It hurts

Why the state of British teeth tells you so much about the country

You will never hear a politician talking about ‘low politics’. Nothing could seem more elitist in an era where nobody, with the possible exception of Jacob Rees-Mogg, wants to be part of the elite. Especially when they already are.

But the difference between high and low politics helps to understand the things the government does, what is vital to the survival of the state, and what isn’t — but still affects everyone.

The next two episodes of More Jam Tomorrow are about high and low politics. This week’s is about teeth. Everyone has them (or misses them). Next time, it’s Trident, a nuclear deterrent which will almost certainly never be used, and whose location at any one time is known only to the Ministry of Defence.

Trident is high politics. Teeth are low politics, very low. And they are getting lower all the time. In the usual course of things, the complete failure of a government plan would attract some attention. Yet when the Committee of Public Accounts set out last month just how much worse things had got since the 2024 dental recovery plan was published, it got little coverage in the media.

Many MPs are alive to the problem, because their constituents complain to them about it. Last month the Lib Dem MP for Frome and East Somerset, Anna Sabine, told the Commons about her visit to a school where a supervised toothbrushing session was taking place.

Sadly, of the 30 children in the room, 10 did not have consent for the toothbrushing — some because forms had not been returned, and some because there was a parental objection to the activity or to the use of fluoride. To ensure that they did not feel left out, my dentist friend played a game where they counted their teeth instead. She said that, based on what she could see from that game, that group of 10 children had 50 obviously decayed teeth, and one child had at least 10 teeth that would need to be removed under general anaesthetic. Those children were four and five years old.

Fifty decayed teeth in 10 kids in reception. Why do we hear so little about this dental crisis outside the Commons? Because private dentistry is now the norm among the English elite. Few opinion-formers use NHS dentists any more, and those that do are usually lucky enough to have signed up with a practice long ago. It is very telling that Reform’s 2024 election manifesto made no mention at all of dentistry. The people trying to pull their own teeth out or gluing them together with Superdrug repair kits have only their MP to complain to.

A tooth-drawer frightening his patient with a hot coal to make him pull back his head. John Collier, 1810. Wellcome Collection. Public domain

The seriously rich have always gone private. But from 1948 until 1990, the vast majority of UK dentistry was done by the NHS. Then, as Ian Mills explains in MJT, the government both cut the money available for NHS work and made it easier for dentists to set up in private practice. It was hardly surprising that many decided to do so.

It is easy to see a dentist in the UK, if you have dental insurance or can afford to pay for it yourself. British teeth can look shinier and straighter than ever before. A dental practice will usually sell you tooth whitening, Invisalign and possibly Botox too. But the chances that it will offer a new patient a check-up on the NHS are low, and falling all the time. We still expect that the NHS will help us when we are in pain or in danger, even if we have to wait. Yet when it comes to teeth, the social contract has almost entirely broken down.

I suspect this is because the state of our teeth is often our own responsibility, or that of our parents. Bad teeth are to a large extent preventable. Like obesity and smoking, they are the result of poor choices, and British taxpayers do not like paying for other people’s poor choices. The thinking, never spoken out loud but implicit in the government’s neglect of dentistry, is that irresponsibility does not justify public money. If the rotten teeth belong to a four-year-old? Blame the parents. And sometimes, as in the Somerset school, the parents are clearly at fault. But that won’t fix the kids’ teeth.

I’m ashamed of the state of my teeth. Inadequate brushing as a child and chronic neglect in my 20s have left me with a tight-lipped smile and the knowledge that the really extortionate bills are coming soon. Even thinking of a drill makes me wince. I’d have said it was painful to make this MJT episode, but anyone who’s had a rotten tooth will know what pain really means.

The story of British teeth is sometimes about pain — and that part of the story is a far more positive one. Dorothy Lunt, a dentist who qualified in the 1950s, remembered how hard it was to have to inflict it on her patients:

In those days we were really not allowed to give local anaesthetics except in extreme occasions and you had a frightened patient who you knew was going to be suffering pain and you were inflicting the pain. And somehow you had to cope with them, that you could get them to sit still in the chair and accept this pain as something necessary. And I found this a tremendous mental drain, at the end of the day I'd be absolutely exhausted.

Lidocaine anaesthetic has transformed how dentists do their job. But the story of our teeth speaks to much bigger changes in British life: the explosion of choice, how much personal responsibility people ought to take for their own health, and the future of the NHS itself.

People who worry about public health sometimes wonder whether it will be possible to sustain public support for the NHS if the better-off continue to opt out of many of its services. The answer is right there in the mouths of reception kids, if they could see them.

The third episode of More Jam Tomorrow is out now. If you find my work interesting you can tip me via Ko-fi.