I first remember being ashamed of my teeth at five. We were guests at the wedding of my second cousin to a man who looked like Tim Curry as Johnny LaGuardia. I was hopelessly in love with the groom, who, for a former Soviet Jew, had strangely white and perfectly straight teeth. While posing arm in arm with his bride for the wedding photographer, he playfully pulled me into the photo, tried to tease and tickle a smile out of me. I squealed, giggled, exasperated the photographer, until I heard Mama shout: “Zakroy rotik!” (“Shut your little mouth!”) Hide my rotting nubs.

My teeth had mostly become brown-gray stumps, full of dental caries — holes in the enamel. I had a sweet tooth, and we always ran out of sweets first. When we did, Mama appeased me with some of the peasant concoctions she’d had in her village: a teacup of gogol-mogol — raw egg, whipped with sugar; a bowl of “whipped cream” — sour cream, whipped with sugar; or “marzipan” — fresh lemon slices, coated in sugar. Always in the evening. Always in front of the television, learning English from some American sitcom. Mama struggled to cover the bitter or sour of these “sweets” with enough sugar. I always returned to the kitchen to add more, scooping the bone-white crystals from the china bowl by the spoonful.

I could hardly blame Mama and Papa, what with the food abundance in America, even for refugees like us on food stamps. When we lived in Ukraine, they waited on mile-long queues for what they were unable to grow, bake, raise, or butcher themselves. They were children of shtetls, Jewish ghettos; grandchildren of the Holocaust; great-grandchildren of the Holodomor — Stalin’s starvation, in the 1930s, of Ukrainian peasants who resisted Soviet collectivization in a desperate attempt to keep their family farms. My parents still carried the weight of those years before they were born, when Ukrainians prepared wild-mushroom-and-grass broth to avoid ending up among the animal and human corpses piled along dirt roads.

Mama tried to keep our bellies full the best way she knew how: with trips to Pathmark on Thursday nights, a time when she knew the aisles would be full of food and empty of shoppers, so empty I could hear the slow whir of the cart’s wheels against the concrete floor. I trailed behind her for hours, dragging tired, sneakered feet as she pushed an oversize cart, weaving in and out of aisles, plucking staples from the shelves: Little Debbies, Twinkies, Smucker’s jam, loaves of spongy Wonder Bread, Mini Babybel cheeses in red wax, shrink-wrapped Perdue chickens, two-liter Cokes, Folger’s instant coffee. How could she have imagined that things so vibrant, plentiful, and filling could cause so much rot and decay? How could she have predicted that the surface of a tooth — a surface two and a half times stronger than bone and built to protect soft tissue, roots, nerves — could be penetrated by something as soft and porous as a Twinkie? Or maybe my mother did know about the dangers of all that shelf-stable sugary food but decided a few teeth were a small price to pay for a full belly.

By the time I was six, my teeth were too soft to stay put. Each one leaned against the next, or twisted like a shallow-rooted tree in the wind. The smaller teeth of my lower mandible threatened to fall out, which would have been tragic at my age. At best, my cheeks and lower lip would have caved in, like a child version of Baba Yaga, that infamous crone-witch from Russian folktales. At worst, I’d have become malnourished, my facial musculature permanently misshapen, like a Picasso. To prevent such a grim fate, my dentist recommended an Advanced Lightwire Functional, or ALF.

The procedure was painless; the only thing required of me was that I recline in the dental chair and stare into the blue eyes of a nice, blond American dentist for an hour or so while his latex-covered fingers wound the thin dental wire tightly around my lower molars and canines, then molded it to my lower palate. The only thing required of my parents was that they bring me back for regular ALF tune-ups. They did not.

Months later, I lay on our plaid couch watching Family Ties, picturing myself with a set of impeccable teeth worthy of Alex P. Keaton. As usual, I absentmindedly massaged the ALF with the tip of my tongue. This time, though, I was suddenly unable to get my tongue beneath the wire. I wrestled with it like a crow with some stubborn piece of carrion sinew, but it was no use. The metal had fused with the flesh of my palate.

When your great-grandparents grew up in Stalin’s terror-famine, your grandparents in the Holocaust, and your parents in a straddle between totalitarianism and democracy, you grew up confused about pain. Especially your own, by comparison. Were you entitled to it? Was it real?

Almost always, the answer was no. Food, shelter, clothing, education — these were readily available to me. Without physical or intellectual deprivation, what did I have to cry about?

Almost always, my parents punished tears. But occasionally, when I lay on our old plaid couch with a skinned knee or a high fever, Papa squatted beside me and pressed his giant, rough palm, then his lips, to my forehead. The first time it felt so strange, so foreign, like he wasn’t even Papa but rather an American sitcom dad. I asked, “What are you doing?”

“Taking the pain from you to me,” he said in Russian.

Mama’s way of anesthetizing pain was dessert. My favorite was torte Napoleon — a much richer Russian version of Napoleon cake made with layers of fried crepes smothered in homemade custard. The store-bought ones were okay, but I loved Mama’s recipe best. Sometimes, when I was sick or hurt, she’d have a small one waiting for me in the fridge. Like breaking the Yom Kippur fast with apples and honey, this, too, was a Soviet Jewish tradition. One atoned with pain, then forgot it with sweets.

Mama’s torte Napoleon almost always worked, but not after the dentist. After the dentist, the taste of iron from all that bloody cotton and gauze lingered for many days — long enough for the cake to go stale in the fridge.

In Bershad, the village where Mama grew up, family members shared toothbrushes with bristles like sandpaper — more enemy than friend to the mouth. Toothpaste, hoarded for its trace amounts of ethanol, was often in short supply, particularly during the Politburo’s many failed attempts at legislating temperance. Reasonably frightened by tales of unanesthetized extractions, steel fillings, and paper-clip root canals, most Soviets visited their underpaid and federally underserved dentists only when they believed their agony was worse than what they would surely suffer in the dental chair. You never needed to look farther than the person next to you on a breadline to see a set of teeth as crumbling as your own. And when you did, even the dentist’s most basic tool — the filling — was beyond reach. This was a village where high-ranking members of the Soviet Communist Party cruised the dirt roads in black Volga police cars and pounced on houses looking for black-market valuables — wristwatches, chains, cash, rings and earrings, which wives would stuff beneath mattresses or into secret holes behind old bureaus. The dentists, Mama recalled, hid gold crowns and partials into thick slabs of farmer cheese.

Today, dentistry is a billion-dollar industry in the former Soviet Union, and the well-off choose resin fillings and porcelain crowns. Gold fillings are symbolic of poverty. But for proud Soviet émigrés like us, who conflated any form of government assistance with the horrors of communism, dental care remained an unobtainable luxury in America, just as it had been in the Soviet Union.

The next time I sat in the chair at the blond dentist’s office, I didn’t look up into his kind blue eyes. Instead, I squeezed mine shut to keep from crying while he jabbed again and again along my lower palate with a long needle, numbing me for the more intense pain of the pliers. Papa had brought me there himself, not only shelling out to cover the cost of the procedure but also giving up a day’s worth of pay. He had scolded me for this in the car on the way over: “You have to always tell us when there’s a problem, before it is a more painful, expensive problem!” This confused me because telling about problems sounded a lot like being a nytichka — a whiner — which was also not allowed.

“Let’s give that some time to numb up,” said the dentist. Even with my eyes shut tight, I felt the dentist’s smile in his voice, sunny and warm like his hair, like his skin, curiously tanned in the middle of a New Jersey winter. We were like vampires by contrast — shocks of black hair against translucent skin, reminiscent of our mythical Transylvanian comrades.

“You feel that?” he asked.

I shook my head.

It wasn’t pain but pressure — the push of the man’s thumb on my palate, the pull of the pliers in the opposite direction — that made the tears come. I felt the weight of Papa standing at my feet, enduring my crying.

“There,” said the dentist, holding the ALF wire — thin, bent, wormlike — in the grip of his pointy pliers.

Papa spoke for the first time since the drive there. “Will it go back in?”

“As you can see,” said the dentist, “the device will do more harm than good if we don’t tend to it.” I glanced at Papa, who nodded stoically as the dentist told him to schedule a follow-up with the front desk. He encouraged Papa to ask the receptionist for a “financial hardship assistance application.”

Papa would never apply for such a thing — not more government handouts, not in America. I knew this because every month when our food stamps came, he marked them “return to sender” and shoved them back into the mailbox.

“I’m late for work,” said Papa. “My wife call receptionist tomorrow.” He motioned for me to stand up.

On our way out to the car, he’d remind me that a parent suffers a child’s pain even more than the child herself. We drove home from the office in silence, and never returned.

The next dentist’s building was bald-faced brick, with no awning or vestibule to protect us from the ocean wind. It was early spring but still bitingly cold. We shivered, hopping from tiptoe to tiptoe. I stared at the bars on the windows as Mama pressed a button, and a staticky voice called from the speaker.

“Who’s there?” The voice was gruff; the accent, familiar.

“Natasha, for tooth,” Mama answered.

It was strange to hear my Russian name fall so freely from her lips when, for almost four years, I had been Natalie. The name, the accent — they suddenly felt like secret passwords to a secret club. Just more of the many family secrets no one had to tell me to keep.

The thing about being small and having to stay silent and unseen is that most people forget you’re there. I eavesdropped attentively when my parents talked to each other. I knew they would have preferred an American dentist to a Russian one — that taking their ten-year-old daughter to a back-alley dentist was a source of shame. I also knew that they felt far more “American” paying out of pocket for a cheaper Russian doctor than taking government handouts to pay an American one.

The blue-eyed dentist had a real office all to himself, with a waiting room and glass doors that stayed unlocked. But he didn’t work on Saturdays, and he wouldn’t see us anyway. He had sent us to collections.

Mama called a Russian friend to find a cheaper dentist. The friend had recommended “Uri” mostly because he worked where he lived: he didn’t have to pay rent twice and could pass those savings on to his customers. “Smart businessman,” Papa said.

Dr. Uri buzzed us in and opened the door to his apartment. “Come in, come in,” he said, using the formal Russian you and smiling through small, stubby, very white teeth. He was a stocky older man with a helmet of coarse salt-and-pepper hair and matching bushy eyebrows. His apartment was empty and felt as cold as a meat locker; the kitchen had been converted into a treatment room, no cookware in sight. He motioned for me to sit in a dental chair next to his stove. Mama stood in the corner.

Dr. Uri rooted around in my mouth. “The lower left molar is decayed,” he told Mama in Russian, whose word for “molar” roughly translates to critical tooth. Or drastic tooth. Or native tooth. A tooth to preserve, to repair. Or, if too wounded, then a tooth to cajole slowly, gently, carefully by its root, leaving the gums and nerves healthy for a stronger tooth to grow there. But to Dr. Uri, my molar was merely a baby tooth. “Not worth fixing.” He yanked the tooth quickly, with no novocaine, as if he had only seconds to extricate the tooth or the decay would live there forever.

My cries gurgled beneath my tonsils, choked back by the river of blood and spit running down my throat. I couldn’t see her, but I imagined that Mama, standing in the corner of that makeshift office, looked like she did when Papa drank too much at the Russian nightclubs we went to on some weekends, or when my whining or bad grades made him angry and he hit me in front of her: slack-faced and bug-eyed, a network of red veins thinner than hairs spidering their way across the glistening whites of her eyes.

“Tell me again how old you are,” the doctor said, looking at digital scans of my teeth.

“Forty,” I answered. He looked down at his file, then up at me, then back at the scans. I thought I saw him wince. He sighed, then delivered the diagnosis with the authority of a lifelong specialist and the concerned, pale-blue cataract gaze of a father or grandfather.

“See here” — he grazed the screen with his pen point — “on your left side? The disc between your temporal bone and mandible has slipped.” He spoke entirely out of the right side of his mouth, the left swollen and droopy, evidently paralyzed. He didn’t share why his face looked like that, and I didn’t ask, but I could see why someone with orofacial paralysis might choose this job. His wound made me trust him.

“Can it be corrected?” I asked.

“It can slip back in if it’s not out all the way. But yours, you see, is no longer attached. It’s bone against bone.”

He pointed at two hot-white kidney bean shapes the size of pinkie fingernails on the screen. The bean on the right rested snuggly between the bones of the temporomandibular joint, but the one on the left had oozed out sideways. I leaned forward, straining to hear him over the hum of his laptop fan and the buzz of some dental imaging machinery pushed up against the far wall.

“How does something like this happen without warning?” I asked.

“It wasn’t entirely without warning,” he said. “Your X-rays showed fillings in almost every tooth. Lots of time sitting with your mouth wide open in a dentist’s chair could do it. Has your jaw always clicked?”

“Yes,” I said, “and came unhinged — really wide, like a snake’s — until now.”

“Now there’s no disc anymore to make the popping noise. But one of your many dentists should have known the red flags and warned you.”

Then he said, “See here, how these teeth lean into that empty space left by your absent molar?”

I nodded.

“That’s called drifting. It’s another risk factor for TMJ. Who left that space empty, anyway?”

“Some dentist from when I was a kid. He thought it was a baby tooth.”

The doctor rolled his eyes slightly, sighed, said nothing in reply.

“Can I have surgery or something?” I said, wanting to be numbed while someone else made the problem disappear.

“I wouldn’t recommend it.” He shook his head. “That’ll just traumatize the joint more. The only thing left to do here,” he said, “is palliative care. Changing habits. Slow, careful self-maintenance.”

We were in the ER with my two-year-old son, who had been vomiting all evening. “Fluoride poisoning,” said the ER doctor to my husband; I listened while nursing my son. “He’ll purge it from his system soon. He’ll be fine.”

“So should we avoid fluoride treatments for him in the future?”

The doctor shook his head. “No. Early intervention is never a bad idea when there is decay. The teeth are sentries, canaries in the coal mine. They help prevent inner damage.”

“But this caused inner damage!” I shouted, losing my cool with the doctor, who remained calm and kind.

“It’s not the treatment that poisoned him. The hygienist didn’t suction him enough. He simply swallowed too much fluoride. All medicines are toxic when overdosed.”

My son stirred, unlatched from my breast, and started heaving. My husband rushed over with a garbage pail.

I sobbed as my son vomited and cried into the bucket. “I just didn’t know, I just didn’t know,” I repeated, chanting my ignorance aloud like a prayer — to the doctor, my husband, my son, myself. “I just didn’t know it could hurt him so much.”

The doctor approached me, patted my shoulder. “There now. Of course you didn’t. No parent ever does.”