Mexico’s Molar City Could Transform My Smile. Did I Want

On weekday mornings in late winter, they start to arrive before dawn. They drive in from Arizona or California, catch a shuttle from Yuma, or park their car in a lot in the Sonoran Desert and cross the border on foot. The path for pedestrians follows State Route 186, past a pair of Jehovah’s Witnesses offering free Bible courses, along a twisting corridor of razor wire and chain-link fence, through passport control, and into Los Algodones. By noon, more than a thousand people will have walked from the United States to Mexico, in the shadow of the thirty-foot wall that divides them. They come on bicycles and in wheelchairs, pushing walkers and leaning on canes. They come to be healed or transformed or to put an end to their pain, preferably at deep-discount prices.

Los Algodones is part Lourdes and part Costco. It has no cathedral, shrine, or holy well, yet it draws more than a million pilgrims every year. For most of its history, the town has had little to offer the average visitor. It sits with its back to the Colorado River, in the empty floodplain where the Quechan people first raised crops—algodón means “cotton” in Spanish. Ranch hands and migrant farmers arrived in the eighteen-hundreds, followed by bootleggers, bartenders, drug runners, and pimps. In the nineteen-twenties, when all of Yuma had gone dry with Prohibition, Los Algodones had forty-eight bars and strip clubs a ten-minute stroll from the border. I spoke to one local man who grew up in San Luis Río Colorado, twenty-five miles to the south. As a teen-ager, he recalled, he used to ride to Los Algodones on horseback, swim across the river to the United States with a backpack full of weed, and return home to Mexico, flush with cash. “It was all whorehouses and cantinas here,” he said.

Then came the dentists. In 1969, Dr. Bernardo Magaña, newly graduated from dental college at the National Autonomous University of Mexico, set up shop directly across the street from border control. Within a year, he was treating dozens of patients a day, most of them Americans. It would be more than a decade before many other dentists joined him. The town was just too rough, Magaña’s son, Bernardo, who now runs the practice with his brother and his mother, told me. “So my dad took it upon himself to clean it up.” In the early eighties, Magaña was elected mayor of Los Algodones. Backed by the state government in nearby Mexicali, he cracked down on vice and shuttered the most notorious establishments in town. Year by year, the bars gave way to dental clinics, the partygoers to patients. According to Roberto Díaz and Paula Hahn, who run a website about medical tourism called Border CRxing, Los Algodones now has the highest per-capita concentration of dentists in the world: well over a thousand in a population of fifty-five hundred. It’s known as Molar City.

When I first arrived, on a Sunday evening in March, the clinics were all closed. At the Quechan Casino, on the Fort Yuma Indian Reservation just across the border, the slot machines were thronged with patients killing time before their appointments or flights home. Myron Arndt, a former tire-shop owner from Minnesota, was hunched over a Rich Little Piggies machine. He was scheduled to get four new front teeth the next day. Mike Sherer, a tinsmith from Michigan, was having some dentures and implants put in, and Terry Bussard, a retired magnesium-plant foreman from Utah, was sporting two new plates of dentures. One of the few without an appointment was Conny Everett, who runs a pretzel stand at local fairgrounds. She needed a cavity filled but couldn’t bring herself to go. She has a tendency to gag during procedures, she told me. “Last year, I got in the chair—it was all paid for—and I just chickened out. I’m, like . . .” She put her fist in her mouth and widened her eyes.

It has been more than a century since the invention of Novocain, but dentistry is still the stuff of frayed nerves and bad dreams. The recumbent chair and whining drill, the blinding lights and masked faces overhead, the needle, the spit basin, and the X-ray film clamped between your teeth—every detail seems designed to inflame our fears. “My family dentist when I was a kid, there was something wrong with the guy,” James Murphy, a retired bookstore clerk from Rhode Island, told me, between spins on a Dragon Link slot machine. “He drilled every tooth in my head. That’s what made my teeth rotten. But he was Irish, and you got to go with the Irish guy.” Murphy was due to fly home the following day with a full set of implants in his upper jaw, and he’d be back in three months to do the bottom teeth. The total cost would be seventeen thousand dollars. “I’ve never smiled so much,” he said. “Back home, it would have been thirty-nine thousand just for the top. And they wonder why people are coming here.”

Crossing the border can be a little daunting the first time, some said. “Took us three years to work up enough nerve,” Ken Foshaug, a retired Coast Guard engineer who was staying at a nearby Sleepy Hollow R.V. park with his wife, told me. “All the guys holding guns and checking you out. Plus the whole thing of going to a foreign country to let someone drill into your teeth.” But Molar City was built on leaps of faith. It’s a place for the poor, the afflicted, the huddled masses without dental insurance. Just a short walk away, on the other side of the wall.

I first heard about Los Algodones from my friend Todd, who lives in Mexico for part of the year. He’d been reading about the town for a while and thought I was made for the place—cheap, poorly insured, mouth a mess. My bottom teeth lean this way and that in a wandering line, like first graders on a field trip. The top row is reasonably straight on the left, but, on the right, one rogue tooth is tilted back so far that it’s half hidden by an incisor. In pictures from that angle, I have a gap-toothed grin, as if I’ve just come from a bar fight or a remake of “Deliverance.” “Snaggletooth” is the term that my wife likes to toss around if I annoy her. When we first met, in fifth-grade orchestra, we were a perfect pair: she had big buckteeth. But by the end of junior high, after her braces came off, her teeth were as straight and prim as everyone else’s. Mine only got snagglier.

A succession of dentists of varying skill and congeniality have worked on my teeth over the years, to no great effect. When I first moved to Brooklyn, the best I could afford was a gruff woman in a practice misleadingly labelled as “modern” above the door. A Russian émigré, perhaps accustomed to patients of a doughtier nature, she was stingy with anesthesia, I felt, and barked through her mask when I fidgeted. A few years later, when I lived in Germany, the health-care system there paid for regular visits to a gleaming, high-tech office in a lofty penthouse. At my first appointment, the dentist peered at an X-ray of the metal post that my Russian dentist had planted in my jaw and shook his head: “When was this work done? The nineteen-fifties?”

Still, technology has its downsides. The more advanced the imaging system, the more expensive the visit, and the more problems it can find with your teeth. Last year, at a routine checkup in Brooklyn Heights, I mentioned that one of my teeth had been feeling a little sensitive. My dentist spent the next hour searching for the cause: he rapped the tooth with a metal tool, had me chomp down on a stick, and, when I still didn’t feel any pain, sent me to the next room for a panoramic X-ray of my skull. He eventually found a hairline fracture in the tooth’s root. It was so faint that I could hardly see it, even under extreme magnification, but he urged me to get a root canal and an implant for three thousand dollars. I kept the tooth and haven’t felt any pain since. What stuck with me, instead, was the sight of my skull. It looked like something unearthed by paleontologists in Tanzania: ancient, battered, encrusted with minerals. When the dental assistant sent the picture to my phone, she glanced up at me and said, “This is what you’ll look like when you’re dead.”

The truth is that our ancestors had much better teeth than we do. Neanderthals and other early humans, like the aptly named Nutcracker Man, had burly, oversized molars for grinding down tough stems and coarse grasses. Modern teeth are much daintier, yet they were still built for diets heartier than ours. Eating was meant to be a workout. Chewing raw plants and sinewy meats both strengthened and lengthened the jaw. Without that exercise, our oral growth tends to be stunted. The soft, processed foods we eat offer so little resistance that our jaws end up shorter than they should be, our teeth overcrowded—ninety per cent of us have some misalignment. Early humans didn’t need orthodontia. Their incisors fit together tip to tip, and their wisdom teeth were ten times less likely to be impacted than our own. Their teeth also lasted a lifetime. The food they hunted and foraged wasn’t laced with sugar, so their teeth weren’t infested with bacteria that exude acids that eat through enamel. Our ancestors, for all their lack of flossing, rarely had cavities.

Dentistry is a losing battle between form and function. Our teeth were ingeniously shaped by evolution, just not for the way we use them now. Most of medical history reads like a long, triumphal march: surgeries refined, diseases vanquished, life spans extended. But dental history—in books like “Evolution’s Bite,” by the paleontologist Peter Ungar, or “The Smile Stealers,” by the historian Richard Barnett—always seems to lead backward as well as forward. Agriculture is invented, only to wear down farmers’ teeth with grit from the stones used to mill grain. Food production is industrialized, only to riddle our teeth with cavities. Anesthesia is perfected, only to encourage people to get rid of their imperfect teeth and replace them with less durable implants, crowns, and veneers. And each advance, at least initially, makes dentistry more exclusive, more expensive, more out of reach for the average patient. Hence the crowds at Molar City.

Every morning at the Hacienda Los Algodones, guests gather over breakfast to trade stories about their teeth. The hotel is owned by the same family that owns the area’s largest clinic, Sani Dental, and most of its guests are also patients. They get a free night at the hotel for a thousand dollars in dental procedures, two nights for two thousand. The Hacienda is a rambling villa on the outskirts of town, with arched walkways, shady courtyards, and adobe walls painted a rich annatto yellow. It was once the private residence of Enrique Jiménez, the founder of Sani Dental, and his wife, Adriana. Enrique’s brother Jorge and his sister Mayra also own dental clinics in town, as do his daughters Marcela and Angelina. The Jiménez family is dentists all the way down.

The Hacienda’s guests are mostly snowbirds—Northerners who migrate south to Arizona and California every winter, following the sun. They’re a restless, nomadic folk, usually retired, who descend in vast numbers on the R.V. parks and rentals of Yuma, Quartzsite, and surrounding towns. (The population of Quartzsite balloons from less than three thousand to more than a million in the winter.) Theirs is a community built on chance encounters between campsites, so they’ve learned to strike up acquaintances quickly—to plop down beside a stranger at an open table and start telling stories. And they all have stories. If they’ve made it to Molar City, they’re adventurers of a sort, and the town has become a bargain hunter’s El Dorado. Cut-rate pharmacies, opticians, dermatologists, massage therapists, hair-transplant specialists, and exotic medical practitioners line the streets around the dental clinics, promising deals unheard of back in the U.S.

On my first morning at the hotel, I looked up from my eggs and beans to find a tall, craggy-looking man standing beside me. His name was Denvy Larson, he said, and he had just driven down from Oregon with his brother. He was a devout Mormon, seventy-nine years old, and had done mission work in the Philippines. But he wasn’t here for that. He’d come to Mexico to turn his pickup into the truck of his dreams. “I want leather bucket seats and pearlescent paint with metal flakes on the bodywork,” he said. “It’ll have live flames in front that taper into ghost flames.” At the next table, Donna LaTorre, a middle-aged woman from North Carolina, was talking about the stem-cell infusion she was getting later that day. She had long, platinum-blond hair, thick eyelashes, and a slight tremor in her hands from Parkinson’s disease. She used to be a bodybuilder, she told me—“a hundred and twenty-three pounds and built like a truck”—but had refused to take growth hormones, so she couldn’t make a career of it. She blamed her Parkinson’s on the pesticides at a tobacco farm where she’d once worked. “Last July, I couldn’t walk,” she said, but she was back on her feet now thanks to the infusions.

Guests like these were the outliers, though. Most were here for their teeth. I met Billy and Nancy Martinez at dinner on my first night. Nancy, who was seventy-three, had long dark-brown hair parted in the middle like Joan Baez and spoke in soft, falling cadences. Billy, four years younger, was short and round and full of vinegar. He would nudge me with his elbow when he told a story, then roll around in his chair laughing at the punch line. They were from Red Cliff, Colorado, an old mining town two hours west of Denver. Billy drove a snowplow and other heavy equipment for the public-works department, and Nancy was a retired customer-service representative for an electrical coöperative. They showed me pictures of the abandoned railroad track where they liked to walk their dog, Miner Jack. Then Billy leaned over and bared his gums at me. He was getting two implants and a few crowns in the morning, he said, yanking his mustache sideways so I could see the gaps between his teeth. He grinned like a ten-year-old on the night before his birthday.

I glanced over at Nancy, who was picking at her plate. “I’m just going to have a consult,” she said. She’d always been self-conscious about her smile, she said. When she was a girl, she had a small, fanglike canine that jutted between her front incisors. The other kids used to call her Dog Tooth. “Oh, yeah, it was cool!” Billy said. Nancy wrinkled her lips: “I didn’t think so.” She finally had the tooth taken out twenty-three years ago, when she turned fifty. But now there was a gap where it used to be, and the edges of the teeth to either side were stained. She still imagined people were staring at her. Two years ago, she and Billy had managed to save enough money to put new crowns on those teeth. But then Miner Jack got cataracts, and they used the savings for his eye surgery. “It’s a standing joke,” she said. “ ‘Oh, when we have money, we’ll get your teeth fixed.’ ”

Molar City seemed to be the solution: the prices were a fraction of those at home. But she wasn’t quite convinced. “I thought maybe I’d think about it but not actually do it,” she said.

Billy and Nancy weren’t especially vain. They just wanted “to face the world with dignity,” as Brett Kessler, the president of the American Dental Association, put it recently, when I asked him about the goals of dentistry. Good teeth have become a social norm in America. The more money you have, the straighter and whiter they’re expected to be. It wasn’t always so. For centuries, the wealthy had terrible teeth. In the sixteenth century, when sugar first made its way to England in large quantities from Brazil, it was an aristocratic indulgence. By 1700, the country was importing twenty-two million pounds a year, a disproportionate amount of which was consumed by the upper classes. When their teeth rotted, they had no choice but to see a tooth puller or a barber-surgeon—sometimes just a blacksmith with a side gig. If his iron pincers didn’t work, the preferred tool was a pelican: a fearsome-looking device with two hooks to grasp a molar and a lever to wrench it out. In France, the most famous of the tooth pullers, le Grand Thomas, plied his trade on the Pont Neuf, in Paris. He took as his motto “Dentem sinon maxillam”—“The tooth, and if not, the jaw.”

It was an egalitarian sort of torture: even monarchs fared no better. Queen Elizabeth I was so fearful of dental work that she lived with aching teeth for years. It wasn’t until the Bishop of London volunteered to have one of his own teeth pulled, as proof of the procedure, that the Queen consented to do the same. In France, a courtlier breed of tooth pullers began to cater to the affluent in the late seventeenth century. Known as dentistes, they had milder manners and better tools—the pelican was replaced by the tooth key, a corkscrew-like device that could fasten onto a tooth and twist it out of the jaw—but only marginally improved results. When Louis XIV had a tooth pulled at Versailles, his dentist yanked at his jaw with such zeal that he tore a hole through the palate and into the nasal passage. For a while after that, any liquid that the King drank would come spraying out of his nose. To plug it closed, his surgeon had to cauterize the hole with a red-hot iron.

Dentistry would have its own parade of progress eventually. Anesthesia was introduced in 1846, the pneumatic drill in 1868, dental X-rays in 1896. Ether gave way to cocaine, Novocain, lidocaine, articaine, and laughing gas for the lucky few. As always, though, there were unintended consequences. Dentures, carved from walrus ivory or other materials and tied in place or mounted on sprung-steel plates, were excruciating to wear and reeked after use. Nonetheless, the ones made with real human teeth were so popular that some parents were said to pull their children’s teeth to sell them. In morgues and on battlefields across Europe, the dead were scavenged for donations—“Waterloo teeth,” they were called, after Napoleon’s great defeat in 1815. Well into the twentieth century, preventive dentistry was beyond most people’s means. My mother-in-law, who grew up on a farm in Nebraska during the Depression, lost most of her teeth by the age of fifteen. Her parents couldn’t afford fillings, so any tooth with a cavity was pulled. When she married, she had partial dentures on top and bottom—a fact my father-in-law didn’t learn until years later. “It wasn’t hard to fool him,” she told me. “I’d take them out after he went to sleep. Or I’d wake up, take them out, and go back to bed.”

Any neighborhood dentist is capable of miracles nowadays—even root canals can be relatively painless. And more wonders are in development: gene therapies that grow new teeth, stem-cell treatments that coax teeth into filling their own cavities, nanoparticles that loosen teeth so that braces can realign them more easily. But the gap between the best care and the worst has only grown. Less than half of all Americans go to the dentist in any given year, the American Dental Association estimates, and the procedures they most need are the ones they can least afford. In 2019, for example, close to two million emergency-room visits were caused by dental problems; oral cancers alone—often detected too late—kill some twelve thousand Americans a year. Whether by cause or effect, Peter Ungar notes in “Evolution’s Bite,” poor oral health has been linked to Alzheimer’s, diabetes, heart disease, H.I.V., osteoporosis, premature births, sepsis, and a host of other conditions. “As your teeth and gums go, so goes the rest of your body,” he writes.

The symptom most common to our dental shortcomings is a seething resentment, occasionally flaring into rage. Dentists may be the most abused professionals in the country, next to airport check-in agents. In 2020, in a survey by the New York University College of Dentistry, three-quarters of dentists reported that they’d been verbally attacked by a patient, and nearly half had been physically assaulted. Dental students were treated even worse: eighty-six per cent had been verbally abused in the previous year. The aggression toward dentists was remarkably indiscriminate: age, sex, race, and years of experience made no difference, nor did the number of patients that they saw per day. The rate of abuse remained the same.

Three years ago, at a dental clinic in Tyler, Texas, a forty-year-old man began to berate the nurses working on his dentures. When a dentist asked him to leave and never return to the clinic, the patient pushed him to the ground. Then he walked out to his truck, came back with a handgun, and shot the dentist and one of his colleagues to death. Two years later, in New Orleans, a fifty-five-year-old woman was accused of stabbing her dentist in the eye. A month after that, in a suburb of San Diego, police reported that a twenty-nine-year-old man stormed into a dental clinic and opened fire with a semi-automatic handgun. He hit the receptionist in the leg and the office manager in the hand, elbow, and torso, then went looking for the dentist. When he found him, hiding inside an office, he shot him multiple times in the upper body.

The alleged shooter in San Diego, Mohammed Abdulkareem, was Muslim; the dentist, Benjamin Harouni, was Jewish. Some speculated that the killing was a hate crime, but the police found no evidence of that. Abdulkareem had been coming to the clinic for months, complaining that the dentures he’d been given didn’t fit. The office manager had taken to intercepting him at the door because he frightened the staff. The attack on the clinic may have been planned—Abdulkareem had bought the gun five days earlier—but it was also strangely impersonal. Harouni wasn’t the dentist who had fitted the dentures, and he had tried to fix the problem at no charge. He was just twenty-eight, less than two years out of dental school, and had made a point of working in a clinic with poorer, subsidized patients. But none of that mattered. Abdulkareem was angry and in pain, it seems, and he wanted someone to pay. Any dentist would do.

“I’m a psychologist, and I deal with a lot of dentists,” Harouni’s uncle, Daniel Sadigh, told me. “When this happened, every one of them reached out to me. They were really scared.” Even with their modern tools and targeted anesthetics, dentists see patients at their most anxious and vulnerable. The mouth is so close to the brain, so tightly encircled by sense organs, that drilling can trigger a fight-or-flight response. Get that damn thing out of there. For a long time, going to the dentist brought with it the certainty of pain. Now it brings a fretful uncertainty. Will the scans uncover issues I can’t feel? Will my dentist suggest a treatment I don’t need? Can I afford the one I do need? And will it hurt after all? “That part of it I’m not so sure has gone away,” Sadigh said. “Nobody goes to a dentist with pleasure.”

The walk to Sani Dental from my hotel was less than reassuring. Every twenty or thirty feet, a hawker would shout and cross the street to shake my hand, or step away from a storefront and fall in beside me. “Hey, buddy, you looking for dental work? Pharmacy?” Before coming to Los Algodones, I’d envisioned the town as a kind of outlet mall: strip after strip of stucco-clad clinics, with parking lots in between. The actual place was more unruly. The dental clinics rose from the streets at regular intervals, some of them sleeker than any I’d seen in Brooklyn (not a high bar, admittedly). But the gaps between them overflowed with street venders, curio shops, taquerías, liquor stores, and T-shirt stands, with the hawkers scouting the crowds around them. “You need a root canal? Twenty per cent off!”

The glass door to Sani Dental was outlined by a giant tooth. Stepping inside from the clattering street felt like a jump cut in an action film, with a subtitle saying “Miami” or “Dubai.” The lobby was hushed and spacious, with two eager young receptionists in matching polo shirts. A long arched corridor stretched behind them, soothingly lit like an undersea passage. There were seventeen examination rooms on one side and a row of white leather couches on the other, with waiting patients. The clinic’s thirty-five dentists and sixty-six support staff see more than nine thousand clients a year. (Sani also has branch offices in Cancún and Playa del Carmen, as well as a plastic-surgery and hair-transplant clinic in Los Algodones called Sani Medical.) At its newly built, three-story laboratory, teams of designers create digital models of implants and dentures, then fabricate the molds with 3-D printers. The finished products are cast in ceramic, gold, titanium, steel, or chromium cobalt, then glazed by local artisans to match the patient’s teeth and gums.

Being a patient at Sani Dental is a bit like being a car chassis at a Ford factory. For the next three days, my teeth and I would get passed from scheduler to diagnostician to clinician to lab tech, then back to the clinician, and finally to an accountant to settle the bill. Each member of the chain was expert at a given task and did it over and over again. Depending on whom you ask, this assembly-line method is either Sani Dental’s strength or its weakness. “They do things fast and cheap and get you out the door quick,” one dentist in Los Algodones told me. “But sometimes it’s detrimental of quality.” To Dr. Juan Carlos Miranda Villa, my diagnostician at Sani, the clinic’s speed and efficiency only increase its quality. “When you do more, you have more skills to do it,” he said. “If I was a patient and I had to choose between a doctor who does five hundred surgeries per year and a doctor who does eighty or a hundred, I would choose the one with more experience. Their hands are faster, their work is better.”

Miranda Villa is a compact forty-two-year-old with a peppery beard and dark, probing eyes. He grew up in a family of doctors—his father was a gynecologist, as is his brother—and speaks with the melancholic air of a man accustomed to navigating his patients’ self-doubts and fears. “You are a curious case,” he told me. “You have that one tooth on the right side. It’s so far back that we could either pull it or grind it, but it would take so much grinding that it might not be worth it.” I had asked him for two assessments, one functional and one aspirational. What did my teeth need to stay healthy, and what would it take to straighten them out—to make them look like those on the posters in his office? The second question seemed to bother him. “My specialty is cosmetic, but function needs to be first,” he said. “If a patient comes in and says, ‘I don’t like my crooked teeth. I want you to just pull them and give me implants’—which is something we hear daily—we tell them no. We won’t pull healthy teeth.”

Still, by the end of our session, he had answered both my questions. To stay healthy, he said, my teeth would need ten fillings, mostly to plug the gaps exposed by receding gums. Straightening them out would take a little more work. All but four of my teeth—twenty-eight in total—would need to be reshaped. This meant grinding them down to little nubs of enamel, like pegs on a cribbage board, then capping them with crowns. The Sani lab would cast the crowns out of white zirconia, a ceramic much harder than stainless steel, tint them to my specifications, and shape and size them to fit my jaw. Then a clinician would cement them into place.

The ten fillings would be seven hundred dollars—about a fourth of the going rate in Brooklyn. The full treatment would cost fourteen thousand. Before I made my decision, though, Sani Dental would mock up some plastic crowns that could fit over my existing teeth. “Smile Design,” Miranda Villa called it. “It’s like trying on a suit before you buy it,” he said.

When I left the examination room, I passed Billy and Nancy Martinez, sitting on a couch in the hall. Billy’s cheeks looked a little puffy—he’d had the first of his temporary crowns put in—but he managed to twist them into a grin. His dentist was great, he said. “I think I got lucky!” Nancy was less pleased. “I think you got lucky, too,” she said. She had decided to go ahead and get her front teeth fixed, only to be told that she needed a root canal as well. “She had some pain,” Billy said, glancing at her. Nancy nodded: “My dentist kept saying, ‘Oops!’ ” Her front incisors were now capped with temporary crowns, so the gap between them was gone. When I asked if I could take her picture, she laughed and said no, covering her mouth. “I’m definitely not photogenic.” The temporary crowns did look oddly artificial—like the plastic vampire teeth that children wear, except more elegant. Costume jewelry for the mouth.

The line between medicine and cosmetics isn’t always clear when it comes to teeth, and insurance companies have smudged it further. Nancy’s crowns were mostly cosmetic, Billy’s mostly functional, but neither would have been covered by dental insurance. Most policies pay for preventive care, like fillings and teeth cleanings, but not cosmetic work, and major procedures like root canals are largely charged to patients. Dental insurance is the opposite of health insurance: the more serious your condition, the less likely your plan is to pay for it. An abscessed tooth can kill you, but if you can’t afford to get it treated you may have to wait until the infection sends you to an emergency room—at which point your health insurance will kick in. Even if your dental plan does cover it, it will pay only a small part of the cost: reimbursements are usually capped at one to two thousand dollars a year. It’s no wonder more than seventy million Americans don’t have dental insurance—three times as many as lack health insurance.

The more sophisticated our medicine, the more demanding our health standards. We expect medical insurance to cover everything from a balky knee to Ebola. “But there is no established minimum standard for oral health,” Brett Kessler, of the American Dental Association, told me. “If I had mouth cancer, Medicare would pay to remove the tumor but not to replace my teeth. If I have a hip problem, I can get a hip replacement. Why can’t I get a tooth replacement?” This unnatural divide goes back to the beginnings of medicine and dentistry. Physicians insisted on it at first—they didn’t want their work tainted by tooth pullers. Then dentists followed suit: by the late eighteen-hundreds, they had their own schools, offices, and specialized equipment, and little interest in being governed by doctors. In 2010, the Affordable Care Act declared that children up to the age of nineteen have an essential right to dental insurance, but adults were left off the bill. By 2019, eighteen per cent of adults couldn’t afford dental care. Kessler believes that medicine and dentistry should be part of a single health-care system—“It’s time to reconnect the mouth to the body,” he says. But it’s a long-term project: the American Dental Association’s latest strategic initiative is called Oral Health 2050. In the meantime, having healthy teeth will be part right and part privilege, with dentists walking the uneasy line between them.

I have a clear memory, from when I was eleven, of sitting in a dental chair in a sunny examination room, watching with a rising sense of panic and entrapment as a dentist told my mother that I needed braces. My mother looked concerned but unconvinced. Why braces? The dentist frowned, as if to say, Isn’t it obvious? Then he tried another tack. Without them, he told her, I was likely to get gum disease. This was debatable. The evidence for the health benefits of braces has never been very strong. In 2008, a review of twelve studies found that orthodontia had actually increased gum recession and bone loss. Another review, in 2020, looked at eighty-seven studies and found “an absence of evidence” for the connection between dental health and misaligned teeth. Braces bring their own risks: they can build up plaque, inflame gums, and erode enamel. If wearing them is worth thousands of dollars and years of discomfort, it’s rarely for medical reasons. It’s because they make your teeth look nice.

My mom promised to make an appointment with the orthodontist, but she never did. She had five children, each with teeth in some state of disorder, and couldn’t afford to refurbish us all. I doubt she would have even if she could. In Germany, where she and my father were born, crooked teeth were just another intrinsic feature, like a big nose or protruding ears. You would no sooner change them than change your eye color. Americans are a little more finicky. As many as three-quarters of all teen-agers now wear braces at some point—up from thirty per cent in the eighties and five per cent in the fifties. Two-thirds of today’s Germans have worn them, but only a third of the French and even fewer of the British. When I was in seventh grade, my father took a sabbatical in southern France, and my parents put us in public schools for two years. I remember looking around at my new classmates—skinny, sardonic, unashamed of their strange knitwear and meandering teeth—and thinking, My people.

These days, my people all seem to have straight teeth. If not, they’ve probably thought about fixing them. Cosmetic dentistry has become a four-billion-dollar industry in the United States, according to one estimate, and it’s projected to double in size by 2034. When I first went to Sani Dental, I had no intention of getting any cosmetic work done. It was just a thought experiment, I told myself. But after talking to Miranda Villa the idea was almost tempting—at least compared with getting braces. The process would take three days rather than three years, he said, and with enough anesthesia I would hardly feel it. I could leave Mexico with new teeth.

Dr. Sofia Terrazas, the clinician in charge of my fillings and Smile Design, was the same dentist who was working on Billy—the one he’d felt so lucky to get. She was thirty-three years old, born in Mexicali, and trained in dentistry and prosthodontics at the Autonomous University of Baja California and the Technological University of Mexico, in Mexico City. She had a high, piping voice and big round glasses that gave her a look of perpetual surprise as she bustled from room to room, chatting with patients and staff. Procedures at the clinic sometimes ran through the night—the record for the latest was four in the morning—but Terrazas never seemed to tire. “We look like a factory,” she told me. “But you see me—I take one patient and stay with them for two or three hours, and the next day the same. I do nothing quick.”

Terrazas’s examination room was surprisingly bare-bones, given the clinic’s often state-of-the-art equipment. Her dental chair had no faucet or spitting basin, and the office’s side walls were partially open to the rooms next door. “I haven’t taken my amoxicillin yet!” I heard a patient say, while Terrazas was placing my fillings. “I need it for my heart murmur before the cleaning.” Then, a few minutes later, in a higher voice: “I thought the bridge was supposed to go on the other side!” Terrazas chuckled and kept on working. She put in six of the ten fillings in a little less than two hours, yet managed to be more attentive than any dentist I could remember. “Pain?” she kept asking, “Pain?” But my mouth was too swollen to answer. She had shot it so full of anesthetic that my right eye and nostril had gone numb, too.

The Sani Dental lab, meanwhile, was working on my mockup crowns. On my first day at the clinic, Terrazas had run a handheld scanner around my mouth, then projected the 3-D images onto a screen. When I looked up, my teeth and ragged gums were smiling back at me, as if ripped from my mouth by an alien predator. During the next two days, the lab used these scans to create the molds for the plastic crowns. When they were ready, on the third morning, Terrazas filled them with a gooey white resin and pressed them onto my teeth, pushing out any air gaps. A few minutes later, when the molds came off, the new crowns encased my teeth like hard shell on a row of tiny ice-cream cones.

Terrazas spent the next twenty minutes chiselling off any rough edges and seams. It was an oddly claustrophobic experience: I felt like a statue trapped inside a piece of marble, slowly getting released by a pick and a drill. When Terrazas was done, she handed me a mirror. The crowns felt rough and intrusive inside my mouth, so I expected them to look just as unnatural. But the reflection in the mirror was weirdly familiar. The smile that the lab had designed wasn’t meant for some toothy ad salesman. It was what I might have imagined as a boy, when I used to hide the gap in my teeth behind my hand when I talked. The new crowns were a pale ivory, as craggy and dully serrated as the old. They just happened to be straight.

Before the procedure, a photographer at the clinic had taken a head shot of me baring my teeth in a big grin. Now she took another. Once Terrazas had pried off my fake teeth, I texted the before-and-after shots to my friend Todd, who had first told me about Molar City. “Do it!” he said. All it would take was fourteen thousand dollars and the destruction of my natural teeth.

One afternoon in early April, a month after my trip to Molar City, I went to Beverly Hills for a second opinion. The dentist I visited, Dr. Kevin Sands, does much the same work as Sani Dental but for very different clients. In an era when closeups of celebrity teeth have become objects of obsession on social media, Sands is the premier dentist to the stars. His patients have included Emma Stone, Ethan Hawke, Justin Bieber, Kanye West, Matthew McConaughey, Miley Cyrus, Robert Downey, Jr., and members of the ruling families of Qatar and Saudi Arabia, as well as Steve Jones, of the Sex Pistols, and Jiffpom, the celebrity Pomeranian.

Sands’s office is in Beverly Hills, on the ninth floor of a building famous for its high-end dermatologists, plastic surgeons, and anti-aging specialists. (Sands told a reporter from GQ that in 2001 he paid the previous tenant four hundred thousand dollars just for the right to take over the lease.) In the waiting room, the walls were decorated with framed magazine covers scrawled with signatures and testimonials. “Dr. Sands—I couldn’t smile in this pic bc I hadn’t seen you in a while,” Kim Kardashian wrote on a picture of herself, glowering on the front of Vogue. “JK. You’re the best dentist ever.” A light pop soundtrack thumped along in the background as a succession of patients wandered in and out: a pair of chatty actors, a raffish young man with golden lips and glittery tattoos, an elderly woman blissed out on anesthesia, wobbling on her granddaughter’s arm. After a while, a sylphlike receptionist named Chanel, clad in chic black scrubs like the rest of the staff, brought me a glass of hot green tea.

“Just a few more minutes and I’m all yours!” Sands said, when he came to introduce himself. He bowed low and spread his arms wide, as if accepting the crowd’s applause, then bounded back to his office. Sands is fifty-two, with the fit look and insistently upbeat manner of a life coach or a personal trainer. He has thick brown hair and a wide, flat grin that squeezes his eyes into crescents. His own veneers are so true to life, he told me in the examination room later, that his mother couldn’t even tell that he had them. I asked him what it would take to straighten my teeth and how much it would cost. “Smile for me,” he said. He took a quick look, nodded—“All right, I already know what I’m going to do”—and left the room. His assistant pulled out a pair of what looked like rotisserie skewers. She clamped them into my mouth to stretch the lips apart and took snapshots and X-rays of my teeth. Then Sands came back carrying a ring binder full of pictures of former patients—like a Big Book of Dental Problems.

“Here is a gap you can drive a truck through,” he said, pointing to a picture as he leafed through the album. “Here is meth mouth—very common in this town. It just bombs out your teeth.” A brief tour of gum recession and misalignment followed, culminating in an especially unfortunate case: “This guy fell on his teeth. They’re worse than yours!” For every unsightly before photo, he showed me a triumphant after, with rows of shiny incisors redeemed through the artful deployment of porcelain and implants. Then he turned his attention to me. “Your teeth are a little messed up,” he admitted. “See these spikes of plaque back here?” He pointed to one of the X-rays. “And see how uneven your gums are? I’m going to go in there with the laser to even that out. Your back teeth are ground down, these front teeth are, too, and your molars are kind of chipped. It’s just age—a lot of wear and tear. Honestly, in your case, a full-mouth reconstruction is the best thing. Get your cusps back to where they were when you were twenty.”

When Sands had finished describing his plans, he left the room again, and his office manager, Andrea Aro, took his place—the good cop to his bad. Young and soothing in manner, with long black hair and warm, wide-set eyes, she had perfect teeth, like the others—veneered by Sands himself—and wanted the same for me. “He is going to rebuild your bite with the magic of porcelain,” she said. “And the prosthodontist will make sure that it works from a mechanical point of view.” This office was only twelve hundred square feet, yet a whole team of specialists would be working on my mouth, including tooth sculptors of the highest calibre. “We make it look easy, but it’s not easy,” she said. “People don’t realize how many people are involved with one tooth.” She smiled, lost in a reverie of Old World dental craftsmanship. “I could talk about it all day,” she said. “I think it’s very special.” Then she handed me the price list.

What are good teeth worth? In 1997, William Ecenbarger, a reporter for the Philadelphia Inquirer and the Reader’s Digest, had his teeth examined by fifty dentists in twenty-eight states and the District of Columbia. Before his trip, Ecenbarger got a baseline diagnosis from a panel of four experts, including a former dean of the University of Kentucky College of Dentistry. The panel agreed that his teeth were in good condition, aside from one molar that needed a crown, and that the work should cost less than fifteen hundred dollars. Four months and fifty dentists later, the diagnosis was less clear. One dentist told Ecenbarger that he needed six crowns, but not on the molar the panel had singled out. Another recommended four crowns—again, not including the damaged molar—and nine thousand dollars in cosmetic work. Others suggested five crowns, seventeen crowns, twenty-one crowns, twenty-eight crowns, or a full-mouth reconstruction. Their prices varied from less than five hundred dollars to nearly thirty thousand.

Ecenbarger’s dentists were from the same country, but their suggestions were all over the map. My dentists were from different countries, but their recommendations were the same: twenty-eight crowns and one implant. The only difference was in cost. Sands wanted a hundred and nineteen thousand dollars for the work—more than eight times the Sani Dental price. The dentists in Los Algodones seemed as well qualified as those in Beverly Hills, and their equipment was often more sophisticated: Terrazas and Miranda Villa checked my teeth with a digital panoramic X-ray machine and a handheld 3-D scanner; Sands used a point-and-shoot camera, standard X-ray film, and a small mirror that his assistant stuck in my mouth. “We keep it old school,” Aro told me. “We aren’t doing 3-D printing or A.I. That’s not going to be the same as a handmade tooth.” To Sands, this was his biggest selling point. “I have real artists do each tooth,” he told me. “And I have different ones make them for males, females, and older people. That’s what separates me. The artist that did my teeth will be doing your teeth.”

What are good teeth worth? To some of Sands’s celebrity clients, the answer could be tens of millions of dollars. Their handmade crowns, magnified a dozen times onscreen, may well look more shapely and natural than Sani Dental’s computer-designed, assembly-line versions. Whatever their price, veneers and crowns can crack or come loose if poorly installed, and what’s left of the teeth beneath them can start to decay. Like nose jobs and face-lifts, they can also look disturbingly artificial—oversized, rectilinear, glaringly white. Two years ago, fans of the actress and singer Selena Gomez became convinced that she’d had her teeth veneered. When Dr. Jordan Davis, a dentist in Utah with a large Instagram and TikTok following, posted a video with closeups of her teeth, it got nearly ten million views. They were too uniform, he said, too white, too opaque. “Her original smile, her natural teeth, I feel like, are much better,” he concluded.

Teeth are emblems of character, people have long believed, whether consciously or unconsciously. “Clean, white, and well-arranged,” they reflect “a sweet and polished mind and a good and honest heart,” the nineteenth-century Swiss physiognomist and theologian Johann Kaspar Lavater wrote. Crooked or decaying, they bespeak “sickness or some mélange of moral imperfection.” Richard Barnett, in “The Smile Stealers,” contrasts Lavater’s quote with one from a booklet published by the American Association of Orthodontists in 2000. Straight teeth demonstrate “a highly visible commitment to self-improvement,” the booklet claimed. They express both “the beauty of conformity” and “the beauty of achievement.”

Still, there’s something to be said for staying crooked. The more I looked at the Smile Design picture from Sani Dental, the more I knew that I’d miss my old biters. (My wife, for all her talk of snaggleteeth, was appalled at the idea of straightening them.) If teeth are emblems of character, mine seemed true to form—jumbled, contradictory, ground down in spots but still good for chewing things over. They went off in every direction but somehow got their work done. In Beverly Hills, after Sands had enumerated my dental flaws and Aro had told me the price to fix them, she noted that I’d still have to wear a mouth guard at night for the rest of my life, because I grind my teeth in my sleep. Then she smiled and added, offhandedly, that my teeth were in good shape over all. “At the end of the day, this is all elective,” she said. “You will live a perfectly fine life without it.”

I felt like I was eleven years old again, hearing the dentist say that I needed braces. This time, I was the one who’d asked about straightening my teeth, but Sands required little prompting. One look at my teeth and he knew that they needed fixing. It reminded me of something Miranda Villa had said when I last saw him at Sani Dental: “Pay attention to the TV commercials. All the actresses with the white teeth—that is what they are selling. But white teeth are not normal. Our teeth are yellowish. As long as they are working, they are nice. If they are straight or crooked, they are nice. It’s God’s creation.”

Before I left Molar City, I checked in on Billy and Nancy at the clinic. Billy looked even more beat up than before. His upper lip was swollen and bruised a mottled pinkish blue, and the skin on his face was rubbed raw. He’d had three root canals that afternoon—“I got a piece of tooth in my eyelash,” he told me—and a set of crowns had been put on his upper teeth. Between procedures, he’d gone out to get a microdermabrasion, a HydraFacial, and a hair-growth treatment. He bent over to show me the bald spot on top of his head. He wasn’t a good candidate for plugs, he said, so the specialist at Sani Medical had drawn some of his blood and injected the plasma into his scalp to spur natural growth. “Next time you see me, I’ll be like the jungle man!”

Nancy had just had her permanent crowns installed. Milk white and smoothly sculpted, they were more natural than her temporary crowns, but I still missed her old gap-toothed smile. Unlike Billy, who’d been rolling through Molar City as if it were one long amusement-park ride, Nancy looked spent. Most of the patients at the clinic seemed happy with their work, and my own fillings had gone in without incident, but her visit had been a comedy of errors. At dinner the previous day, she’d swallowed one of her temporary crowns. Then its replacement fell off, too. She was so sore from the procedures by then that she told Billy she wished she’d never done them. I asked her how she felt now—was it worth it after all? “Yeah,” she said, with a wary smile. “But I have to wait and see.”

Billy put his arm around her shoulders. Earlier that day, he’d pulled a ziplock bag from his pocket and shown me two pieces of what looked like broken ivory. The dentist had just removed these old implants from his jaw, he said. They’d cost him eight thousand dollars back in Colorado. “I’m going to make Nancy a necklace,” he said, then laughed. “What an adventure!” ♦