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I'm sure part of the deeper issue is that preventative care is not really popular in the US among many, along with far too many sweets. Unfortunately, even if t

I'm sure part of the deeper issue is that preventative care is not really popular in the US among many, along with far too many sweets. Unfortunately, even if that changed overnight, tomorrow we'd still have the exact same problem. Systemically, we have to consider the costs of dentistry and why they are high; we have to consider the hand of the insurance company and their price regulation; the costs of materials; the costs of running a small office & regulatory compliance of same; the costs of dental school; and more. This is largely an exercise in system thinking and determining which lever is most effeciacious in improving public health outcomes. Insurance regulation is a narrow way to affect costs without disrupting the choices dentists and patients have made in their life regarding location, choice of careers, etc. Grew up poor, but we had floridated mouthwash to help cope with well water, and my parents made sure we hit the dentist 2x a year for cleaning & sealants. I wonder if the cost curves for dental care are different now, 20 years later. I'm very grateful to them for taking me to the dentist as diligently as they did. These days I have dental insurance, but still do the 2x/year clean.

mancerayder 9y ago
There's this seemingly unspoken assumption that fluoridated drinking water has dental properties worthy of whatever other risks it could have. I don't know either way, in fact I'm very curious for a trustworthy source, not of water but of evidence. Anecdotally, I always drank bottled water growing up in the US. I also never had a cavity. Is it genetic? Both of my parents have terrifying teeth issues. Is it diet? Partly - thanks to my mom, I was never obsessed about sweets. Anecdotes aside, why does fluoride belong in drinking water?
- pnathan 9y ago
  http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf http://www.who.int/water_sanitation_health/publications/fluo... In summary: The beneficial and the detrimental effects of fluoride naturally present in water were well established by the early 1940s. High levels of fluoride present in concentrations up to 10 mg l–1 were associated with dental fluorosis (yellowish or brownish striations or mottling of the enamel) while low levels of fluoride, less than 0.1 mg l–1, were associated with high levels of dental decay (Edmunds and Smedley, 1996), although poor nutritional status is also an important contributory factor. Concentrations in drinking-water of about 1 mg l–1 are associated with a lower incidence of dental caries, particularly in children, whereas excess intake of fluoride can result in dental fluorosis. In severe cases this can result in erosion of enamel. The margin between the beneficial effects of fluoride and the occurrence of dental fluorosis is small and public health programmes seek to retain a suitable balance between the two (IPCS, 2002). The various in Basically: appropriate amounts of fluoride help your teeth to not decay.
- xapata 9y ago
  Read the literature. It's not just anecdotes.
- mindviews 9y ago
  I see a couple of other responses here, but let me address why fluoride belongs in _drinking water_ Fluoride belongs in drinking water in much the same way iodine belongs in salt---it's an extremely cheap, low-risk, and effective way to improve public health. Read some of the references for more details https://en.wikipedia.org/wiki/Water_fluoridation#Effectiveness https://en.wikipedia.org/wiki/Water_fluoridation#Effectivene... but the short version is that fluoride is safe and effective and because it's so widespread in use, even if you only drink bottled water you're probably getting secondary exposure from other food/drink sources. And if you brush your teeth regularly with a fluoride toothpaste, then you've got that delivery mechanism covering you as well. In the end, the public health benefits are there because fluoridation is pervasive and hard to avoid. By similar argument, you probably also don't have an iodine deficiency because of all the iodized salt in use. This is interesting because people relying on anecdotal evidence is pretty much the same failure mode for why so many people don't recognize the importance of vaccination. Because it's so pervasive in the US (and other places) it's easy to find stories of "I wasn't vaccinated and I didn't get sick" or similar "I didn't X and Y didn't happen" but it's not just the primary exposure, but all the secondary exposure and effects that also play an important role in public health efforts.
  - mancerayder 9y ago
    fluoride is safe and effective and because it's so widespread in use, even if you only drink bottled water you're probably getting secondary exposure from other food/drink sources. And if you brush your teeth regularly with a fluoride toothpaste, then you've got that delivery mechanism covering you as well. In the end, the public health benefits are there because fluoridation is pervasive and hard to avoid. By similar argument, you probably also don't have an iodine deficiency because of all the iodized salt in use. So, I don't think you're factually wrong in most of what you said. But I have to say, you're saying that it's pervasive in other sources besides tap water (since you raise other food/drink sources), but still in your first sentence asserting that it belongs in drinking water. So I ask you, if these other sources of beneficial fluoride exist (like our toothpaste, or even food/drinks), why would it need to be added to the drinking water? And why, of all things, would they choose fluoride to add to the drinking water, and not the myriad other minerals/vitamins we're deficient of. I know that's proposterous to imagine - but fluoride somehow made it.
- Spooky23 9y ago
  It belongs there because it effectively prevents needless human suffering. Fluoridated water is one of the public health triumphs of the last hundred years. It reduces cavities by 40%. The people who harp on about this are equivalent to anti-vaxxers. NYC has been fluoridating since 1965, as have other cities. If there were evidence of health problems, surely there would be credible evidence by now.
propman 9y ago
UoP the Bay Area's local dental school costs 160k a year...that means dentists are paying back 600k (120k undergrad) in very high interest loans for a long time. This is higher than medical school. College cost increases in every discipline and the government backing of all loans equally has been one of the biggest scams in this country.
- pnathan 9y ago
  I'd like to see Jubilee on student loans and free university for all who are admitted. I think it'd unskew a lot of weird knock-on third order effects harming the country.
  - poikniok 9y ago
    In this fantasy world can I spend my whole life partying in university, or is there some time limit?
    - sanswork 9y ago
      If you can fund your whole life partying in university you can fund your whole life partying outside of university. Free university is about free university not about paying for your cost of living.
    - pnathan 9y ago
      The people who really took their school seriously often couldn't afford it too well. They knew where they were coming from and didn't want to go back. Collectively, we should support them, in my judgement. As we're all adults here, we know that some people don't behave well, and that's true universally.
xapata 9y ago
Dental "insurance" is generally not really insurance, but a weird payment plan and a bit of collective bargaining. They often pay only 50% of non-preventative procedures and cap annual claims.
- LyndsySimon 9y ago
  While that's true, the real benefit of dental insurance in my experience is just like that of medical insurance - negotiated rates.
  - xapata 9y ago
    Many plan negotiated rates ignore regional inflation, so in some high cost areas the better dentists refuse insurance. In Manhattan for example, you can't pay rent on your dental office taking South Jersey rates. Caveat emptor and all that. I opted out of dental insurance, even though I get my teeth cleaned twice annually. It makes sense to pay out of pocket for me. Some plans also have bizarre reimbursement, or encourage worse treatment plans. Especially state-run Medicaid, but that's another story.

mancerayder 9y ago

There's this seemingly unspoken assumption that fluoridated drinking water has dental properties worthy of whatever other risks it could have. I don't know either way, in fact I'm very curious for a trustworthy source, not of water but of evidence. Anecdotally, I always drank bottled water growing up in the US. I also never had a cavity. Is it genetic? Both of my parents have terrifying teeth issues. Is it diet? Partly - thanks to my mom, I was never obsessed about sweets. Anecdotes aside, why does fluoride belong in drinking water?

pnathan 9y ago
http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf http://www.who.int/water_sanitation_health/publications/fluo... In summary: The beneficial and the detrimental effects of fluoride naturally present in water were well established by the early 1940s. High levels of fluoride present in concentrations up to 10 mg l–1 were associated with dental fluorosis (yellowish or brownish striations or mottling of the enamel) while low levels of fluoride, less than 0.1 mg l–1, were associated with high levels of dental decay (Edmunds and Smedley, 1996), although poor nutritional status is also an important contributory factor. Concentrations in drinking-water of about 1 mg l–1 are associated with a lower incidence of dental caries, particularly in children, whereas excess intake of fluoride can result in dental fluorosis. In severe cases this can result in erosion of enamel. The margin between the beneficial effects of fluoride and the occurrence of dental fluorosis is small and public health programmes seek to retain a suitable balance between the two (IPCS, 2002). The various in Basically: appropriate amounts of fluoride help your teeth to not decay.
xapata 9y ago
Read the literature. It's not just anecdotes.
mindviews 9y ago
I see a couple of other responses here, but let me address why fluoride belongs in _drinking water_ Fluoride belongs in drinking water in much the same way iodine belongs in salt---it's an extremely cheap, low-risk, and effective way to improve public health. Read some of the references for more details https://en.wikipedia.org/wiki/Water_fluoridation#Effectiveness https://en.wikipedia.org/wiki/Water_fluoridation#Effectivene... but the short version is that fluoride is safe and effective and because it's so widespread in use, even if you only drink bottled water you're probably getting secondary exposure from other food/drink sources. And if you brush your teeth regularly with a fluoride toothpaste, then you've got that delivery mechanism covering you as well. In the end, the public health benefits are there because fluoridation is pervasive and hard to avoid. By similar argument, you probably also don't have an iodine deficiency because of all the iodized salt in use. This is interesting because people relying on anecdotal evidence is pretty much the same failure mode for why so many people don't recognize the importance of vaccination. Because it's so pervasive in the US (and other places) it's easy to find stories of "I wasn't vaccinated and I didn't get sick" or similar "I didn't X and Y didn't happen" but it's not just the primary exposure, but all the secondary exposure and effects that also play an important role in public health efforts.
- mancerayder 9y ago
  fluoride is safe and effective and because it's so widespread in use, even if you only drink bottled water you're probably getting secondary exposure from other food/drink sources. And if you brush your teeth regularly with a fluoride toothpaste, then you've got that delivery mechanism covering you as well. In the end, the public health benefits are there because fluoridation is pervasive and hard to avoid. By similar argument, you probably also don't have an iodine deficiency because of all the iodized salt in use. So, I don't think you're factually wrong in most of what you said. But I have to say, you're saying that it's pervasive in other sources besides tap water (since you raise other food/drink sources), but still in your first sentence asserting that it belongs in drinking water. So I ask you, if these other sources of beneficial fluoride exist (like our toothpaste, or even food/drinks), why would it need to be added to the drinking water? And why, of all things, would they choose fluoride to add to the drinking water, and not the myriad other minerals/vitamins we're deficient of. I know that's proposterous to imagine - but fluoride somehow made it.
Spooky23 9y ago
It belongs there because it effectively prevents needless human suffering. Fluoridated water is one of the public health triumphs of the last hundred years. It reduces cavities by 40%. The people who harp on about this are equivalent to anti-vaxxers. NYC has been fluoridating since 1965, as have other cities. If there were evidence of health problems, surely there would be credible evidence by now.

propman 9y ago

UoP the Bay Area's local dental school costs 160k a year...that means dentists are paying back 600k (120k undergrad) in very high interest loans for a long time. This is higher than medical school. College cost increases in every discipline and the government backing of all loans equally has been one of the biggest scams in this country.

pnathan 9y ago
I'd like to see Jubilee on student loans and free university for all who are admitted. I think it'd unskew a lot of weird knock-on third order effects harming the country.
- poikniok 9y ago
  In this fantasy world can I spend my whole life partying in university, or is there some time limit?
  - sanswork 9y ago
    If you can fund your whole life partying in university you can fund your whole life partying outside of university. Free university is about free university not about paying for your cost of living.
  - pnathan 9y ago
    The people who really took their school seriously often couldn't afford it too well. They knew where they were coming from and didn't want to go back. Collectively, we should support them, in my judgement. As we're all adults here, we know that some people don't behave well, and that's true universally.

xapata 9y ago

Dental "insurance" is generally not really insurance, but a weird payment plan and a bit of collective bargaining. They often pay only 50% of non-preventative procedures and cap annual claims.

LyndsySimon 9y ago
While that's true, the real benefit of dental insurance in my experience is just like that of medical insurance - negotiated rates.
- xapata 9y ago
  Many plan negotiated rates ignore regional inflation, so in some high cost areas the better dentists refuse insurance. In Manhattan for example, you can't pay rent on your dental office taking South Jersey rates. Caveat emptor and all that. I opted out of dental insurance, even though I get my teeth cleaned twice annually. It makes sense to pay out of pocket for me. Some plans also have bizarre reimbursement, or encourage worse treatment plans. Especially state-run Medicaid, but that's another story.