing a scornful laugh. The dentist herself is kind. Rare. She stops drilling when I whimper, slack-jawed from the pain. A moment ago, I told them to go on, that if they’re quick, I can hack it. When the air pick starts up against the raw nerves of my back teeth, I convulse, moan. The assistant snorts. ‘She can’t even take it for one second’, she crows. ‘Not even one second.’
The first time I ever flossed, I sniffed the waxy line between my fingers and reeled back, repulsed. The rot of it, sitting between my teeth. Fecund with horror. Now, I do it in the shower, drown the smell.
The magazine tells me that people with 28 teeth or fewer are likely to face stress, lifelong health problems and separation from loved ones. I count my teeth. I have 28. I press my tongue against the wisdom tooth snarling behind my left molar. It sits just below the gum, gives me infections, makes a fuss. Come on out, little tooth, I think. Bring us luck.
When I was seven, perhaps, my favourite teacher came round for dinner. I remember this particularly, because I had a loose canine. While she was in our house, as I was trying desperately to appear cool and adult, my dad tied a string to the root of the tooth, and the other end to the door handle. The memory cuts out as the door slams.
I am comparing scars with a friend. I have anxiety, she has borderline personality disorder. We share the same name and the same thin white lines of scar tissue skating the crimson slick of our inner cheeks.
My dentist is horrified. ‘You bite your cheeks’, she says. ‘You grind your teeth. You brush too hard.’ I can taste metal and chalk. ‘You have to be kinder to yourself’, she says. ‘That gum line will never grow back’, she also says.
There is, of course, a correlation between intelligence and anxiety. There is, of course, a correlation between anxiety and teeth grinding. My Facebook feed is peppered with long statuses from artists who can’t afford regular dental care, who are being told that they’re brushing their teeth too well, that they’re causing irreparable damage with their fastidious oral hygiene. My boyfriend calls it The Overachievers’ Gum Rot Club.
An old housemate’s toothbrush, bristles splayed out like an anemone. ‘You’ll brush the enamel right off your teeth’, I say. ‘I’m just making sure they’re clean’, he says. He was clever. We’re all clever. Lucky to have brains like these. All medicated now, of course. Trying to calm the storm.
My boyfriend dreams of his teeth falling out. Beside him in the dark, I listen to the bone saw crunch of him grinding them in his sleep. When he wakes, he stares at the ceiling. On his arrival home from work, animating videos for corporate clients, I ask, ‘How was your day?’ He answers, ‘It was a day.’ In the night, the dog leaps onto the bed and pushes between us, rests his head on my lover’s arm, as though my caresses do not pass muster, as though my presence is no balm.
Dreaming of losing your teeth: fear of inaction. Of loss of personal power. Of saying the wrong thing. Concerns around money. Repression. Loss of control.
I see a specialist. He leans back in his chair. It will cost $4000 to remove my wisdom teeth under general anaesthetic. ‘What about the chair?’ I ask. He chuckles. ‘You couldn’t handle the chiselling.’ I am quiet. ‘What do you do for a living?’ he asks. I say that I’m a photographer. ‘Oh!’ he says. ‘So lucky, to be able to follow your passion.’ I show him my bank balance. He doesn’t charge me for the appointment.
Another friend tells their psychologist, ‘I just want to be normal.’ The psychologist turns her head like a bird, listening. ‘Well’, she says, ‘One in four Australians have a mental health condition. And that’s just the people who are in the system, who are actually seeking help. In reality, it’s probably closer to one in two’. My friend is mollified. I am baffled. Who are they, the members of this mysterious, calm half? What is it to not know the pressing horror, the catapulting terror, the dull, deadening desire to be nothing? Just wait, I find myself thinking. You’ll find it. You’ll be one of us. How could you not be?
We’ve always had tooth decay. Ancient skulls have been found with tiny holes drilled into molars, capped with beeswax to protect from infection. The drills have changed, but the process remains the same: drain and fill, drain and fill. If you just let the decay out, it’s not enough. There’s a gap. Bad things get in.
Statistics are delicious, in a dreadful way. They expose, clarify. Artists have always had a bad reputation for mental stability. Poets in garrets, painters lopping off ears. It wasn’t until 2016, when an Australian report on mental health in the arts was released by Entertainment Assist, that the metaphors became crystallised. 44% of arts industry workers experience moderate to severe anxiety (ten times higher than the general population). 58% experience moderate to severe depression (five times higher than the general population). 7.7% have attempted suicide. Roadies and techs are the worst hit, as it turns out. Support crews without support, existing in a brutal cycle of drink, travel, late nights, no sleep, driving. Interviews with roadies revealed that most have attempted or considered suicide. So lucky to be doing what you love. Lucky ducks. The average artist, the report says, earns well below the current minimum wage. They would struggle to pull together $2000 in an emergency. These emergencies happen more often than you’d think. Car insurance. Vet visits. Dental bills. The median rental price in Melbourne is $430 per week. Whenever I see Facebook statuses complaining about yet another client demanding free artistic work in exchange for ‘exposure’, I see the same comment posted over and over: artists die of exposure.
Bruxism (the medical term for teeth grinding, a word containing a sense of brutality, of force) is not only most common in sufferers of depression and anxiety, but it can also be caused by many of the medication used to treat these disorders, particularly SSRIs, including Prozac and Zoloft.
A Joanna Newsom lyric swims through my head: and all we want to do / is chew and chew and chew.
In the early 1600s, the London Bills of Mortality began recording the cause of death for British individuals. ‘Teeth’ remained the fifth or sixth leading cause for hundreds of years. Refined sugar is partly to blame. The wealthy suffered first, sipping on the sweet new imports from across the seas, gnawing their teeth down to blackened nubs. Now, dentists track the way poverty causes poor diets, causes decay. One in 25 Australians over 15 has no natural teeth at all. Most of them are wearing dentures, of course. But imagine: if you fill the MCG on Grand Final Day, 4000 people in the stands don’t have a single tooth in their heads.
My doctor describes patients coming in two months after starting medication, sobbing, saying, ‘I never knew how much I was missing out on.’ People who’ve started businesses, transformed relationships, taken steps into spaces they never knew existed. Freed from shackles they didn’t feel until they were gone. When people ask about my own medication, I praise it. ‘There are no side effects’, I say. ‘No withdrawal if you want to go off it. It’s freed me. My anxiety’, I say, ‘is under control.’ I say it even when I veer off freeways, shaking. I say it when one of my back molars cracks in two from the pressure in my sleep. Everything is relative.
The human jaw can exert, on average, 200 PSI in force. The commonly repeated notion that you could bite through your own finger with the ease of biting into a carrot isn’t true, for various reasons. Gristle, for one. Your finger is more than bone. Still, it’s a lot of pressure.
My dentist asks why I haven’t had my wisdom teeth out yet. ‘Because I don’t have $4000’, I reply. She shows me the fractured molar, the force exerted by my own skull against itself. Cracked in the night, without my knowing. She moves a camera over the offending tooth, guilty in the bright light. She tells me that this is bad news. That I need a $500 mouthguard, a $1700 crown. Tears roll into my ears as she drills. The dental assistant looks pointedly away until I stop crying. I get into my car. The bumper is held on with gaffer tape. It has been like this for two years.
The same phrase occurs seven times in the Bible, mostly in the book of Matthew: ‘there shall be weeping and gnashing of teeth.’
There’s an abiding rumour that George Washington had wooden dentures after all of his real teeth were pulled. It’s not true. He wore several sets, some made of metal, some of ivory. Most, though, were made from real human teeth, probably from slaves, certainly from the poor. A twinkling smile to frame his speeches, wrenched from the mouths of others. Gruesome, perhaps. Or maybe, a symbol of inverted power; poverty infiltrating wealth. Or maybe, the words that formed a nation, passing through a crowd of teeth, a congregation of Americans in the mouth of one man. A smile full of hope. Shining, shining.
My dog, a giant black greyhound with sleepy eyes, begins to limp. His paw swells up, red and leaking pus. The vet suspects a grass seed, puts him under, opens him up. I put the $800 bill on my credit card. When I go to collect him, she looks a little embarrassed. ‘Sometimes,’ she says apologetically, ‘there’s nothing in there after all. It happens enough that we have a phrase for this type of surgery. We call it letting the bad spirits out.’ She laughs once, a little too high and too short. While he was under, she adds, they did a dental clean. He sits bolt upright in the car, staring straight ahead, licking his bright white teeth. At least he has them. Our friend is fostering a greyhound named Brice, who is entirely toothless, his canines ground to stubs. She’s not sure whether the trainer filed them down or whether Brice did it himself, gnawing for years on the metal bars of his cage.
My psychologist smiles at me, sad-eyed. ‘I know you want a cure,’ she says, ‘but you won’t get one. It just doesn’t work like that. I can teach you how to surf the anxiety, but it won’t just vanish.’ In the car, my feet deaden, my heart hammers, my vision tunnels and my head feels like expanding putty, bloating outwards, drowning me. I say out loud, ‘This is okay. You’re not going to die,’ and remember my mother’s voice above me at the cinema in my childhood, when I would have a panic attack every time the lights went down. ‘You’re okay. You’re not going to die.’ I try to surf. Fear pulls me under, tumbles me, and I try to stop it, slam down the walls, slam on the brakes. The water crashes over me and spills upward, tossing spume into the air.
Australians aged 15 and over have, on average, 12.8 decayed, missing or filled teeth. That’s over half your smile propped up, filled in, lost.
I wear my new plastic mouthguard to bed, feeling like a boxer sliding into sleep. The next morning, I run my finger over the pocks and marks in the plastic, the smooth surface ruptured. One night and already its perfect form is ruined. I click it away from my teeth and they ache, set free after a night fighting nothing.
In an attempt to limit unnecessary stress, I try to avoid news reports, but certain articles filter through. 12 years to prevent catastrophic sea level rise. 60% of land vertebrates extinct. I think about the Theodore Parker quote, popularised by Martin Luther King - ‘The arc of the moral universe is long, but it bends towards justice.’ A climate scientist tells me that in parts of Fiji, when the tsunami alarms go off, there is no higher ground to evacuate to. Whole families tie themselves together with rope, put babies in buckets and hope that they float. How do you surf a wave that goes forever?
American research suggests that the highest rates of depression and anxiety exist not at the top or bottom of social hierarchies, but in the middle. This is where tensions exist between internalising and externalising loci of control, where the worker makes decisions that make no real difference to their lives, but bring high levels of stress. Managers, supervisors and freelancers have higher rates of depression and anxiety than owners and workers, for example. Too much power, too little agency. It’s the cost of the American dream.
Dental fee inflation in Australia increased at a rate of 50.5% over the last decade. You have to spend money to make money. But sometimes you just spend and spend and the gaps get wider and the bad things get in.
I watch a lecture by Johann Hari, author of Lost Connections. He breathlessly cites research showing that antidepressants are much less useful than you’d expect. That most of the factors that cause depression and anxiety are social and structural. That we’re all so lonely, so lacking in community, so profoundly powerless in our jobs that it’s no wonder we’re all lost and quaking. A man in the audience puts up his hand. He asks what could be done for a family member, shut in with anxiety, hermitted for decades by fear. Hari’s face takes on a tense sheen. ‘I don’t know’, he says. ‘We require such profound social change. Such profound change in the way our society is run and our medical community is structured. The answers are practical - group activity, meaningful work, decentralised power structures. But for this family member’, he says, ‘I don’t know. I’m sorry. I’m sorry.’
Australian adults with depression, anxiety and other mental health conditions have 95% higher household out-of-pocket expenditure than people with no chronic health conditions, and are highly likely to forego care because of cost. People with mental health conditions are 7.65 times more likely to skip healthcare than people without them. At some point, when you’ve been connecting the dots for long enough, you just end up drawing circles, spiralling down like water through a plughole.
I don’t just grind my teeth when I sleep. I do it when I write. I never realise at the time. Not until I stop concentrating. Until I come to. I’m doing it now.
My electric toothbrush vibrates when I’ve brushed for long enough. It makes me feel like a child. I load it with expensive high-fluoride toothpaste. I am instructed not to drink water for half an hour afterwards, and the forbidding of it makes me thirsty. I think about the people who say that fluoride makes you docile. I do not feel docile. I feel tired and I feel angry. I photograph a Lunar New Year event. A man from the government in a pinstripe suit says that Melbourne is booming. Flush with investment. Fit to burst with potential. My rent has gone up again. That night, when I spit toothpaste, it is stained with blood.
Between 2011 and 2017, Melbourne was ranked the World’s Most Liveable City by the Economist Intelligence Unit every single year. Even now, it continues to get perfect marks for health care. Smile, you lucky things.