What Pennsatucky’s Teeth Tell Us About Class in America

pensatucky

I know she is supposed to be a cross between a villain and comic relief, but Tiffany “Pennsatucky” Doggett is my favorite character to watch this season on Orange is the New Black. For those (few) who have not watched the series, Tiffany is a caricature of an ignorant/hillbilly/Jesus freak/meth head. In the first season, we saw her provoke and eventually fight Piper, the attractive, articulate protagonist and author of the memoir on which the series is based.

In the midst of a prison culture formally and informally divided by race, Tiffany embodies an equally powerful yet rarely discussed social divide: class. In the first season, we learn that Tiffany wound up in prison after going to a women’s clinic for her fifth abortion and deciding to shoot a nurse she who makes a condescending, classist remark. She’s surprised to find herself embraced by the right-to-life movement as a hero and spends most of season one as a wanna-be religious leader whose  cluelessness is a constant punch line. She isn’t cute or funny or even a font of homespun southern wisdom. Though white, she has nothing in common with most of the other white women: Machiavellian Alex, gender-savvy Nicky, hip Sister Jane, the peacenik Yoga Jones, or even Russian entrepreneur Red, all of whom are presented as smart, literate women who are capable of scheming to improve their lot in life. Tiffany doesn’t even fit in with Morello, a none-too-bright white woman with a working-class accent who lives in a fantasy world of romance and Hollywood magazines. 

The producers of the series provide viewers a clear visual cue of the class divide: The first time Pennsatucky opens her mouth we see a hideous display of broken and missing teeth. More than any other marker in America, teeth indicate class status. Perfectly white and straight teeth—the kind we see on celebrities—belong to the super rich who can afford costly cosmetic dentistry. Nicely aligned and healthy teeth are the sign of professional and upper middle class individuals who can afford regular dental care and basic orthodontia. Crooked teeth with delayed root canal work and a few crowns means the mouth belongs to a middle-or-working- class individual who has access to basic dental care but nothing fancy. And rotted teeth, like those Tiffany and her friends sport, mark the women as poor—a status with both economic and moral meaning. As I’ve been told countless times by Americans who do not earn enough to scrape by, being too poor to have respectable teeth is like wearing an “L” for loser on your face. 

pennsatucky with broken and missing teeth

Pennsatucky cries with joy as she heads in a prison van to get a set of new dentures. 

As a sociologist, I work with women who have experienced poverty and incarceration. And while I don’t know anyone quite like Pennsatucky,  I do know Joy. Raised in a middle-class family, she began to struggle with substance abuse in the wake of ongoing sexual abuse at the hands of a family “friend.” By her early thirties, she had spent over a decade in and out of substance abuse treatment, psychiatric hospitals, the streets, shelters, and jails. I first met her in a rehab program where she looked well groomed and nicely dressed. When I asked her how she’s managed to survive all that she’d been through she told me, “I take care of myself. Even when I don’t have a place to live, I go into the restroom at Burger King and brush my teeth.” A few years later Joy and I chatted about what she is most proud of having accomplished recently: “Going to the [drug treatment] program, attempting to get better, taking care of myself—brushing my teeth even though I don’t have running water in my apartment.” A few months later she called me in tears. She had gone to the dentist and was told that she has seven cavities but that she couldn’t get them filled for another six months because she had maxed out her dental coverage under Medicaid. “By then I’ll have to have my teeth pulled. I used to say bad things about people with no teeth and now I’m going to be one of them,” she said. In short, Joy realized that by losing her teeth she would be losing her class status. 

On Downton Abbey and other BBC period shows, we easily discern the different accents, even dialects, of upper and lower classes. On Orange is the New Black, as in real life in America, access to healthcare remains a class indicator. Rotten teeth are hard to hide. Tooth decay is embarrassing. It signifies that supremely unforgivable character trait: not taking care of oneself—a particularly serious flaw in women, who are expected to look attractive. Several women I know cover their mouths when they speak or chew, and never, ever laugh—they don’t want anyone to see their teeth.

Many of us assume that rotten teeth are volitional—that if someone had just brushed and flossed then they’d have nice teeth. But it’s not that simple. Though teeth are part of our bodies, health care programs treat them as an afterthought. Dental health is not covered by standard health insurance and Medicare has no dental benefits, so about half of Americans don’t have dental insurance. In recent years, the cost of dental care has been increasing faster than the cost of other medical care. There’s also an urban/rural divide on access to dentists: 45 million Americans live in communities where there is a serious lack of dentists. 

an infographic showing the lack of dentists in the US

Infographic from the Pew Charitable Trusts

Tooth decay also signifies drug use, especially the “low class” drugs—crack cocaine (Joy’s drug of choice) and crystal meth (Tiffany’s drug). As the national panic shifted from crack to crank (meth), the “faces of meth” became poor white faces with rotted teeth, often attached to stories of women who neglected or endangered their children in their lust for the drug. For women, missing teeth also signifies being a victim of domestic abuse, and while we Americans pity victims, we also blame them for not being brave or strong or smart enough to get away from their abusers. More broadly, on one side of the class divide are those with normatively attractive bodies, respectable educational achievements and decent jobs. On the other side are those whose poor teeth and other “defects” are read as signs that they are incapable of managing their own lives.

pennsatucky with straight, white teeth

Pennsatucky starts smiling at everyone when she returns with her brand-new teeth.

Like her or hate her, Tiffany scores a victory over the system during the second season when the prison has to pay for a full, beautiful, functioning set of dentures to replace her few remaining rotting teeth. (Sadly, that’s probably not what would really happen: I’ve never heard of anyone getting good dental care in prison. Quite the opposite—women often lose teeth in prison.) When she gets her new teeth, she’s visibly changed. Her lower-class white friends in prison start to think of her as annoying as she shows off her new pearly whites. Two her old friends accuse her of acting as if she is too good for them now. But in an era in which class divisions are increasingly permanent and uncrossable, shiny dentures are not enough to allow her access into the middle-class white clique that includes Piper and Nicky, women whose straight, even teeth are their own.  If we on the left really want to reach across class lines, we should seriously consider making “Free Dental Care for All” our rallying cry.

Related Reading: Can Orange is the New Black Change the Way Congress Thinks About Prisons?

Susan Sered, author of Uninsured in America: Life and Death in the Land of Opportunity, is Professor of Sociology at Suffolk University. Follow her blog at susan.sered.name.


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Comments

10 comments have been made. Post a comment.

"Two her old friends accuse

"Two her old friends accuse her of acting as if she is too good for them now." And therein lies a whole other issue: once you improve/leave the trailer park/leave the streets, all of a sudden people think that YOU think you're better.. God forbid you try to improve yourself.

I agree, but I think this

I agree, but I think this goes with the whole old saying of "misery loves company."

beyond "Free Dental Care for All"

I just want to add that a lack of dental benefits isn't the only hole in our health care system that contributes to this problem. There's also the inadequate coverage for mental health treatment. How are these related? People with mental health issues often struggle with self-care, including oral health. It's something I've struggled with for many years, and I've discovered that my experience is far from unique. I know how important it is to brush and floss regularly. And it seems like it should be so easy to set aside 10 minutes a day to look after one's mouth. But for someone living with depression, it can sometimes feel nearly impossible to find the necessary motivation, even as we're acutely aware that we'll eventually pay a terrible price for neglecting our teeth.

If we want to improve people's dental health, in addition to free dental care for all, we should expand that demand to include free mental health care for all.

Glad someone's talking about this

Like most class signifiers in the U.S., the topic of teeth is usually very taboo, so I'm very grateful for this article. I've noticed on reality shows even people who are supposed to be from a poor background have good looking teeth. It's like any other unattractive-coded trait--it's simply not visible in media, and, speaking from experience, this can make it a hard trait to live with.

Though this article makes a good point about the class-underpinnings of this particular beauty standard, I wish there had been more emphasis on the fact that American standards for "good" teeth are almost entirely cosmetic. Consider, for instance, American jokes about how "bad" British teeth are, when in fact British people on average have healthier teeth than Americans (http://www.economist.com/node/15060097). It's the old philosophy of "what is beautiful is good." Getting basic quality dental care alone isn't what you need to access the class/attractiveness privilege in the U.S. You also need unnecessary cosmetic procedures like whitening.

Thanks for forthright commentary on a sensitive matter

Among Western women, class and wealth are generally conflated with traits that are worn racially and facially. OITNB treads new ground in drawing public attention to the subtle sociologic gist that are encoded in the mundane details of human phenotype: e.g., height-to-weight ratio, nose form, dental occlusion, cheekbone substructure, fat deposit pattern, skin and hair texture, eyelids form, tendency to form moles, etc. All of these imbedded clues to what philosopher Martin Buber termed "Other-ness" are symbolically exposed when Piper takes on Pennsatucky.

Poor & De-Toothed

Sometimes I wish there were more posts, comments, and articles written by women who are actually poor.
Even though we might not have all our teeth, we do have voices.

At any rate, I'm a poor woman who does have basic dental care through my state's health care program, so I consider myself lucky indeed. However, my choice of dentists is limited and no matter where I turn, the first answer to any dental problem seems to be: "pull it out." I've now lost five teeth, And yes, it is mortifying when the gaps are visible. The health care program will provide a partial denture but only for "necessary" teeth - whatever that might mean. And my understanding is that you only get a chance for one of those every five years, Anything that you lose in the meantime is your own look-out.

I don't mistreat my teeth. I brush & floss & until I hit my sixties, everything in my mouth was going fairly well. Now I have trouble chewing, I'm self-conscious about grinning and guffawing, and I'm probably less likely to seek help when I do need it for fear that yet another tooth is on its way out -- after the last one was pulled, its next-door neighbor started to feel a bit shaky - whether or not this has anything to do with the dentist's hands also being shaky I have no idea.

Health is health

Thanks for tackling this matter on your post. Unfortunately this really happens, not just in America but in the whole world. People in position tend to overlook dental matters. They probably think it's just gingivitis or something teeth related, she'll survive. The thing is, it's still the person's health we're talking about here. No matter how little or small it is, it still concerns someone else's health and it should be given attention.

Geoff

As a Registered Dental

As a Registered Dental Hygienist, I was taught by superb professors in my school that dental health is full-body health. The two must go hand in hand to understand and help those like the character above. (I've never seen the show.)

Also, some of my one percenter patients have the whitest teeth I've ever seen. Underneath that is a mouth full of crowns, bridges, fillings, root canals, active infections, gum disease, and I could go on.

Today's cosmetic dentistry does a great job of giving the illusion of oral health. Thanks for reading.

Eva Watson/RDH

Sad, but true.

As a single mom, I've spent a fortune on braces and repairs for my children, even as adults. However, my teeth have paid the price. With a root canal and crown running $1700 per tooth, my class status doesn't allow for it.
As I type, I have at least 3 infected teeth, and only 5 teeth that are cavity-free and decent looking. Dentures are cheaper and I am slowly saving for that day, hoping that an abscess won't cause an even worse issue with my health.

Put simply-it's not about class

High class dope addicts have bad teeth too...