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Fluoride, Freakonomics, and Employment Discrimination

Wichita is one of the few large cities in the U.S. that does not fluoridate its water. The battle over fluoridating the city’s water supply has waged, on and off, for over half a century. This week the City Council declined to decide the issue, leaving it up to public vote. Proponents argue that water fluoridation is a proven safe and effective way to prevent tooth decay that would save Wichitans millions of dollars a year in costs for preventable dental reconstruction. But can fluoridation also improve wage-earning potential for women?

Women who grow up in communities with fluoridated water earn about four percent more than women who do not (after accounting for all other variables). This is according to a study featured in the book SuperFreakonomics (follow-up to Freakonomics, the best-seller that applies economic analysis to everyday issues). The effect is mostly concentrated among women from families of low socioeconomic status (who are less likely to prevent or fix dental problems that stem from lack of fluoride). Employer and consumer discrimination are the likely factors that cause oral health to impact earnings, according to the research. This could be based not only on less attractive physical appearance, especially for positions that involve customer interaction, but also on a perception that bad teeth equate to poor health or poor personal hygiene. Access to fluoridated water during childhood did not have a negative effect on men’s incomes, however. (See The Economic Value of Teeth.) 

The existence of a labor market penalty for bad teeth is not surprising. Economists have long-recognized that physical appearance affects wages—the so-called “beauty premium.” But the lack of a bad-teeth penalty for men is interesting, as other research shows that looks actually affect income more for men than women.

So, getting to the matter of employment law, is dental discrimination illegal? In a word, no. Employment in Kansas is at-will, and "bad teeth" is not a legally protected class. But if bad or missing teeth are related to a physical impairment that substantially limits a major life activity (or the employer regards it as such), there may be ADA implications. And, of course, if an employer penalizes women for having ugly choppers, but not men, such unequal treatment could be unlawful sex discrimination. That would be a kick in the teeth.


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