What Pennsatucky’s Teeth Tell Us About Class in America

Author’s note: Friends and colleagues who know that I’ve spent most of the past decade working closely with criminalized women have asked me what I think of “Orange is the New Black”. While I could do without the dubious emphasis on sex among the women, and I doubt that women prisoners ever have the kind of power attributed to Red or Gloria, overall I think the series does a good job portraying women prisoners as real, complex human beings and of showing the miseries of life inside and outside of prison for most incarcerated women.

(A version of this post with fabulous photos: http://bitchmagazine.org/post/what-pennsatucky%E2%80%99s-teeth-tell-us-about-class-in-america)

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 book on which the series is based. At the start of season two, when Tiffany returns from a three week stint in solitary, even her former friends – the other poorly educated, young white women – turn on her.

Tiffany isn’t cute or funny or even a font of homespun southern wisdom. But in the midst of a prison culture formally and informally divided by race, Tiffany embodies an equally powerful yet rarely articulated social divide: class. Though white, she has nothing in common with the other white women: Machiavellian Alex (Piper’s lover and nemesis), gender savvy Nicky, hip Sister Jane or even Russian entrepreneur Red, all of whom are presented as smart, literate, able to plan and scheme, and holding some understanding of the outside world. 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 to 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, 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 young or middle-aged middle or working class individual (someone with access to basic dental care but no more); a complete set of dentures indicate an older working class individual. And rotted teeth, like those sported by Tiffany, marks one 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.

Teeth: The Orphan of the Healthcare System

I don’t know Tiffany but I do know Joy. Raised in a middle-class family, she began to struggle with substance abuse in the wake of on-going sexual abuse at the hands of a family “friend.” By her early thirties she’s 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, to my eyes at least, she looked attractively 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 she can’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.” In short, Joy realized that by losing her teeth she would be losing her class status.

Like Joy used to, 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, they are not treated as such in the health care landscape. Dental health is not covered by standard health insurance and Medicare has no dental benefits. About half of Americans don’t have dental insurance and those who do have it find that it doesn’t cover all that much. In recent years, the cost of dental care has been increasing faster than the cost of other medical care. And while there are some expansions of oral health care in the ACA, only a small percentage of dentists accept Medicaid patients and nearly 50 million Americans live in communities where there are no dentists at all.

Teeth, Class and Gender

On Downton Abbey and other BBC period shows we easily discern the different accents, even dialects, of upper and lower classes. Here, today, the combination of mass media and near universal public school education has eliminated, or at least smoothed out, the permanence of speech patterns as class markers. Clothing used to mark class but with mass production of cheap clothing by low-wage laborers even the poorest Americans can get hold of clothes that do not immediately betray class. (I know this from accompanying homeless women to clothes banks.) Health remains a class indicator: wealthier Americans are healthier and live longer than poor Americans. But, in an age in which the conditions that kill most people are invisible (heart disease, diabetes, and so on) health isn’t easily discernible from the outside.

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 women have told me that they applied for jobs, did well on phone interviews and then weren’t hired when they were interviewed in person. Their suspicion, which I concur with – is their bad teeth were seen as a detriment in work involving retail and face-to-face customer service as well as in hospitals and schools. While men seeking low-wage work may also suffer dental discrimination, they are more likely than women to obtain jobs in warehouses and factories where toothlessness may not be seen as a serious detriment to employability.

Rotten teeth lock people into cycles of deteriorating health that are strongly correlated with poor earning potential. Bad breath is the tip of the iceberg. Untreated oral infections are associated with cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight.

Tooth decay is painful. A white woman I met some years ago in Mississippi told me that, unable to afford a dentist, she has more than once grabbed hold of an aching tooth, closed her eyes, told herself that once it’s over she’ll feel some relief, and yanked hard. Many more people have told me that they use alcohol and prescription and illicit pain medication to manage the pain of toothaches. Not infrequently, heavy use of alcohol or pills further locks people into cycles of misery: addiction, criminalization, incarceration.

Tooth decay signifies drug use, especially the “low class” drugs – crack cocaine (Joy’s drug of choice) and crystal meth (Tiffany’s drug.) During the height of the crack panic, toothless African American “crack whores” were held up as the epitome of evil – women so unnatural, so evil, that they would harm their own children and degrade their own bodies for another hit of the crack pipe. 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.

And 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.

Pennsatucky’s Pyrrhic Victory

Like her or hate her, Tiffany scores the single largest victory (unrealistic though it may be) over the system – a victory far greater than Piper’s furlough or Red’s smuggling scheme. Tiffany gets the prison to pay for a full, beautiful, functioning set of dentures to replace her few remaining rotting teeth. (Full disclosure: I’ve never heard of anyone getting good dental care in prison; quite the opposite – women often lose teeth in prison.) But of course, there is a price. When she can’t find an alliance with any of the other women she turns to the powerful white father figure (Mr. Healy) to take care of her. As he hugged her and she cried, I flashbacked on the earlier episode showing what sparked Tiffany’s prison career. When she came to an abortion clinic for her fifth abortion, she ended up shooting a presumably middle-class nurse (or at least middle-class in the eyes of Tiffany who lumps together people who believe in Hussein Barak and electric cars and who can eat out in restaurants, as opposed to people like her who learn to make casseroles out of the free baby food given out to poor families by WIC) who made a snarky remark that seemed to imply that Tiffany was promiscuous, irresponsible or just too dumb to stand up men’s demands for sex. In any case, the snarkiness was charged with classist venom (as was the shooting).

Class was the final straw that drove Tiffany to seek comfort from Mr. Healy. In season one she had a few minions – other white women clearly marked as lower class — who followed her around. Though their devotion to Tiffany had already begun to wane while she was in solitary, they decisively turned their backs on her when she returned with her new teeth. By the middle of season two her old friends accused her of acting as if she is too good for them now. But in an era in which class divisions are increasingly permanent, essentialized and uncrossable, her shiny dentures are not enough to allow her access into the middle-class white group.

At the risk of reading too much into what is, after all, a television show, the snide nurse at the abortion center (assumedly at least perfunctorily a feminist, otherwise why would she risk her life at an abortion clinic in the Bible belt), the suit-wearing lawyer who manipulates Tiffany into becoming an anti-abortion icon, her rejection by the tooth-some women in prison, and the paternalism of the prison administrator shed a certain light on how class is playing out these days. 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. 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.

You can read more on Joy here: Guilty Until Proven Innocent

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