It's visible cavities and decay, it's not like you're diagnosing based on symptoms someone is describing to you, which I can understand for general doctors or specialists drawing blanks or different conclusions.
But as in every job dentists also feel pressured to point out other people's lack of quality work to promote their own. You'll see this in the IT guy who immediately recognizes that whatever the previous one did on your computer was amateurish and they can do it better, same with the electrician, the plumber, the mechanic, the plastic surgeon, etc.
After college I worked at the computing lab. Someone started to talk about OOP. One dude said that OO was one thing; the other contradicted saying it was another thing. They started to debate about what said things were really .. they never reached any sort of conclusion.
Medicine isn't different. Sometimes I think we need a 2-tiers doctor meeting where you can have at least 2 different opinions in one go.
I've been to another dentist and they said
things completely different. I don't
understand how two professionals can draw
polar opposite conclusions.
I know they have tumor boards for cancers and such where they try to arrive at a consensus plan of treatment for an individual patient.
Surely there are such solutions for dental / other medical issues, right?
Somewhat tangential from all this, I'm amazed that in this day and age we still have such a hit or miss approach to treating patients. Its mind blowing how little our medicine has advanced in some aspects despite cutting edge innovations.
What Is a Tumor Board? An Expert Q&A
Source: a dentist.
" Some dental professionals have questioned this practice in the first decade of the twenty-first century. The use of a sharp explorer to diagnose caries in pit and fissure sites is no longer recommended and clinicians instead should rely on "sharp eyes and a blunt explorer or probe." Penetration by a sharp explorer can actually cause cavitation in areas that are remineralizing or could be remineralized. "
A long time ago, a dentist we had told our parents we had good mouth bacteria or something. I don't know how true this is and I don't put much credence in it, but interestingly enough, the only time in my life I had any kind of gum problems was when I was regularly kissing someone with constant tooth problems. It went away after we broke up and i haven't had problems since again. Again more just a little side note than anything scientific or would recommend basing decisions on.
It sometimes seems like life is just a game where you can min-max your stats if you want but RNG rules in the end.
So it’s really hard to draw any conclusion from these cases.
Do you think stress levels are a factor that typically go unstudied that play a part in these things?
Gut-brain connection? Just good genes?
The way we're all bombarded with all kinds of health-centric information of varying integrity these days one would think someone is studying this in a massive way with very large trials across varied populations.
On day its TMAO in red meat the next day its something else. Surely someones studying all of this as a whole, right?
Teasing Out the Role of Red Meat and TMAO in Cardiovascular Risk
So I'd like to think someone is looking at the things you mention. Someone should study my wife's grandparents, BBQ and 7&7s are their way of life and they're as spry as can be
I've gone through a lot of diet changes over the years. I used to consume tons of sugar (multiple chocolate bars & 3 cokes a day), later tons of fast food, then healthy food, then mostly vegetarian & low carb & next-to-zero sugar or sweeteners. Never had a cavity throughout all those phases.
Ummmm Have you noticed that people tend to keep their distance when you talk?
Explain the math here? You went to the dentist 27 years ago but now you are rounding up to 30 years later?
Actually a larger point. How do we know (we don't) that you were correctly diagnosed as having three cavities that needed filling? Maybe the dentist was just an opportunist and you didn't even have any cavities? Or (someone who knows dentistry better can comment) there is a state whereby it could be considered a cavity but not such that it definitely needed to be filled?
I apologize for the lack of mathematical precision.
Using a precise number within two sentences of a rounded number is utterly inexcusable. I have nothing to say for myself. It was a contemptible and inexcusable mistake and I am going to voluntarily suspend myself from HN for 27 hours.
> brushing with fluoride toothpaste that matters, not the brushing alone. Doing that doesn’t just prevent gingivitis and plaque formation; it also prevents cavities, which is the outcome that we care most about.
> powered toothbrushes reduce both plaque and gingivitis more than regular toothbrushes
> toothbrushing with flossing versus toothbrushing alone most likely reduced gingivitis, or inflammation of the gums
Article seems to miss that gingivitis is a bigger concern than cavities for adults
I wonder how many people will toss their toothbrushes after only reading the headline and develop problems as a result. Seems like journalistic malpractice.
Why? Because her knowledge is tribal ritual knowledge, not a scientific one. Her knowledge is a bunch of rules in a form "if <symptom> then <treatment>". Completely useless knowledge for my decision making process.
So it is a good thing when mass-media brings an attention to this sad fact. We need to bring an attention to this, to make medicine to think big phylosophical questions and to change itself. On the way of this we can damage people with a bad decision making process, who could stop brushing their tooth because of headlines. It is bad, but there are upsides of that: next time when they come to a dentist, they will get an evidence that their decision making process is not perfect. So they will be able to learn something. To my mind, a couple of teeth as a payment for an improved decision making process is a good deal.
1. It is not full of shit, there are only one word in a phrasing that makes the headline misleading. It is "surprisingly". In medicine there are nothing surprising when there are not enough scientific verification for a conventional wisdom. And yes, I'm ok with it.
2. It doesn't serve the purpose of getting people to trust their doctors less. If someone do it the wrong way, the reality would fix it anyway. It is a good outcome. People would learn how to do decision making, doctors would be forced to rethink ways they persuade their patients that doctors know better. It is more contraversial, I agree, but I can live with it. Why should I have less information I need, if someone cannot deal properly with information of this kind?
You know, I'm riding bike as I rode before despite of risk of retina detachement. I decided that 10 years of riding is good enough evidence for me. When I have no access to a scientific knowledge on topic, I have no other options except to fall back to use an anecdotal evidence. In any case I'm not going to through out my bike, I like it and I believe that psychological health is more important than physical.
(At the same time I acknowledge, that article doesn't express it in such a wording, it does it more vague, leaving some crucial information behind links and stressing the point of lack of evidence, to justify the headline. It is clumsy.)
Also in the article mentioned yearly X-rays, frequency of brushing, scaling and polishing, bonded amalgams, interdental brush, preventive visits. Not every in the exact sense that "little evidence found", and I didn't bother to visit the all linked articles to see what is there, but nevertheless, I want to point, that brushing and flossing is just a part of the article.
In any case I see that the headline is good enough. After some thinking I even do not see "surprisingly" as a redundant word: surprise is a subjective feeling and the author can be surprised when I'm not. Moreover I guess that not only the author was surprised but some of his readers also.
It's not 'malpractice' and it's a mistake to think that what you consider journalism is anything other than a vehicle to sell advertising in the end. There seems to be this assumption that what is written (especially and actually in the NY Times (which I do read and pay for)) is pure and good and the people writing spend untold hours to get the story right and fairly balanced. My anecdote is when I was interviewed a few times in the past by the NYT the writer fed me conclusions and it was very easy to figure out what to say in order to get my name printed. (A contrary position to the point and stated vehemently was almost certainly the way to go..)
What about journalism to you means it should have some kind of a higher calling? The people working in that industry have jobs and families to feed. If they simply did the right thing they wouldn't be employed very long if their competitors didn't follow the same path.
When 'journalists' write either left leaning or right leaning pieces are they being circumspect and covering all angles with fairness? Or are they just making sure they have food on the table and/or ensuring that readers continue to patronize the paper (or broadcast) that they work for?
It's nice to think that someone else who has to earn a living and feed their family should be 'above it all' but in reality that is never going to be the case.
Maybe a better idea is to teach children in school over and over that what you read and what is reality are two different things. Don't believe what you read.
It's concerning to me how prevalent this seems to be in a number of Very Important news memes we've been listening to for the last several years.
I would bet it's not only profitability but also ROI that dictates how long a paper can part with a journalist for his investigation in a story before it becomes too much time in the eyes of management; the highly comprehensive piece does not bring that many more readers and possibly even less if the topic at hand is very specific.
As well politics on the other hand are dealt with on a daily basis and accuracy can more easily be measured even by the mainstream reader unlike a highly specialized field.
There are surely cases where something is so bleedingly obvious no one has thought to do a peer reviewed study of it. Then there are things long assumed and just part of standard procedure in the same category that are worth a bit of rigor.
By the way:
- there is scientific evidence in dentistry just like any other branch in medicine
- there are good and bad dentists just like in any other profession
- the good ones tend to be very scientific and evidence-based (I know I am, everything I recommend and do is based on solid evidence, and I provide links to pubmed to any patient that asks for information)
- a good dentist should be able to answer any of your questions or doubts in a split second, I often draw simple sketches to explain concepts to patients
- please use your common sense: even though it might be hard to prove with 3 standard deviations that flossing makes a big difference (for all sorts of reasons that statisticians know very well, including the difficulty of tracking a large group of patients), it's pretty obvious that removing rotting food from your gums is good and leaving it there to putrefy is bad, don't you think? same goes for all the other claims...a powered toothbrush is better simply because it does more iterations per minute than a manual one...again, common sense
But is that actually true? Has anyone actually confirmed it with replicable scientific studies? Did early human teeth rot to hell over the first 10 years of their lives? Why don't cats and monkeys need to brush and floss?
"please use your common sense"
The problem with common sense is that it can be deceptively nonsensical, and we tend to ignore that we haven't proven it because we "know" it's true already.
Looking at modern dog dental hygiene to learn about how wild animals’ teeth work is as silly as looking at our dental hygiene to see how a hunter gatherer’s teeth work.
Thanks to waterpicking, the gums in that area of the jaw have healed and I shouldn't experience any more bone loss as long as I waterpick or floss.
Works best with meat-flavored toothpaste.
Of course it is difficult to definitely prove whether or not vitamin C supplements reduce the duration of a cold. That doesn't mean that we should all just abandon empiricism and start gulping vitamins because it is "common sense."
What if someone's "common sense" leads them to believe that use of a an abrasive cleaning technique like flossing might damage their gums? I can think of any number of non-scientifically backed rationalizations one could use for or against flossing.
So, even if not-definitive, what research is there on whether flossing improves oral or overall health?
- It's irrelevant to know if flossing "improves" overall health...what is relevant is that it will not worsen it, and you are removing rotting stuff from your teeth, and worst case scenario you just waste 2-3 minutes and have a more pleasant breath..why overcomplicate things?
It doesn't worsen your health, it either does nothing or improve it, so it is reasonable to do it
Medical literature is full of these things: do you need people to prove it with several studies that it's good for you to go for a walk every day? Try to weight the cost-benefit of your actions...if the cost is small, the risk non-existant, and the potential benefit high, it's usually a good idea
There are thousands of wives tales and pseudoscience remedies I don't need to waste my time on. If not backed by actual science, this type of recommendation is no better than any of them.
Basically, good current dental hygiene practice is to brush and floss like the experts tell you.
It wasn't obvious to me that that would be true. Most cleaning tools aren't vibrating brushes.
I was actually concerned about damaging the teeth. You are effectively putting a power tool in your mouth.
2. I've heard that brushing teeth before sleeping, regardless of food consumption, is great because of reduced saliva during rest means reduced anti-bacterial effects of it. Any truth in that?
3. Last dentist appointment I got mentioned that my tooth will literally explode if I don't remove it. I've read there been odd cases of that happening in history, but is there realistic chance of that happening? How would that even come to pass?
P.S. Thanks for doing AMA. I've had nothing but horrible experience talking with dentists, or even bad experiences in general.
I’m not afraid of needles. I’ve had plenty of uncomfortable medical procedures. I can tolerate all other kinds of pain. But why doesn’t local anesthetic work on me for dentistry?
It's a known syndrome, and may be associated with ADHD symptoms, episodes of intense skin flushing or redness (erythromelalgia) and epilepsy.
Other medical sources:
Lower molars receive 2-3 different innervations and it is sometimes hard for a dentist to get all of them numb
I don't have the paperwork but I've always been curious what is was that he gave me/if it was common practice. Also, if it was purely a sort of amnesia, was I in excruciating pain during the time?
I have since moved away and not been back to a dentist. If it is common, I can only imagine the stupid things I would have said or done during the procedure since during the onset I remember being extremely high. It kind of made me embarrassed to return the couple of times I did only because I don't remember what I could have done.
Also I don't rinse after brushing my teeth, to keep the toothpaste in place so it acts as protection all the night, is it useful too?
A great resource for these questions is nutritionfacts.org (free and full of references to scientific studies)
On the other hand, what are your thoughts about the relation between the type of foods we eat and dental health?
My understanding is that sugar, and (complex?) carbs in general have a massive toll on teeth. Admittedly I'm no expert, but it would seem that eating the food we evolved to eat (vegetables and meat mainly) should not damage our teeth in a significant and therefore would be no need for dental health practices.
Whether or not that is feasible on a population level is another question, but I'm fairly convinced at this point that the garbage food is wrecking our health and that includes teeth.
1. my hygienist said it made no difference in plaque formation on my teeth (I did A-B experiments)
2. I was concerned it was abrading the enamel.
I'm old, btw, and am mostly concerned about receding gums and bone loss. I brush, floss, use the pipe cleaners for between teeth, and run one of those pointy rubber things along the gum line, and still get gingivitis. My dentist says there's nothing more I can do about it.
I've also tried various mouthwashes, which made no difference.
Anything else I can try?
2. enamel is far too strong to be abraded by the brush, what does get abraded is the dentin (the yellowish part closer to your gums, that's why sometimes you can see small dent-like abrasions there) so try to focus on brushing softly in those areas. A good idea is to use soft bristles
All you do is good and you're probably already doing 95% of what can be done, the other risk factors are smoking, female hormones, stress and diet. If you are not stressed, don't smoke, are male and eat mostly plant-based whole foods you can't do much more than that
Click on "sources cited" to find plenty of research
I am not a dentist but have similar issues:
Consider wearing a mouthguard at night? Grinding teeth during sleep can contribute hugely to bone loss.
Also make sure you're using the rubbertip correctly. It's supposed to massage the gum with the flat part, not poke with the pointy part.
Teeth are pretty hard on the Moh's scale relative to bristles. If you're abrading enamel, it's from something in the toothpaste (which has all kinds of mineral abrasives), or tooth-tooth contact from chewing/grinding.
From my not-a-dentist :) perspective, the concept sounds workable.
eg creation of the 3D model from scans, using a CNC machine to create the object from Zirconium, etc.
But I've no idea what other parts would need evaluating to make real sense of it. :)
1- You actually need a CAT scan of the tooth you want to replace beforehand..sometimes it's not possible (i.e. people who lost their teeth years ago, and now want to replace them)
2- Costs are probably significantly higher for everyone
3- Normal implants are more versatile, as they are basically hollow screws where you can mount a second screw shaped however you want (a tooth abutment, an attachment, etc) so they are also used to stabilize dentures, to create full mouth reconstructions such as all-on-four etc..this is not possible with these zirconia implants
There's evidence that your mom's prenatal diet (and not strictly genetics) may be a salient factor.
This book is eye-opening. A dentist traveled the world in the early 20th century when there were a lot more indigenous people to visit who had had no previous contact with modern processed flours etc. Those still on their traditional diets almost all had excellent teeth, without ever owning a toothbrush. But when modern foods were introduced, their teeth went to shit within a generation. Probably some epigenetics playing a role, though they didn't know about that then. Also I believe this may have been before flours started being fortified, so you would probably see a less pronounced decline if you somehow did this today. But the takeaway seems to be that a high protein paleo-ish diet kind of takes care of everything.
Actually, your point about flour heavy diets basically sending folks that used to have perfect teeth to cavities sounds very not luck based. Which is it? Genetically some folks have cavities, or that common modern diets lead to cavities?
If diet of the mother is important, we can start educating future mothers to have diets that help. Sure, there is no panacea for people with bad teeth today, but that is true for a lot of things we take corrective action on.
Here's a trans-generational example: My dad makes a bunch of awesome choices that result in his becoming rich. Then I get born, and someday inherit that fortune. I'm much more inclined to describe my own outcome as luck than his, probably because my own decisions had less to do with it.
On the other hand it's not really so straightforward, because so many occurrences are attributable partly to random chance and partly to free will by somebody or somebodies. Maybe my rich dad benefited from luck, like not being crippled by polio or war, or not being born into a repressed social group. And of course my own "good luck" is a result of dad's explicit choices (your point), plus it also hinges on my own actions, such as not doing anything particularly atrocious to alienate him such that I get written out of the will. So is he a genius or just lucky? Probably a bit of both. Am I lucky or just shrewd/a good son? Probably a bit of both.
Pulling it back to what I think you are saying, though; there are still some obvious points that need more exploration for a causal factor. And if it can be found, then it should be exploited more.
So, if there really is a link between mother's diet and bone health, we should find out what that link is. If it is diet related, we should find out what about the diet leads to it.
I'll note my bias. I have the best teeth of my siblings. I likely have the worst brushing habits. Even in grade school, when I had braces, I would brush the night before the dentist, and would generally chew gum/whatever whenever I wanted. Easy to say I got lucky genetically. But what if there is more to it than that? What if my genetic luck was my allergy to damned near all food which knocked out some specific food that caused issues? (Would be almost poetically ironic if it was milk or some such.)
So, colloquially, I don't disagree that luck is a big factor. I just don't think luck should rule out looking for causal factors that can be exploited. Pretty sure that is standard for exploration/exploitation strategies in any learning scenario, no?
In my thirties, I experienced a lot of dental problems such as toothache, bad breath and gum disease. Eventually it got the point where I was in so much daily pain that visiting a dentist didn't seem such a bad idea after all.
For the past 18 years or so I've followed a strict regime of brushing twice daily, flossing and three-monthly sessions with my hygienist.
My hygienist is fastidious and is always disappointed in me, no matter how hard I try she'll always find a spot I'm missing or not cleaning thoroughly enough.
Regardless of this though, my dentist checks me over every 12 months, I have x-rays every 18 - 24 months and there are seldom any problems.
I've had a couple of treatments for chipped enamel over the past 18 years but, apparently, that's a result of aging rather than poor hygiene. Nothing else.
So, yeah, the scientific evidence for regular brushing my be lacking but I'll take my personal experience any day of the week thanks.
I now brush gently and floss daily. I never want another of those grafts.
Or perhaps a special brush with accelerometers (or other sensors? cameras in the head?) would be needed?
They invented this decades ago.
I remember in the 80s when I was a kid going to the dentist.
They would get you to chew some type of pill that temporarily stained your teeth. Then you would brush your teeth while your dentist watched.
In the end you were able to see exactly what you missed because of the stain. It was really a genius product.
Back then it was something you did at the dentist's office but it looks like Amazon has them for sale at: https://www.amazon.com/Butler-Red-cote-Dental-Disclosing-Tab...
I'm not a dentist, so I would ask your dentist before trying them.
Like programming, being able to see the output of what's happening really helps debugging!
Seeing inputs is also useful.
I guess if you were to use disclosing tablets every time you brush ...
So in this case, you'd probably want to use 1 tablet a day for maybe 10 days in a row or keep using the tablets until you can consistently see you're getting good coverage. Then after you've done it a few days in a row with good coverage you know what it feels like and you're good to go.
The package comes with over 200 tablets so you'll have plenty of practice opportunities.
Oral-B's Bluetooth toothbrushes with the Oral-B app shows a mouth map and tells you where you're missing. Available at almost all major retailers.
PS - I don't realistically think people will use Oral-B's solution daily, too awkward (requires sticking the phone to a mirror/face alignment), but useful for "spot checks."
That was never explained to me as a kid, so I never learned how to floss right or why it was important. I guess I can do a better job as a parent with that wisdom, at least.
Life hack: use POH brand dental floss, the white stuff, not the black. It's much thinner than the competition and so it's much easier to use.
Also, in addition to brushing and flossing, did you change your lifestyle? Did you start eating better, working out or changing your diet? Were you stressed when you were younger but have less stress now?
You can't even rule out the placebo effect. Does going to a hygienist make you think your teeth/gums are healthy and therefore boosts your immune system and the health of your gums/teeth?
If something works for you, that's great, but that isn't science.
I can't wait to discuss this theory with her.
This dentist had the balls to drop out of network, probably because he's good and has enough patients to not cave in to the absurd demands of insurance companies (they pay far less than a FFS practice, just FYI)
So you decide to drop your good dentist, and go to lower quality ones, just because they are in-network (guess what? these guys actually need to drop their fees because they don't have enough patients otherwise)...and then you find out that these new dentists are lower quality and need to prescribe unnecessary procedures to make ends meet
Solution: like in any other field, value quality over price, go back to your old dentist.
It's like Apple charging more for an iPhone simply because it's higher quality and is time-tested, of course if you buy cheap cell phones they are worse and screw you up some other way.
The real problem is insurance companies here, they are screwing both dentists and patients extracting money in a place where they shouldn't be (why do you need a middleman between a doctor and a patient anyways?)
I agree, we don't.
Problem is right now if I pay for dentistry via "insurance" then it is pre-tax dollars and or my employer pays some/all of the premium. If I pay it completely out of pocket, I am now using post-tax dollars and my employer isn't picking up a percentage.
Our incentives themselves are irrational. You're essentially forced to go through insurance/your employer, and punished if you don't.
I'd love to see both dental + health insurance "unbundled" from employment, and a large HSA-like pre-tax savings account which can be used on premiums, that employers can choose to contribute to (in cash dollars). That way if you wanted to skip dental insurance, and pay per-treatment you could (and pick any health insurance plan you liked, including ones that could include dental benefits).
PS - The reason the existing HSA structure doesn't work for well for dental is two fold: It requires high-deductible health insurance, and the cap is low when you start using it for other areas (vision/dental).
Reducing our intake of sugary and acidic foods and drinks would have a much greater effect with much less effort. The problem is that the profit margins on carbonated flavored water are massive so the opposition to such change will be huge.
This is the exact same argument that was used to evade studying the effects of low doses of aspirin on heart disease. Everyone “knew” it worked, so it was thought to be unethical to put people at risk of heart disease into a control group. Many millions of people spent money for years to consume a constant supply of aspirin.
When the question was finally studied, it all turned out to be nonsense. In fact, it turned out to increase death rates from higher cancer risk. All that money could have been spent on actually improving health.
That's certainly not the conclusion I came to at all from the article you linked. The main takeaway I got was that daily aspirin may not be warranted if you're not at high risk of heart disease (one reason earlier studies showed more conclusive benefits of aspirin is there were more smokers, i.e. more high risk people, back then).
So yes, it makes sense to look at risk/benefits for individual patients rather than "all old people get aspirin", but the idea that aspirin can protect against heart attacks is not nonsense.
So naturally I was curious about it being “nonsense” for heart disease.
A quick skim of the article + a quick search shows it’s not as clear cut and conclusive as you suggest.
Interestingly, neither is the increased risk of cancer discussed in the article. Aspirin has been shown to have the opposite effect too.
I found it hard to glean what dosages where used in the studies mentioned in the article but the couple I saw were 100mgs per day. I didn’t see mention of if they were enteric coated or taken with meals.
In the US baby aspirin is 81mg and in the UK there are 75mg available. Both are enteric coated. In Australia it seems 100mg might be considered low dose and widely available.
It would be interesting to see more studies on this topic using lower dose, coated, aspirin taken with a meal. The US/UK low dose aspirin are 19-25% lower than at least a couple of dosages the studies mentioned. Those lower dosages may help mitigate bleeding risk.
Seeing as some of aspirins effects are longer lasting, perhaps alternative dosing schedules could also be looked at (every other day etc.) - this may further help mitigate the bleeding risk whilst still providing benefit.
But ya, dosing is underrated. Something that's bad at X dose may be beneficial at 1/Yth the dose.
The ethics aren't too difficult because we don't have strong evidence one way or the other. I think a bigger issue would be blinding the study participants. The groups assigned to the higher frequency brushing may change other routines (e.g. diet).
> The problem is that the profit margins on carbonated flavored water
It could also be the strong acidity of a lot of drinks in general, even if we replace the carbonation/sugar with something else.
Sodas (the sweetened ones), which I’m guessing are what GP is mostly referring to (what with the mention of sugar earlier in the paragraph) have sugar, which may encourage the growth of bacteria that are detrimental to teeth; and some of the flavorings are more acidic or react chemically with enamel to dissolve it.
There's usually a pile of acid added for "tartness" to sodas that lower pH, which overwhelms the buffers.
Often, it's phosphoric acid. Phosphoric acid will quickly react with any free calcium to form insoluble calcium phosphate which will mostly go right through you. So not only are you robbing your mouth of calcium you're also robbing the re-supply process.
There's even less evidence for pulling wisdom teeth:
("The Prophylactic Extraction of Third Molars: A Public Health Hazard")
I'm lucky like the author. 47. Zero cavities. Gums are healthy. Brushed infrequently as a kid and never flossed. Teeth were treated with fluoride by a dentist as a kid. Didn't start brushing daily till high school. Didn't start flossing daily till my thirties. Skipped going to the dentist at all for maybe 5 years in my mid-twenties. Typical western diet. Never had braces. Straight teeth.
Both parents, both sisters, and my brother all have several to many fillings.
I see my dentist twice a year but they only take x-rays every 18 months.
At 21 my dentist wanted to pull my wisdom teeth. I asked why, he said they're hard to clean and I'd lose them at 30 anyway. I said I'd take my chances and found another dentist.
I'm old now, still have them, and they're still in good shape.
= win, probably the main reason for everything else.
Perhaps you just got the right mix of soft and hard food in early childhood and developed a perfect jaw. Or good genes and different father. ;-)
I am reminded of the randomized control study they did on parachutes which showed that parachutes were useless. Of course, to ethically allow people to jump out of an airplane without a parachute, they made sure the jump was not more than a meter and a half off the ground.
What that satirical study actually showed is that randomized control studies don't always make sense.
They're not saying "no dental care". They are saying "no dental floss", or "no fluoride toothpaste", or "no fluoride in water", or "brush once a day". The reality is that a significant percentage of the population falls into one of these three categories (I was surprised you could by toothpaste without fluoride, but you can - there's a market for it).
And yes, while you can't do true randomization, you can compare dental outcomes between these groups.
And finally, saying it's "unethical" is a stretch. It's not unethical if there is no good reason to believe these measures are good for health. Until there's a clear study, these all fall into the same category as other traditional/folk medicine. When I first went to my current dentist years ago, he said "Your insurance covers two cleanings a year, and we'll give that to you. However, I'll have you know that there's no evidence that twice a year is better than once" and he proceeded to tell me a bunch of other common dental practices, their origins, and the lack of studies on them.
It reminds me of the whole 8 glasses of water a day belief, which until about 10 years ago was commonly promoted by doctors. Then in about 2005-2007, someone published a literature survey showing no studies had ever recommended 8 glasses with good reason. All my doctor friends knew of this survey and promptly stopped recommending it.
The article is complaining that there are no randomized control studies and using this to conclude that there is little evidence to support flossing. They are simply disregarding other types of studies like the observational study you are pointing out have value. These observational studies show such clear benefits to flossing that directing a person to stop would be considered unethical. I am pointing to a more facile example where you would never imagine performing a randomized control study because it is obvious that the no treatment control is dangerously unethical.
Doctors end up being susceptible to public misconceptions just as much as the general public. Not everybody reads original research or health guidelines. So someone hears that the official guide recommends 2.5 liters of water, with no mention of the accompanying note that most of this comes through ordinary food intake, and they misinterpret it as needing 8 glasses of water a day. That is the case for the 8 glass a day myth: no scientific study ever recommended it, but half readings of some literature seemed to imply it.
If you like myths like those, read through https://www.snopes.com/fact-check/water-works-2/ especially when it gets to the diuretic effects of caffeinated beverages. I mostly learned about this when I started talking to foreigners about it and realized it just wasn't common knowledge outside of North America that caffeine causes dehydration.
The study PDF: https://www.bmj.com/content/bmj/363/bmj.k5094.full.pdf
This is often exactly what you want actually ... controlled trials typically can’t take into account enough useful variation in patient conditions to be a useful guide for any given patient. Meanwhile the dentists mental database can be ... if your dentist is a good one.
For example, implant placement at a 45 degree angle are totally weird mechanically speaking given that the biting force runs down but dentists may do them to recruit better quality bone because they know that implanting into low density bone or calcious mass will likely lead to an implant failing but they just don’t see much failure due to weird angles ... this particular case happens so often actually that some companies now recommend placement at 45 degrees.
Personally experience, conferences, etc . It’s not how the world ought to work but it is how it mostly does.
It very obviously works aesthetically, especially if you drink a lot of tea. I had no idea it was even supposed to have any health benefits besides the free check-up which some (my) dentists throw in.
Covers both lack of evidence-based science in dentistry, and also culture (thankfully doesn’t seem to be the norm) of over treatment.
Being a Melvyn Bragg podcast, it includes a reading list:
Barry K. B. Berkovitz, Nothing But the Tooth: A Dental Odyssey (Elsevier, 2016)
John A. Long, The Rise of Fishes. 500 Million Years of Evolution (The Johns Hopkins University Press, 1996)
Neil Shubin, Your Inner Fish: A Journey Into the 3.5-Billion-Year History of the Human Body (Vintage, 2009)
T. M. Smith, The Tales Teeth Tell: Development, Evolution, and Behaviour (MIT Press, 2018)
Peter S. Ungar, Teeth: A Very Short Introduction (Oxford University Press, 2014)
Peter S. Ungar, Evolution’s Bite: A Story of Teeth, Diet and Human Origins (Princeton University Press, 2018)
I used to get plaque build up something awful, but since I started taking probiotics a few years ago for another problem, I don't seem to have that problem anymore.
Toothpaste can also deliver fluoride, but I drink a lot of tea (which concentrates fluoride from the soil) so I'm more concerned about excessive fluoride exposure than too little. I've been brushing my teeth with plain water for years and they are as healthy as ever.
Xylitol. Been trying this recently, and it is amazing. Using the Xlear sinus mist has massively reduced snoring and sleep apnea issues. Using Xylitol as a mouth wash - my teeth feel much smoother now. Go do the research and check it out for yourself.
Apagard toothpaste. Its pricey, but switching to this dramatically reduced the drama during dental visits.
What drama was there during dental visits? Found cavities? How often do you go to dentist/how often did the drama happen before you switched toothpaste? Sorry for blunt questions, I really don't know what that could mean.
Now that I’m not spreading the cost out over the year it is harder for me to get motivated to go and pay $250.
I noticed a causal relationship between eating eating sugary foods and toothaches, so I cut out sugar a few years ago, which reduced the pain by 80%. But there was still a subtle aching after every meal, sometimes even if I immediately brushed my teeth (can't reach every single place).
But cutting carbs altogether, has completely eliminated the mild background toothaches (and not so mild ones) I just took for granted.
I heard recently that with the advent of agriculture, humans switching to a carb-rich diet, cavities (in found skulls) increased by 500%.
I floss daily and brush a little more than 2 minutes each time. Still get dental issues, but I feel like it would be worse without it.
Maybe just doing something makes it feel like I have some control in the process.
yeah well its not like my non-existent flossing habits will supplant my waterpick half-solution. But I do wonder the support for any of this wisdom.
This really should not be hard to validate.
The only study I could find showing this was done in the late 70's. Waterpiks have changed a lot since then. And you'll find plenty of studies showing how effective Waterpiks are at removing that film. All these papers were funded by Waterpik.
Why are dentists insisting Waterpiks are bad when there is no independent study comparing modern Waterpiks with regular floss? And why doesn't anyone do the damn study?
A waterpik used incorrectly may cause gum problems, so maybe that's why dentists don't like them across the board. If you put the thing on the highest setting and aim it so it pushes your gums up that may cause damage.
But if you keep it at a low / medium setting (a lot of waterpiks go from 1 to 10 in terms of pressure) and aim the water straight at your teeth and trace your gums then you should be good (there's videos showing how to do it). Not only does it remove all sorts of food particles, but it also stimulates your gums.
Same as mine. Well, sort of. They never recommend Waterpiks, but they all say "Cool! You use a Waterpik! I hope you're still flossing with string, though".
>A waterpik used incorrectly may cause gum problem
Also, are there incorrect ways of using string floss that can cause dental problems?
>If you put the thing on the highest setting and aim it so it pushes your gums up that may cause damage.
"May" is not good enough. What is the evidence? There are plenty of people who use it at the full setting. It's not hard to study the topic. Of course, Waterpik muddles the issue because the highest setting differs from product to product - but when they publish their papers they specify a precise pressure, which is easy to measure. The other reason I ask: Their papers showing that Waterpiks are as good at removing film than string floss use fairly high settings.
>But if you keep it at a low / medium setting (a lot of waterpiks go from 1 to 10 at 0.5 intervals in terms of pressure) and aim the water straight at your teeth and trace your gums then you should be good (there's videos showing how to do it). Not only does it remove all sorts of food particles, but it also stimulates your gums.
If I do this, can you explain why I still need to use string floss? Do you have any studies showing that string floss is more effective than Waterpik when a Waterpik is used properly?
I appreciate your willing to share the information you have heard/read, and please don't take this as an attack on you, but your comment is a classic example of what I'm complaining about. Lots of claims, but not pointing to a concrete study.
None, other than asking my hygienist which setting I should personally use, and she told me don't go above 5. I trust her judgment so I left it at that.
Also one of the waterpik tips (mine came with like 6 different tips) literally has a warning label that says "CAUTITION: Only use this tip on the lowest setting". It's a much sharper tip and for fun I put the waterpik on 10 with that tip and aimed it at my sink. The stream looked so powerful I'm surprised it didn't cut the Earth in half. I can't say for sure what would happen if I aimed that at my gums but I'm not trying.
> Also, are there incorrect ways of using string floss that can cause dental problems?
Yes absolutely. If you jam the floss into your gums as hard as you can sure I'm sure you'll be able to do damage.
> "May" is not good enough. What is the evidence? There are plenty of people who use it at the full setting.
I think it's because everyone is different. I know people who are 70+ and brush their teeth once a day, never floss, haven't visited a dentist in 20+ years and have little to no cavities and very little plaque build up. That's with smoking too.
> If I do this, can you explain why I still need to use string floss?
From personal experience the waterpik I have on setting 5 with the standard tip has a much different feel to it than string floss. String floss feels like it cleans the side edges of my teeth better where as the waterpik seems better for dislodging things that I have trouble getting out even with string floss.
> Do you have any studies showing that string floss is more effective than Waterpik when a Waterpik is used properly?
No, I'm not a medical doctor or dentist. I'm just a dude who brushes their teeth.
>No, I'm not a medical doctor or dentist. I'm just a dude who brushes their teeth.
I hope you realize that the whole discussion, and submission, is about the lack of scientific evidence to back these claims. Everyone is welcome to do whatever makes them feel better, but medical professionals should not give guidance that is not based on much evidence. Unfortunately, the dentists do not appear to have any more information than you do. Some have literally told me "Oh, we were just taught that in dental school" (regarding Waterpiks).
I see food particles that come out of my mouth after using a waterpik (even after string flossing and brushing). Normally I waterpik first but during the testing phase I did it last because I was skeptical on what it would actually do for me.
None of the staff at the place I goto say they learned it in dental school or hinted at doing it for the sake of doing it. They've been in practice for 20+ years and have seen a lot of patients. I'm guessing they have a large enough sample size to come up with something. In my opinion experience is often a good deciding factor when you have nothing else to work with.
That QUIVERING image?
That SWAYING image?
That WOBBLING image?
I cannot accept we now live in a world where such things go without saying.
If the same software was giving different outputs for the same inputs in 2 different locations, everyone here would see that as a concern to be addressed.
It's kind of the same thing with dentists: a good surgeon will tend to lean towards surgery, and there are usually at least 2-3 different ways of solving a particular problem
Peroxides are potent sterilizers and getting them deeper into teeth may clean deeper than any surface treatments, right?
With twice yearly dental X-rays, though, even though the doses are really small, all X-rays carry a risk of cancer, so it seems close to malpractice to request these X-rays without evidence to back it up. Try refusing X-rays at your dentist's office because you've done your own research, though, and they look at you with the "Oh I bet you don't vaccinate your kids either" look.
The Banana Equivalent Dose (BED) of a mouth xray is apparently 15 for 2 xrays.
Personally I hate bananas (well, just the smell, taste, look, and texture).
Aeroplane flights (4 hrs of flying is about 2 xrays) might be a greater exposure source for people who travel a lot.