When do you become middle class?

This is the premise, though not so bluntly stated, of Mary Otto’s new book, “Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.” The dividing line between the classes might be starkest between those who spend thousands of dollars on a gleaming smile and those who suffer and even die from preventable tooth decay.

If the idea of death from tooth decay is shocking, it might be because we so rarely talk about the condition of our teeth as a serious health issue. Instead, we think of our teeth as the ultimate personal responsibility.

… dental care is still associated in our minds with cosmetic practices, with beauty and privilege. It is simultaneously frivolous, a luxury for those who can waste money, and a personal responsibility that one is harshly judged for neglecting. In this context, “Teeth” becomes more than an exploration of a two-tiered system — it is a call for sweeping, radical change.

Excerpts from the Review of TEETH: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, by Mary Otto - 291 pp. The New Press. $26.95.

Review by Sarah Jaffe in the NEW YORK TIMES BOOK REVIEW (3/23/2017)