The Dental Bite: More Than Just a Tooth

I chose this title, The Dental Bite: More Than Just a Tooth, because of a moment that stayed with me long after my dental appointment ended.

Today, I had a medical appointment that wasn’t easy for me at all. I haven’t been doing very well these days, and my Professor, JD, who is also a dentist, recommended that I see another dentist. Interestingly, this dentist had also been part of my program in the past, the LEND Arizona program.

Even with that connection, deciding to go was not easy.

I am afraid of dentists. Not just dentists, I am afraid of hospitals in general. I’m afraid of needles, and I’m extremely sensitive to medical environments. Even before anything begins, my body reacts. I cry. I feel pain before pain even exists.

So just getting myself to the appointment already felt like a victory.

The Moment of the Bite

When I finally sat in the dental chair, the dentist first tried to observe my tooth just by looking at it. Shortly after, he asked for an X-ray to see what the eye alone couldn’t see.

Then he asked me to open my mouth. He placed something inside and said, “Please bite.”

Instinctively, I pressed my lips together.

He stopped me and said, very clearly, “No. I don’t want you to put your lips together. I don’t want the lips. What I want from you is to bring the teeth together, to bite the top teeth and the bottom teeth.” I believe he understood I was not doing what he asked me to do.

I paused.

And in that pause, I thought: This is one of the reasons why I avoided coming to a doctor’s appointment for so long. I was confused, "like what should I do, what is to bite, OK, let me try something different and try to put the teeth together as he is asking." Well, apparently it works.

The Dental Bite: Why It Matters

This is where language enters the room.

Going to a medical appointment in Portuguese is already hard for me. Imagine going to one where you must explain pain, fear, and discomfort in English, and where you must also understand instructions that use words you don’t use every day.

Words like top.Words like bottom.

Even today, I sometimes use Google Translate just to be sure.

At one point, in the very beginning of the appointment, he asked me which tooth we were looking at, top or bottom? I hesitated. So I used my finger. I pointed downward and said, “Bottom,” just to make sure we understood each other.

He adjusted the lights and continued. I was agitated.

“Are you nervous?” he asked.

“Yes,” I said. “I’m afraid.”

Then he said something that changed everything: “Don’t worry. Today we’re not doing anything. Today is just observation.”

I thought inside me, uff, no needles.No procedures.No pain.

Just observation.

I could breathe again.

Even so, while he was using the X-ray machine, tears were falling from my eyes, which I quickly wiped away, telling myself everything was alright.

Understanding the Bite

He said again, “Please bite.”

But the meaning of bite still wasn’t coming to my mind. It’s not a word I use every day. In my head, I was translating apertar (squeeze), trying to understand what he wanted. I kept closing my mouth instead of bringing my teeth together.

Then he explained again, slowly, clearly.

I stopped. I organized everything in my mind. And then I did exactly what he meant.

“Yes,” he said. “That’s it.”

By the third or fourth time, I finally understood what "bite " meant to him in that clinical context.

That moment stayed with me because it reminded me how fear, language, and vulnerability live in the body at once.

What Is Happening in My Mouth

Over time, the filling on my tooth wore down and eventually came out, leaving the tooth exposed. Because of that, and because I delayed going to the hospital, the situation gradually became worse. After the examination, he looked at me and said, “Unfortunately, we’ll need to extract this tooth. It’s very damaged. The structure could not be saved. He told me that "if you had come at an earlier stage, like one year ago, the tooth structure might have been sufficient to save.” He also told me that there was an infection, and he would give me antibiotics to treat it. After the extraction, another procedure would be necessary to maintain the space where the tooth would be removed, protecting it for the future. We talked about insurance, options, and next steps.

The visit was calm. Friendly. I was then more at peace.

He asked how I knew the professor who recommended me, Dr. D. I explained that I'm part of the LEND Arizona program. The dentist also shared some of his own experience in the program and even talked about working in Africa, in countries close to mine, Zambia, visiting Botswana, Tanzania, etc.

Before I left, he told me I should discuss the options with the front desk lady so I could see what insurance might cover.

The International Student Reality

But what stayed with me wasn’t only the diagnosis.

It was a question that kept repeating in my mind: How do international students feel when they go to a doctor’s appointment? It doesn't matter which one. How do they feel if it is not their first language?

While I can only speak for myself, whose first language is not English, I also have some experiences with my friends that are not encouraging.

I felt insecure. Not only because I’m afraid of hospitals. But because understanding matters. Being understood matters.

The fact that it was a recommendation helped a lot in building confidence.

When I arrived in the U.S., I knew I needed to see a dentist. What I didn’t know was how expensive dental care is here. I didn’t know that health insurance doesn't automatically include dental coverage. I didn’t know how the system worked. I have university health insurance through my scholarship, but I didn't realize it doesn't cover dental appointments.

In my first weeks, I went to hospitals trying to find coverage for my children and me. It wasn’t possible at the time. It took me one, maybe two years, to understand the system and learn about options, places like El Rio. Even then, when I tried to schedule appointments, the waiting list was long. Six months or more. We never got an appointment.

I wasn’t avoiding care because I didn’t want solutions. I was searching for solutions, but timing, access, and cost did not align.

And while timing wasn’t right, my tooth didn’t wait.

The Choices No One Wants to Make

You have to pay for the house. You have to pay the price of living.

And then the questions begin:

Should I pay the rent? Should I pay my son’s school fees? Should I create conditions for my children? Should I buy food? Or should I go to the dentist?

I am a mother of two. One is an adolescent; the other is a young adult. They are part of a community. And being part of a community requires resources.

My daughter is 13. She goes to birthday parties. Her friends come to hers and bring gifts. And when it’s their turn, she needs to go too. She needs to belong.

So when people ask, “Why didn’t you go earlier?”It’s not because I didn’t want to.

It’s because I had to prioritize.

Today, I finally went.

And then reality hit again. The decision to go also cost me something: my rent is delayed, and I will have to pay a $75.00 fine, plus $10.00 for each day of late payment. Well, at least I went to see a dentist.

The next treatment will cost $512.Today, I paid around $100 and something for the visit. And I still need to pay rent.

For a moment, I felt ashamed.

Ashamed that it might look like I don’t take care of myself. But how do you take care of yourself when you’re constantly choosing between essentials?

I had to negotiate rent. I told them payment would only be possible on Friday. Why? Because I needed money now to pay for the appointment.

I also paid for insurance, a small one, not a full one. And even that insurance won't start until March.

So again, the question returns: What do you prioritize when you can’t do everything?

Because the truth is, you can’t. My son starts one of his classes tomorrow, and we need to pay. How do I pay? My stipend is just a student one.

When There Is No Plan

One of the questions I asked at the clinic was whether there was a payment plan.

The answer was honest, but heavy.

They explained that they once offered payment plans, but many people failed to pay. Some disappeared. Some never completed the payments. Eventually, it became a burden, and they decided not to continue offering that option.

So, in my case, there was no plan.

Even the part that insurance does not cover, around $250, still has to be paid out of pocket. There is no alternative.

And this is where another layer of the international student experience appears, the informal conversations, the shared survival strategies.

One friend told me she would never do dental treatment here in the U.S. again. She is also an international student from another African country. Instead, she traveled to Mexico to receive care.

Another friend told me he will wait and do treatment when he returns to Africa, where he feels more comfortable and where care is more accessible. In the meantime, he recommended medication, something he has been taking for almost one year now, to manage pain until he can travel. He even showed me which medication to take and where to buy it. That moment stayed with me. Because staying one year without proper dental treatment is not a choice someone makes lightly. In my case, it wasn’t one year, it was two.

And again, it was not because I didn’t try.

From my very first year in the U.S., I tried to access care. I tried to understand the system. I tried to find options. But the waiting lists, the costs, the insurance limitations, and the timing worked against me.

So when we talk about international students and health, especially dental care, we are not talking about a lack of responsibility.

We are talking about delayed care as a survival strategy.

Closing Reflection

This story is not about neglect. It is about survival. It is about systems. It is about language, fear, money, feelings, and motherhood.

And maybe The Dental Bite is not only about teeth.

Maybe it is about the moment when you finally bite into reality and still choose to keep going.

This moment also helped me recognize the power of community and friendship. One of my friends, having gone through a similar situation, offered to lend me the money to help cover the cost. Even if it was all of it, or only part of it, even if it was a process, her gesture meant a great deal to me. I thanked her deeply and said I wanted to understand the insurance process before making any decisions. She said what mattered most was that I knew I was not alone, that I had support, that I had a backup. That reassurance stayed with me.

I am also deeply grateful to my professor, whose class discussions created a space that was not rooted in judgment but in understanding. The way he addressed why people often delay medical or dental care, by explaining the reasons and the consequences with care and compassion, made me feel seen and included. Because of that, I felt safe enough to approach him, even as shame or fear lingered. He gave us the space to speak honestly, and that gave me the courage to take the first step. Perhaps I did not go before because I was not ready yet. Perhaps this was the right moment to connect, to learn, and to understand that it is okay to ask for help, and that it is necessary to take care of myself.

A Note to the Reader

If any part of this story feels familiar, I would love to hear from you.

Have you ever felt this way during a medical or dental appointment? Have language, cost, insurance, or fear shaped your decisions about care?

If you have experiences, recommendations, or options you think I should explore, please share them. This space is open for reflection, connection, and shared learning.

Vanessa Macamo