There was American author Donna Tartt's description of a British character's "rabbit teeth" in her Pulitzer-prize winning novel "Goldfinch." "The Simpsons" episode where a dentist terrifies Springfield's resident oddball kid Ralph Wiggum into better brushing habits by showing him a book called "The Big Book of British Smiles" featuring revered national figures like Prince Charles with misaligned or misformed teeth. And who can forget super spy Austin Powers' grotesquely discolored grin in his three feature films?
In an effort to discover whether there's any truth to the widely-held belief, Watt teamed up with researchers from both countries to gather and analyze national data on the subject.
Their conclusion, published Wednesday in the journal BMJ, may be a shocker to those on our side of the ocean: Americans do not have better teeth than the English. In fact, by some measures Americans' teeth are actually worse. They have significantly more missing teeth (yuck) and the inequalities in oral health are much wider between rich and poor in the United States than in Britain.
"We were very surprised with our findings," said Watt, a professor of dental public health at University College London, told The Washington Post. Watt, it should be pointed out, is Scottish.
The analysis was based on information from two nationally representative health surveys -- the British Adult Dental Health Survey (ADHS) and the U.S. National Health and Nutrition Examination Survey (NHANES). Both are nationally representative surveys with comparable information about oral health and socioeconomic position. The data the researchers used included people ages 25 who underwent a clinical examination to check their teeth. About 8,700 in Britain and 9,800 in the United States were included in the analysis by education about 7,200 in Britain and 9,100 in the United States in the analysis for income.
As might be expected, the researchers found strong links between levels of education and household income and oral health in both countries. That is, the more educated and wealthier had better oral health. But the disparities were much greater in the United States.
The researchers said there could be several reasons that may explain the differences between the two countries. One theory they had was that perhaps it might be due to the more diverse ethnic composition of the population in the United States, but their analysis showed this was not the case. Other possibilities may include the fact that dental services in the United States are provided privately and can be pricey and that they are part of the nationalized health-care system in Britain; or that Americans may have riskier behaviors that impact oral health such as smoking or consuming higher amounts of sugars.
In addition to looking at clinical data, the group assessed how people perceived their oral health in both countries. That included looking at how dental diseases impacted quality of life in areas such as pain, eating, speaking and their confidence in socializing.
Despite their better teeth, the British reported more significant impacts on their quality of life. "This could be partly a cultural difference - the English complain more!" Watt theorized.
There is of course the possibility that if you look at other measures of oral health that Americans could come out better. This study, as people who enjoy making fun of English teeth will inevitably point out, was limited to analysis of missing teeth and did not include aesthetic or orthodontic outcomes.
Below is a look at some data from the Organisation for Economic Co-operation and Development that provides more context by showing how the United States and Britain do in oral health in relation to other countries. Note that Britain not only did better than the United States, it did better than all the other OECD countries that reported data that year.
To be fair, while the BMJ study said Americans' teeth are no better than the British's teeth, it stopped short of saying they were worse. The researchers actually talked about "a mixed picture," with Americans having significantly more missing teeth and the British reporting more impacts due to dental issues (could it be all the people poking fun at them has made them extra self-conscious?)
Watt said that as oral diseases continue to be a major health problem across the world that maybe the study will help make British teeth less of a running joke: "Perhaps now Americans will not laugh at English teeth anymore?"
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