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Comment by rilindo | Hacker News Reader

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> A new UCL paper has revealed that the wide-spread belief that the British have poorer teeth than our American cousins is, in fact, a myth.

> The research led by Richard Watt, Professor of Dental Public Health in the Department of Epidemiology and Public Health, found that the mean number of missing teeth a person has is significantly higher in the US.

https://www.ucl.ac.uk/eastman/news/2015/dec/us-vs-uk-who-has...

I am glad they did this work, but I don't think it gets at what's behind the joke about British teeth.

For me, the exemplar is the Austin Powers jokes about his teeth. It's not that the average Brit has fewer teeth than the average American. It's that a person who American would expect, for reasons of class and style, to have an engineered smile (very white, very even teeth) instead had a perfectly natural one. Even the movie suggested that the stereotype was somewhat outdated. But to the extent we still have the stereotype, it's about upper- and upper-middle-class use of orthodontia and whitening. Plus the distinctive American emphasis on the big smile, which to a lot of non-Americans can seem mildly deranged.

I looked it up, because I was curious about the ranking per country, not only US vs UK.

Uk is 4th best according to this ranking

https://www.yongeeglintondental.com/2018/07/23/healthy-prima...

Missing teeth != Poor teeth.

Pretty sure the joke is just that british have tea-stained brown teeth.

Also, pretty sure it's just a joke in the same realm that rednecks from appalachia carry a piece of hay in their mouth.

Given the health care in the US, that isn't surprising.

I always assumed this was a comment on the level of dental care provided by the NHS.

For example, they’ll happily provide you a root canal without a crown – a crown costs significantly extra.

I doubt many dentists in the US would be comfortable providing that standard of care.

I'm pretty sure it's now based on the observation that very wealthy and important people in Britain don't have giant blinding veneers.

Americans think that the class terror that forces them to spend thousands or tens of thousands on their children's teeth (and their own) is universal, rather than a norm that we find ourselves locked into now. Americans with anything going on with their teeth look poor or disreputable, and it severely hurts your job chances.

Rich British people are just like "do you know who I am?"

https://www.nhs.uk/nhs-services/dentists/what-dental-service...

£300 seems not very significant if we are comparing the US to the UK in this discussion.

A £300 optional surcharge to perform what US dentistry rightfully considers the baseline standard of care is going to result in a lot of people’s teeth having subpar function and appearance.

But they don’t pay for almost anything routine in the UK. In the US my understanding is you are not typically getting any free dental care. £300 is not a major expense for a typical person in the UK.

I didn’t claim it was an unaffordable expense.

I claimed that treating it as an opt-in extra, for additional charge — instead of the baseline standard of care — results in a lot fewer people receiving it, and thus, a lot more people with subpar dental function and appearance.

In other words, to save money, the NHS provides a lower standard of care as its baseline. Hence the popular idea that British dentistry is subpar.

I haven't tried to push the subject too hard but NHS dentists will at least in some cases just say "you'll need a crown afterwards" and that's that.

Also

> If you need treatment from more than 1 dental band as part of your treatment plan, you will only be charged the cost of the highest band. You will not be charged for each individual treatment.

I think the idea that people have in terrible teeth in the UK is a bit outdated, but did you look carefully at the study?

The ‘better teeth’ you report is 7 missing teeth on average in the uk vs 7.3 in the US. Both of those numbers seem high to me: you’d need to have all wisdom teeth plus three more removed for example. It made me wonder whether that average was biased by old people[1] with many missing teeth[2], who I think aren’t that relevant to the idea about teeth being bad in one country rather than another.

For the ‘oral health impacts’ measure, which corresponds to a questionnaire, OHIP-14[3], with questions like ‘have you been self-conscious because of your teeth, mouth or dentures?’ The score for the UK is lower than the US here, though I guess the measure is less objective and you can imagine cultural factors would impact the answers (eg maybe people from one country would downplay things more, or if worse teeth are more socially acceptable in the country, people there may be less likely to be embarrassed about their teeth.

I think the kind of ‘bad teeth’ more common in the U.K. is crookedness (eg overlapping incisors or over/underbite) and teeth being more yellow. The paper notes that they weren’t able to measure things like that.

My general impression is that bad teeth in the US (on someone who grew up there) are a pretty strong signal that someone grew up poor, and this is a little less the case for the UK.

[1] the paper claims these are ‘age-standardised’ numbers. I don’t really know what that means but I guess that it means the number is mostly meaningful for comparing the countries rather than what people in those countries are like. For ages 25–44, they report averages of 3.7(UK) vs 4.6, which still looks a bit high to me. There’s about five times the rate of toothless mess in the US for that age group which made me think there might be some small population in the US with many missing teeth that isn’t so large in the UK, but the paper found the same income-based inequality in number of missing teeth

[2] The paper claims to have gotten similar results when excluding the toothless

[3] Slade GD; Derivation and validation of a short-fortn oral health impact profile. Community Dentistry and Oral Epidemiology 1997; 25; 284-90.

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