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The teeth of misfortune:dental health, a marker of social inequality

The teeth of misfortune:dental health, a marker of social inequality In "On the teeth, what they say about us and the social war", Olivier Cyran reveals the reality of inequalities in access to oral health. The opportunity to look into the fate of this prodigiously vital organ, whose survival depends on our place in the social hierarchy.

Hard to imagine today, when ultra bright smiles are displayed in large advertisements and sparkle on our screens, but for a long time, the etiquette at the King's Court advocated laughing and smiling with your mouth closed. Let's live crested, teeth hidden.

But at 18 th century, two works sweep away the rule:Rousseau, in his novel Julie ou la Nouvelle Héloïse* describes her heroine's smile long, wide and across; and the painter Elisabeth-Louise Vigée Le Brun made a self-portrait in which, at the height of the scandal, she smiled with all her teeth out. A few centuries later, Hollywood domination will complete the reign of open molars.

"Oral-health-inequalities are strongly correlated to social inequalities"

These stories are told by journalist Olivier Cyran, not without irony, in his book Sur les dents. What they say about us and the social war** (Ed. La Découverte). Because behind the anecdote, the observation is clear:"When you do social journalism and you are interested in the balance of power in society, it is difficult to miss dental work. What is strange is above all to realize how absent the subject is from public debate”, analyzes the author. Indeed, even the Ministry of Health recognizes this, according to a 2011 document quoted in the book:"Oral health inequalities are strongly correlated with social inequalities."

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“We cannot deny it, abounds Olivier Cyran. Even the public authorities admit it. But there is a fundamental contradiction, because on the other hand, we hear a lot of speeches which tend to individualize the problem. people who have problems with their teeth. 'You only have to blame yourself. If you brush your teeth properly, if you avoid alcohol, sugar and tobacco, if you have a good diet, you won't have a problem.' Except that we are not equal when it comes to teeth and the social determinants that affect oral health."

Despite this established reality, the guilt-ridden discourse works to the full and traps the victims of dental problems in a deep sense of shame. Beyond the physical pain endured, "the teeth represent both an intimate territory, but also a calling card stretched out in the eyes of the world."

And, sometimes, this intimate territory has been painfully damaged by life, making everyday life impossible.

The poor, lost-in-advance in a biased system

Olivier Cyran's book is not lacking in testimonials from toothless or suffering people. Women victims of domestic violence, refugees with a bumpy path, poor people excluded from the system; their teeth act as an indicator of all those whom the unequal organization of care leaves on the side of the road. "Even if there are attempts at reform, with the rest at zero charge for example, we remain in a system that puts reimbursed and capped care in competition with uncapped non-reimbursed care. And to earn a living, dentists are required to give priority to care with high added value."

Abdel Aouacheria knows something about it. The current vice-president of the association La Dent Bleue, which aims to inform users of dental care, is also the founder of the collective against Dentexia, "a group of patients who came into being following the liquidation of the chain of low-cost Dentexia associative dental centers, which brought together more than 3,000 victims between 2016 and 2017. These low cost centers owe their opening to the Bachelot law of 2009, the objective of which was to relax the rules for the creation of health centers.

This deregulation of the market has allowed any businessman to create a dental center, without even being a dentist. The law, supposed to protect users from a risky financial arrangement, proved to be easily circumvented. At Dentexia, care was paid for in advance, often on credit by patients of low means; poor quality medical equipment used; and dentists forced to operate on a production line to make money. When the company went into liquidation, hundreds of patients saw their care journey stop "in the middle of the watch". "I saw intolerable things, elderly people with no teeth left in their mouths, others with wires in the middle. Several people also thought about committing suicide," says Abdel Aouacheria.

Re-politicizing the subject

He too is a victim, he receives up to 34,000 emails of grievances, tinged with despair. With others, they lead the political fight, so that the public authorities recognize their responsibility and, above all, so that abandoned patients can be decently cared for by other practitioners – because many have refused to come to the aid of the victims. , seen as "bad apples".

Today, aid has been put in place by the State, but under such strict conditions that few have been able to benefit from it. "Of the 1,000 files submitted, more or less 500 were accepted and received a partial response." After this atrocious experience – far from over for some – the members of the collective decided to enroll in a process of empowerment , "so that users who have experienced setbacks can be heard". Hence the creation of La Dent Bleue.

"When dental problems arrive early, you give up getting treatment. When you have accumulated worries for decades, they become heavier, but you do not necessarily have the means to pay and you have to make a trade-off between, everything simply put gas in the car, finance your studies, buy food. It's not just a problem of money, it comes from further afield. These questions are rooted in social reality", notes Abdel Aouacheria.

According to him, it is high time to put "the ethics of care " at the center of the question of dental care. Put the practitioner and the patient on an equal footing. "Because for the moment, as a patient, you are completely undervalued." An approach that is part of the discourse of Olivier Cyran, who calls for politicizing the issue of dental care:“It is a collective problem. The social fabric as a whole is damaged. We must take hold of this major political issue."

(*) Julie or the new Héloïse by Jean-Jacques Rousseau, Editions Flammarion-GF. Available on Place des Libraires or Amazon

(**) On the teeth. What they say about us and the social war by Olivier Cyran, Editions La Découverte. Available on Place des Libraires or Amazon

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