Which is something insurance companies are reluctant to acknowledge.

As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter.

Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left.

1 in 5

Americans older than 65 do not have a single real tooth left.

Over two days at the civic center, volunteer dentists would pull 795 teeth. A remarkable number of patients held steady jobs — a forklift operator, a librarian, a postal worker — but said they had no dental insurance and not enough cash to pay for a dentist.

Matello had both problems, adding to her frustration about being cut off from a world that many wealthier Americans take for granted.

“The country is way too divided between well-off people and people struggling for everything — even to see the dentist,” she said. “And the worst part is, I don’t see a bridge to cross over to be one of those rich people.”