Our culture thinks “perfect” white smiles equal healthy smiles — but that’s basically fake news. This misguided notion leads to a pletoothora of problems, as conventionally ideal smiles don’t necessarily mean they’re a vision of health and even unhealthy smiles are exacerbated by issues of poor education and wealth inequality. (The most 2018 thing is an oral health subscription service talking about wealth inequality). As our culture continues to obsess over sparkly teeth, it distracts from the health issues that are really stuck in our teeth while causing anxiety, declining oral health, and even... joblessness. That might sound like a loooong reach, but we’re serious. So, what do we do about it?

“Perfect smiles” started with Hollywood, of course.

There’s a nickname for your six top front teeth, “The Social Six,” for a reason. As Mary Otto outlines in her book aptly titled, “Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America,” there’s a very clear point in American pop culture when these six teeth started becoming symbols of social and economic dominance — way before Kylie Jenner could smile in a selfie on Snapchat.

Otto says a Hollywood depression-era dentist, named Charles Pincus, began working with studios to fix up the smiles of dazzling icons with less-than-dazzling smiles, thus creating the idea of a movie star smile. He even created snap-on veneers for Shirley Temple, which is why we never really saw her smile change on screen.

Ultra-white, straight, and sparkly smiles (mostly achieved by veneers, or “thin, custom-made shells crafted of tooth-colored materials designed to cover the front side of teeth” according to the American Dental Association ) became yet another beauty standard for everyone to chase for all the wrong reasons.

But, the idea of a “perfect smile” isn’t so perfect

Beauty standards focus on… beauty, and when we focus on things like potentially harmful whitening and expensive dental operations that prioritize cosmetic appearance, our oral health is basically a background extra when it should really be the movie star lead.

Even if you have the healthiest of mouths and you’re following the ideal routine, that might not lead to the ideal smile aesthetic — but it can lead to very real anxiety because of the importance our culture places on beauty. According to the ADA, 1 in 4 American adults avoid smiling due to the condition of their teeth. In a survey done by the American Academy of Cosmetic Dentistry, 75 percent said they judge a person’s success based on their ugly smiles and half of respondents deem bad teeth as a consequence of poor oral hygiene.

It’s true that a portion of this group actually has poor oral health, but the beauty standard could actually be making their oral health even worse. According to Carrington College, one of the main reasons that a majority of Americans don’t visit the dentist regularly is embarrassment about the appearance of their teeth. In other words, anxiety over not fitting beauty expectations might be leading to people not getting the oral care they need.

How the smile standard fits into wealth inequality

Low income people are Less likely to visit the dentist and follow a proper oral health care routine, leading to worse oral health outcomes compared to other income groups.

As Otto says, “The teeth are made from stern stuff. They can withstand floods, fires, even centuries in the grave. But the teeth are no match for the slow-motion catastrophe that is a life of poverty: its burdens, distractions, diseases, privations, low expectations, transience, the addictive antidotes that offer temporary relief at usurious rates.”

This problem, unsurprisingly, increases anxiety rates among low income people. According to the ADA, 29 percent of low-income American adults say the appearance of their mouth and teeth affects their ability to interview for a job, compared to just 18 percent of all Americans. Poor dental health affects speech (like a missing front tooth or even chipped can change the way you actually produce speech since your tongue plays off the back of your front teeth) which can increase social anxiety. And, bad breath related to poor oral hygiene can also worsen social anxiety.

This creates a cycle that exacerbates both poor oral health and, possibly, wealth inequality. If you’re unable to take care of your teeth properly and there’s a beauty standard that you’re expected to adhere to, you’re more anxious about going to a job interview or a dentist appointment… and these problems can become even worse.

So, what can we do about it?

We’re not going to write a thesis on how improved oral health care can solve wealth inequality because that’s not true (there are sooo many more factors contributing to this giant-as-heck problem). We’ll leave that one to the academics—but, we can help with what we know about: oral health.

As the recent body positivity movement proves, each and every one of us can help change our culture by challenging beauty standards head-on. It starts with having open conversations about how we feel about our smiles. When your friend says they really need to whiten their teeth or your little sister says she wants veneers, don’t be afraid to discuss why they’re feeling this way—and be honest about how you view your own oral health. If you take really good care of your teeth (you probably do because you’re reading this) and your smile still isn’t the ideal, tell them why that’s okay. If someone in your family is afraid of the dentist because they’re embarrassed of the condition of their teeth, have a conversation about why that might be counterproductive.

A solution also lies within advocating for improved education and access to proper oral care for people who might otherwise not have it—specifically low-income people—will help improve oral health, and subsequently decrease anxiety.

If we can even begin to separate our ideas of beauty and health, we could make a huge difference in how we feel about ourselves and each other—and improve everyone’s oral care routines while doing it.