I.

Yesterday, on the drive to a Wisconsin cabin abutting a twisty frozen lake, Sarah, my retreat buddy, compared visiting The Dells to getting a colonoscopy or root canal—one eventually must do it if one lives in the upper Midwest, even if it might be uncomfortable. Indeed, necessities are often noted for their discomfort. As a woman over fifty, I have had my requisite colonoscopy, and I have had three root canals thus far. As a woman over fifty, my life has been overstuffed with necessary, painful requirements.

My first root canal was many years ago—in San Francisco, the first city I lived in after fleeing my hometown. A large amalgamate filling had gone bad and fallen out, as they can after a while. The next was when that root canal had to be re-done. Upper right, two from the back. The third was on the other side. Same tooth but on the left, two from the back. I could display my dental chart as a visual metaphor to explain that no matter what level of intervention, sometimes best intentions fail. Sometimes they're just stop gaps on the way to entropic inevitability. With the last root canal, I was in the office for more than two hours.

I like my dentist. He is Greek, with a faint accent and dry sense of humor, and his eyes crinkle when he smiles under his mask. What I especially like, though, is his matter-of-fact approach to the truth of my mouth, though he is not uncaring. I mean matter of fact in that he intuited—despite my inability to engage in meaningful conversation (mouth full of gauze, tools, and rubber wedge)—my desire for knowledge, so he demonstrates and explains without sugar coating, though, naturally, a dentist would be unlikely to sugar coat anything. For example, he showed me the various files used to clear out the root from the dying tooth. On this day, he prepared my tooth by creating a sterile environment, which required isolating the tooth with a rubber skirting as if my mouth were an operating theater.

I have a photo of myself mid-root canal that I took when Dr. Constantin left the room for more than an hour. In the picture I am lying back, as one does at the dentist, with the requisite white cloth covering neck, chest, and shoulders, and there is a large piece of turquoise blue rubber protruding from my mouth and blanketing my lower face, as if I got caught midway through trying to swallow a deflated balloon. My eyes are a little wider than usual—what you might call a surprised expression—but I am giving the camera the thumbs up. I took the photo with my phone to send, mid-procedure, to my best friends in our eternal text thread. This is because I had been lying there, alone, for over an hour. It is hard to have a loose piece of rubber in the mouth, especially with an asphyxiation phobia, without the ability—or should I say permission?—to remove it. If I inhaled too vigorously, I would occlude my throat by sucking in the rubber.

I had seen the man and women through the window as they were approaching Parkway Dental, which is why Dr. Constantin had left my room. At this point, it was after hours, the offices closed. From a distance, I recognized their cultural status, where their placement in the American hierarchy has been determined by the equation of income times race times class, as in who one comes from. People can articulate this through body language, in the way they hold themselves and move through space. She was white and blonde and thin in that way that says choices were made between sustenance and substances. He was black and carried himself as if he were entering an unfamiliar, potentially hostile, territory. Ninety minutes later, the dentist returned to my room and apologized. In that interim, he performed an emergency extraction on the man, the couple having wandered in off the street in a state of desperation. The man's abscessed tooth was so infected, so swollen, that he could no longer close his mouth, and the infection had started to move into his jaw. The dentist sent him on his way with a packed socket and powerful antibiotics. I learned all of this as Dr. Constantin chattered at me, cheerfully increasing the gauge of files used to hollow out the slightly gnarled and calcified roots of my molar with its little backstory of failure.

II.

If you exist on the peripheries of American society, if you are unaware of how the system works, if you are without insurance, if you are undocumented, if your life does not accommodate the kind of self-care that exists on a higher tier of Maslow's Hierarchy of Needs—because you're still struggling with the basics of food, shelter, clothing, clean water, and basic hygiene—then your teeth become the thing you hope to get to when stability is achieved. Emergency Rooms, which are often the only resort for health care for the indigent or near-indigent, are not equipped to deal with dental emergencies. They may be able to prescribe antibiotics, drain an abscess, or administer a dental block, but they cannot extract the kernel of infection. Emergency dental clinics exist, but you need to know how to access them. My husband, an ER nurse for many years, having worked in three different county hospitals in three different states, has seen his share of dental trauma—entire sets of teeth broken from the mouth, an abscessed infection that was so bad the patient's throat was occluded. There are no dentists in the ER, though.

Deamonte Driver, a twelve-year-old Maryland boy, succumbed to sepsis when his tooth infection crossed the Blood Brain Barrier. A long-haul truck driver from Sacramento developed a toothache on a delivery to New York and died when the infection entered his blood and lungs. A former NFL player died when a beam fell on his head at the construction site where he worked. It turned out that the head injury was not fatal. Instead, his autopsy revealed bacterial sepsis with cerebral abscesses and necrotizing lobar pneumonia due to tooth infection.

III.

In my mother and stepfather's wedding photo, they both smile with all their teeth. He was Nuyorican, a veteran, and looked like a baseball player with his mustache, goatee, and thick, black hair. In the photo, she is blonde and radiant, eyes illuminated like she could see her beautiful future right in front of her, lit like a Christmas tree. This is 1994. A couple years after they had met in A.A, both securely sober. This was before his diverticulitis and multiple abdominal surgeries when he was prescribed fentanyl for the pain. After that, with each relapse, each trip down to the basement to "do the laundry," another tooth fell from his face. In the very last photo I saw of him, taken in a Florida prison, he had no teeth left. You could tell by the way his lips caved in as they do when there is no dental structure to rest against. He died in prison just before this year's winter holidays. His sister retrieved his body from the system.

At some point, my mother's front tooth was capped poorly, but she had no money to improve it, so a rare wide smile revealed a poor-fitting chiclet, its top edge lined with black. Another time she lost a cap on a molar and never replaced it. When she smiled—rare or feigned—I could see the shaved down nub of a tooth left naked.

IV.

I have a Sonicare. I run it over my teeth for the two minutes it is timed for, and then I turn it back on and run it for another two. Sometimes I brush three times a day. I get great pleasure from flossing. Every molar in my mouth is filled or capped. My childhood dentist began filling them when I was four.  

My husband has a Sonicare. His teeth are white and only slightly irregular, and his smile is natural and brilliant. His front teeth were bonded when he was a teenager because he was jumped in high school and had many teeth broken by fists and boots. In a photo album there is a picture that was taken after the assault. This documentation had been for the police. My husband, just a boy then, is pulling down his lower lip to expose the ragged tips of his shattered bottom teeth. 

My fifteen-year-old has a Sonicare and has had one since the tooth fairy began exchanging dollars for baby teeth. He also had his molars sealed by his pediatric dentist. He likes to play around when he's brushing his teeth by vibrating the heel of the brush against the bathroom mirror or by pushing too hard with the toothbrush so that it makes an intentional warning sound, and he does these things to antagonize his mother, because he is a teenager, and because he knows that it triggers anxiety in me, so then I yell and he gets his thrill. We are creatures of habit who like to play out our minor dysfunctions reliably on schedule. My son has no cavities. His teeth are movie-star perfect, despite years of sucking his thumb and lack of orthodontia. Nevertheless, he refuses to part his lips when he smiles.    

V.

My sister is losing everything. Her stable job, gone. Her eldest son, moving away from home, finally fed up with her mental illness. Her youngest son, taken by the state, and too many strikes against his mother, so she cannot see him. She has a record now. Can't get another job. She lost her boyfriend after assaulting him, because he confronted her about drug use. Another charge on her record. Then her boyfriend died of heart failure. She's lost her car, her phone. She doesn't know how she'll get to court. Her house is being foreclosed on. Florida won't help her and does not care if a person is dragged down by vice or illness or trauma. When I spoke to her last on the phone she said, and to top it off, all the teeth are falling out of my head.

VI.

My son was four, and we were at the park near our house, visiting with distant cousins who live in Palos Verdes, which is adjacent to where we lived, San Pedro. It was another sunny Southern California morning, Latinos setting up celebratory bounce houses and party tents on the coarse St. Augustine grass beyond the playground. I was sitting on a cement bench, watching my son stim, his monologues and hand gestures articulating his rich internal life.  Enormous ornamental fig trees leaned over the open spaces, providing us with shade and the faint smell of rotting fruit. The ground around the trees, and around the benches, was ridged, gullied, and mounded by an impressive network of roots.

My son ran over to the bench where I was sitting, and he tripped over a tree root. Imagine, if you will, how velocity does what it does—the kind of damage sustained when a speeding car hits a concrete wall, say. Or the way velocity explodes the watermelon when it is tossed from the roof of a building. My son's face, nothing to slow it down, connected with the edge of the park bench with a crunch—like the sound of a car hitting a wall mixed with that of a watermelon being pulverized. He landed on his mouth. I think often of the sound that escaped from my own face. Guttural, maternal, anguished howl—completely automatic. I picked him up, the fifty pounds of him, and ran to my car.

In the emergency room the damage was assessed. His teeth, baby teeth, were bent back, the force and unyielding nature of the bench had pushed the top row of his teeth back into his mouth, and a ragged split opened at the corner of his mouth. Before the plastic surgeon stitched up the wound, he grabbed that top row of teeth and slowly, with determined strength, pulled them back into place. There was some concern he would lose his teeth not long after, but they came out on regular schedule. There was concern the adult teeth sleeping in his gums would be damaged. They were not.

In my jewelry box I have a little, plastic container shaped like a tooth, and in that little tooth are my son's baby teeth. I don't know what to do with them. Some, seemingly brittle, have broken apart. The teeth's roots are so short one wonders how they stay in a child's mouth for as long as they do. I showed the collection to him. He had exactly the reaction one would expect. Gross, mom. Put those away.

VII. 

I still have my wisdom teeth. They came in when I was in my late teens and on my own. I had left home as soon as I turned eighteen and moved in with my boyfriend and his family, as if that household were any less dysfunctional than my own. I remember how his mother would start in early with her white wine from the big, green jug, though I know she, too—this form of her—was born from what came before. That we all come from a history that is sometimes too hard to escape, each misfortune reinforcing what links us to prior generations, making it as unbreakable as the strongest fishing line. My boyfriend's estranged father, whom I never met, relied on methadone from the clinic. Toward the end of our relationship, my boyfriend stopped paying attention to his personal hygiene, and I could see a thick, yellow plaque forming along the gumline of his bottom row of teeth. Teeth are runes that can tell you everything.

As my wisdom teeth broke through, they pushed my other molars forward, and though it was painful, I did not go to the dentist, because I did not have a dentist. I did not have dental insurance through my retail bookstore job, and if it was available, I didn't know, because I didn't know to seek out dental care.

In my late teens I also lost a filling, which opened a hole into the tooth, and I remember having to clean out the hole when brushing, to lavage it. The tooth remained unfilled for too long, which led to that first root canal.

I now must brush extra carefully way in back. I now have thirty-one teeth crowded into my mouth. As I age, my front teeth on the bottom crowd together, some popping forward, some pushed behind.

VIII.

Thirty-one teeth and not thirty-two, because it is possible to get a root canal, to get that root canal re-done, and to still have a tooth die. I had to see Dr. Constantin again, but this time it was for an extraction.

If you've ever had an extraction, you may know it is not as simple as it has been portrayed in the record of pop culture. It is not, in my experience, as easy as grasping a tooth with pliers and giving it a firm tug, the intact tooth shining between the tool's grabbers. The roots of my teeth are not tidy. They twist and gnarl like tree roots, as explained to me by my dentist, which means my long-beleaguered tooth would not come out neatly. It needed to be broken apart in the socket and taken out in pieces. It is not easy to break apart a tooth. A kind of violence was applied by Dr. Constantin to shatter the molar. It took much longer than you would expect. My mouth like the scene of a crime. 

During this process, I received multiple calls and messages from my sister, brother, and nephew. I finally answered my phone when I could, knowing something terrible must have happened. My mother was in the hospital with a brain bleed, and no one could tell me how bad it was. My husband, with his ability to parse the language of medicine, talked to the nurse on duty in the ICU where my mother was being treated, and through that conversation, it became clear that I needed to travel immediately to Florida.

First, though, we had to finish with the extraction. Once the largest pieces of tooth were removed, Dr. Constantin used forceps to fish, from the socket, the offending piece of infected tissue, and he held it before my eyes in the strong, clinical light—a piece of red, glistening meat with a white globule on one end. That was the nucleus of infection that wanted to set up house in my face. With a mirror he showed me the dark pit in my gum, a black hole, that opened to my sinus. 

Afterwards, he packed the socket with a bone and blood slurry, sewed it closed, and covered it with an oral bandage. I was given a course of antibiotics and told to make an appointment in three months for the first part of an implant procedure.

I got on an airplane the next morning, my face swollen, a green bruise shadowing my cheek. I know now that when I got on my flight that morning, my mother was already dead, but modern medical technology approximated the signs of life—air was being pushed and sucked from her lungs, an epinephrine drip was keeping her blood pressure up, and her blood was circulating. When I got to the hospital room, I could just see a few of her teeth, the ventilator tube crammed into her mouth and hanging from the side.

We—my sister, brother, and nephew—sat in chairs around her bed, not speaking. We were asked when we wanted to turn off the machines—an impossible, necessary choice. I spoke to my mother and touched her hair. I touched her hands, which were resting on each side of her, a rolled-up cloth cupped in each palm. I whispered I'm sorry. That I had been unable, through will or long-distance advocacy, to fix her lymphoma or reverse the effects of the chemotherapy and the way it shattered her mind, wiping memories clean like a solvent applied to writing on the wall, and the way it shriveled her, all strength and will to continue washed from her veins one titrated drip at a time. It's not that I really thought I could have done any of those things. That's one reason why I cried. The whole scene felt sordid, like grief theater in a bad medical TV drama. The staff rolled in a snack cart, and my kin ate cookies and fruit cups until we couldn't stand to sit there anymore, and we finally said okay. Turn them off. When they switched off the ventilator, removed the tube, and stopped the epinephrine drip, her mouth fell open as muscles went slack. I could just see the row of her bottom teeth—glistening ivory and stoically straight, lined up like wet tombstones in a veteran's cemetery.

All that week my tongue drifted to the bundle of sutures where my tooth used to be and prodded the wiry nest. Slowly the bruise faded, and little by little the swelling decreased as I quickly organized a celebration of life for Elaine. That was my mother's name: Elaine Susan Torres. She had been involved in the recovery community for many years—I now carry her thirty-year sobriety coin around as a good luck talisman, and to keep her memory close. I keep it as reminder of her long struggle to achieve an uncomplicated life, one in which she did not need to be tethered to a husband whose addiction sucked her dry and to a daughter, my sister, whose neediness was all-consuming. She never managed to cut those cords. She had believed they would slowly kill her. There is no evidence to the contrary.

Many of the people who came to her celebration of life were friends she had met in A.A. What I remember from attending meetings with her when I was a kid, and from meeting her friends in recovery, is how much addiction can devastate a face. Certain sensory images still stick with me: the smell of percolated coffee, circles of smokers shivering in the cold outside the church hall, and the sheer number of wrecked adults with wrecked mouths exhaling smoke from gaps in their teeth.

For months, small pieces of bone would make their way through the tissue where my tooth used to be, tunneling from my jaw to the surface, and I would spit spicules like large, white grains of sand. It's all healed smooth now. An empty space where a tooth used to be.

An empty space where a mother used to be. I was supposed to make that appointment for an implant, but I haven't yet, more than a year on from the extraction. Here's what I haven't figured out yet, in terms of my own motivation: Have I not replaced the tooth because I don't want to pay the large expense? Have I not replaced the tooth because that absence has become symbolic? Have I not replaced the tooth because I am not ready for another traumatic dental procedure? Have I not replaced the tooth because I can't make time in my life for self-care? Have I not replaced the tooth because I can eat fine without it and don't need it? Have I not replaced the tooth because of some strange allegiance to where I came from, allegiance to what I came from? As I consider these questions, the tip of my tongue rubs back and forth along the smooth, empty gum.             

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"Through the Teeth" manifested as an essay because I have too many stories associated with teeth to not write about them and because of my close proximity to addiction and poverty and the way I understand teeth as status. I'm deeply aware of the way a dental x-ray can chart out the failure of America's class system.