I’m looking in the mirror and trying on faces. I’ve always been self-conscious, with fluctuating levels of severity – the effect of comments made about my appearance over the years which have left slow puncture wounds, still hissing decades later. It is a symptom, I guess, of our collective, commodified dissatisfaction with how we look.
Today – and every day that I can remember over the last few years – one aspect of my appearance has particularly affected me: my teeth.
My teeth prompt a wave of hot shame whenever I stare back at myself. At the front they’re chipped and broken, skirted with rough edges that catch on my lips and tongue. I practise smiling without revealing them.
Later I’ll cancel a date, not for the first time, because I’m worried I won’t be able to manage to do that performance properly.
My teeth haven’t always been this way. They were fine, once. Until my late 20s I barely remember having an opinion on what they looked or felt like. They did not consume my thoughts or prevent me from living how I wanted to. They were almost straight after having a brace as a teenager, more or less even, not white (from years of smoking) but good enough.
I would often become anchored to the sofa for weeks, sleeping (albeit very little) there. And that’s when it began: the teeth grinding.
My best friend, who I lived with, said she could often hear the sound of my teeth grinding from the kitchen, two rooms away. Over the months the grinding increased in severity, meaning that, if I did sleep, I woke up with a headache and a relentlessly aching jaw. My dentist prescribed me a mouthguard to wear at night.
Then I was prescribed the antidepressant Prozac. This medication eventually enabled me to go back to work but there was a trade-off. The teeth grinding doubled down. By the time I stepped back into the office it was so constant that I was wearing my dentist-prescribed nightguard whenever I could in the day, as well as while I slept.
Eventually, with the help of a concoction of different medications as well as a few therapists, the depression began to lift. But the marks it left on my body remained, particularly in my mouth.
This, it turns out, is extremely common. We don’t talk about the damage that depression and anxiety can do to our teeth and gums but it is very real. Research has shown that people who suffer from depression may be more likely to experience tooth loss and dental pain.
Our oral and mental health are very closely linked. When we don’t care for ourselves, going to the dentist is almost unthinkable; under the heavy weight of depression, even managing to brush your teeth twice a day can feel like too much. Stress can also cause burning mouth syndrome (just as it sounds – this is the name given to a condition which encompasses pain or discomfort in the mouth). Medications for mental health such as antidepressants can cause dry mouth, which has a detrimental effect on gums. Eating disorders can cause tooth erosion. Anxiety can, too.
Research has shown that people who suffer from depression may be more likely to experience tooth loss and dental pain.
My dentist even asked me if I had bulimia because of erosion to my teeth. In fact, my fight-or-flight mode causes me to vomit almost immediately when I begin to panic. This is what had caused the damage.
Eventually, for me, my oral health became intrinsically linked to my mental health. Or, rather, it was a constant reminder of it. The damage to my teeth, irrevocable as it was, felt like scarring of sorts; the living memory of something – the depression – that very nearly killed me.
I felt shame that I allowed myself – and subsequently my teeth – to break in such a public way. I began to shy away from interviews for work, to hold my hand near my mouth if I laughed. I dreaded meeting new people.
Perhaps this makes sense. Intimacy lives in our mouths. There is nothing more thrilling than a snog, nothing more delightful than the soft flesh of lips touching, nothing that fills the whole body like the words that come out of them. When you’re self-conscious about your mouth, it’s not just your appearance that suffers. It’s your sense of self.
There’s a reason that the well-worn meme "you’re not ugly, you’re just poor" often references teeth – British teeth especially, and British working-class teeth more than that.
People on lower incomes are more likely to be stressed and to have damage to their teeth, and less likely to be able to afford to fix them. This – oral health inequality – has been acknowledged by Public Health England.
I now live a middle-class lifestyle but for years I accepted that my teeth were beyond repair because I’d never be able to afford what I deemed to be a cosmetic treatment which can cost thousands of pounds to fix them.
Like many other people with depression, I stopped going to the dentist when I was ill and convinced myself that I’d be told there was nothing to be done.
Thankfully I was very wrong. There is a lot more NHS help available than I realised.
Last February I went to see my local NHS dentist, Dr Viorica Luti-Medhrian in Crofton Park, southeast London. As always, I reflexively cried as soon as I sat in her chair, for no other reason than the humiliation of an open mouth.
"I’m going to refer you," she said, to King’s College Hospital Department for Restorative Dentistry and Traumatology. She explained that my case of grinding was severe and needed further treatment that I might not have to save thousands of pounds for. Within six months I had my first appointment.
Since then I’ve been back to King’s five or six times and, over the course of six months, have had my teeth almost fully repaired.
I was taught jaw exercises (with grinding – or bruxism – the temporomandibular (TMD) muscle which connects your jaws becomes overworked and enlarged), had my teeth bleached and composite bonding applied on the edges of the top four to make them appear smooth and solid. I still have more appointments to attend. The bottom set will also be smoothed and then an even more hardy nightguard will be fitted to prevent this happening again.
If I had paid privately, this would have cost upwards of £3,000. Let’s pause on that figure for a moment and think about how few people can afford it. This is a vicious cycle, with poverty and mental health conditions caught in a feedback loop. We know that children and adults living in households in the lowest 20% income bracket in Great Britain are between two and three times more likely to develop mental health problems than those in the highest. And of course, because they are in the lowest income bracket they will be the least likely to be able to pay for private treatment.
And so it has been heartening and remarkable to see how King's' dentistry department works. During my appointments, tipped right back in the chair (one time for almost four hours), I’ve listened to people with the same wobble in their throat speak with gentle dentists who are eager to help them at no personal cost.
When you're self-conscious about your mouth, it's not just your appearance that suffers. It's your sense of self.
Each time I’ve felt awed by their work, carried out in reassuring voices, which is crucial and, like most of the NHS, chronically underfunded. Clinics like this go some way to democratising how our teeth are cared for.
The department – and others like it around the country – is not only fixing teeth but building confidence and, probably, opportunity with it.
Teeth and oral health are symptomatic of mental ill health but it can also be true the other way around. The harm that damaged teeth can do to self-esteem is equally valid, especially when we’re surrounded by images of perfect sets on Instagram. While oral health matters, appearance really shouldn’t – yet it increasingly does.
In the age of social media, where age-old stereotypes about "bad British working-class" teeth persist even as we are all more visible online than ever, it is hardly a surprise that there has been a rise in the number of people seeking teeth surgery abroad (almost 260,000 Brits travelled elsewhere for veneer or bonding treatment in 2018). Some have dubbed this the "Love Island effect" because the show’s contestants often, wittingly or not, promote perfect, fluorescent white teeth as a beauty standard. But it isn’t without complication.
Statistics from the British Dental Association (BDA) show that 29% of dentists surveyed have treated a patient for complications arising from dental work performed abroad. Of the dentists who saw such complications, 60% said problems arose because the initial treatment was of poor quality; 59% because of infection; 56% because of pain; and 33% because the initial treatment was clinically inappropriate. This is before we get on to some of the more worrying teeth-whitening trends doing the rounds on TikTok.
My teeth aren’t perfect now. They won’t ever be and that’s okay. They weren’t perfect before I became ill. This isn’t about perfection, it’s about restoring who I used to be. My teeth now look like they did before I was ill.
When I visited my family recently they compared how I look now to old pictures and said it was like the last five years never happened to my teeth. A few weeks ago I stepped out of King’s Hospital feeling very self-conscious about my teeth once again, this time because they seemed brand-new. At home I looked in the mirror, trying on faces. I smiled and, for the first time in years, I thought, Okay. Things might be okay.