A geographical sample in a rural area of eastern Guatemala revealed widespread, premature and heavy losses of permanent teeth. Social and environmental influences that affect tooth loss include inadequate diet, refined sugar, poor oral hygiene, absence of fluoride, lack of preventive education and insufficiency of dental care services. Land hunger and family poverty are of paramount importance. Gender-based cultural differences are apparent in tooth extraction rates, and use of dentures. No one escapes visitations of severe orofacial pain that cast a blight upon the quality of rural life. Periodontal disease drives the poorest of the poor to spend disproportionately large sums on pharmaceutical pain-killers and destructive traditional medicines. Lay 'tooth-pullers' visit remote rural homes to extract teeth. Only full edentulism can bring patients permanent somatic and financial relief. Community dental health is conspicuously neglected in official policies and plans for rural development.