15 ms·

Surprisingly little evidence for usual wisdom about teeth

160 points by wallace_f 8y ago

mathewsanders 8y ago
This recent article on the Atlantic is more interesting read: https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/ https://www.theatlantic.com/magazine/archive/2019/05/the-tro... Covers both lack of evidence-based science in dentistry, and also culture (thankfully doesn’t seem to be the norm) of over treatment.
usgroup 8y ago
I think individual dentists will often go on anecdotal evidence. A single dentist may fix 10k+ teeth or more and treat the same patients over 20 years or more and is therefore often well placed to consider what worked in their practice. 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.
- majewsky 8y ago
  Anecdotal evidence is widely considered inferior to controlled studies, and for good reasons: Confirmation bias, survivorship bias, etc. are incredibly hard to avoid for a single person even if they're aware of them.
  - naringas 8y ago
    it just occured to me that natural selection is basically survivorship bias. hahah
  - usgroup 8y ago
    Anecdotal evidence doesn’t have to have any of those qualities but I do think that’s exactly right, yet most decisions just won’t have a basis in controlled trials due to the variation in the patient group and because you just can’t have controlled trials for most things . 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.
barbegal 8y ago
I tried to find studies for the effects of teeth brushing frequency but the only ones I could find were cohort analyses as opposed to randomised trials. It seems like despite a lack of evidence, it would be very hard to ethically approve a randomised trial of teeth brushing over a long period. I honestly believe brushing teeth twice a day is very much a ritual which achieves very little on a per effort basis. 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.
- abtinf 8y ago
  > It seems like despite a lack of evidence, it would be very hard to ethically approve a randomised trial of teeth brushing over a long period. 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. https://utswmed.org/medblog/aspirin-heart-disease/ https://utswmed.org/medblog/aspirin-heart-disease/
  - hn_throwaway_99 8y ago
    > When the question was finally studied, it all turned out to be nonsense. 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.
  - whycombagator 8y ago
    I am pretty sure that low dose aspirin has some benefits for some people/conditions. At least I remember reading studies that suggest as much. 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.
gibolt 8y ago
I've read similar articles before, and yet I still feel the need to follow all the suggestions. 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.
gerbilly 8y ago
The main differences in outcome, like the anecdote the article leads with, might be due to different micro-flora in the mouth. 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.
caprese 8y ago
I met some dentists the other day that waterpicks may be doing more harm to gum density, while still helping get food particles out to avoid plaque building (which itself will do harm to gum density and cause other forms of decay) 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.
- BeetleB 8y ago
  When I first discovered Waterpiks a year ago, I was extremely frustrated at the fact that all dentists hate it, and that there were very few studies on it. The universal belief, found all over the Internet, is that Waterpik is good for removing food particles, but is ineffective at removing the film, which regular floss does. 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?
  - nickjj 8y ago
    My dentist and his team of hygienists are big fans of waterpiks, but not as a substitution to anything. You would still brush and floss (with string) as usual. 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.
    - BeetleB 8y ago
      >My dentist and his team of hygienists are big fans of waterpiks, but not as a substitution to anything. You would still brush and floss (with string) as usual. 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 Evidence? 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.
hn_throwaway_99 8y ago
At least with flossing, regardless of whether there are double-blinded controlled studies for it, it makes my mouth feel much cleaner when I do it, I can see a lot of plaque coming out when I floss, and there certainly doesn't seem to be any evidence against it. 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.
- pbhjpbhj 8y ago
  [Please check my numbers.] 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.
  - projektfu 8y ago
    Banana equivalent doses assume that the radiation is distributed over the body. This is true for backscatter and other nonspecific radiation. It is not true for collimated radiation such as an x-ray. One explanation for "cell phone cancer" is that people who have annual dental radiographs have develop neuromas which are then (probably incorrectly) blamed on cell phones. https://www.ncbi.nlm.nih.gov/pubmed/23211211 https://www.ncbi.nlm.nih.gov/pubmed/23211211
deleted 8y ago
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dwighttk 8y ago
I had dental insurance a couple years back and went to the dentist for a cleaning after probably 10 years and the dentist and the cleaning tech both said my teeth looked about like I skipped my last 6month visit (before I told them it had been a decade) 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.
blfr 8y ago
Surely the twice-a-year teeth cleanings matter? In 2005, Evidence-Based Dentistry highlighted a systematic review on the effects of routine scaling and polishing (you call it teeth cleaning). 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.
paulsutter 8y ago
Bogus headline, article confirms basic beliefs are true: > 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
- mikeash 8y ago
  I guess people wouldn’t click on “Most of the standard advice about dental health is spot on but there’s some doubt around the edges.” I wonder how many people will toss their toothbrushes after only reading the headline and develop problems as a result. Seems like journalistic malpractice.
  - gist 8y ago
    > Seems like journalistic malpractice. 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..)
    - mistermann 8y ago
      Obligatory: https://medium.com/@addictiondocMD/a-new-corollary-to-the-gell-mann-amnesia-effect-3578a37ed3e9 https://medium.com/@addictiondocMD/a-new-corollary-to-the-ge... 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.
js2 8y ago
A similar article in The Atlantic was submitted a few days ago: https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/ https://www.theatlantic.com/magazine/archive/2019/05/the-tro... There's even less evidence for pulling wisdom teeth: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963310/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963310/ ("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. No smokers. I see my dentist twice a year but they only take x-rays every 18 months.
- nickpeterson 8y ago
  I'll add one. I had bad cavities and several root canals by the time I was 22. Dentist told me to start using a fluoride mouthwash. I use it occasionally (few times a week?), no new cavities for 10 years straight. Seriously no other change.
  - deleted 8y ago
    [deleted]
  - ricardobeat 8y ago
    No change in diet at all?
    - nickpeterson 7y ago
      Nope, if anything it's worse.
- lazyjones 8y ago
  > Never had braces. Straight teeth. = 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. ;-)
nobrains 8y ago
"To recap, there’s good evidence that brushing twice a day with fluoride toothpaste is a good idea, especially with a powered toothbrush. For children, there’s good evidence that the use of fluoride varnish or sealants can be a powerful tool to prevent cavities. The rest? It’s debatable."
ufo 8y ago
I have read that one of the reasons for the lack of evidence is that it is really hard to run randomized the trials for these things. Getting a cohort to brush or floss exactly according to instructions fof a long period of time can be challenging.
dazc 8y ago
As a 20-something I often skipped brushing, never flossed and would rather have a leg amputation without anesthetic than visit a dentist. 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.
- seanmcdirmid 8y ago
  I’m in a similar boat, but my teeth are pretty good. The one thing to look out for is bone loss caused by inflammation, which is why flossing is so important. Bone loss won’t cause your teeth to fall out until you are 60+, so it’s easy to ignore even if it shouldn’t. 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.
  - lisper 8y ago
    My parents made me floss, but I hated it, so when I went to college I quit. Then I had a dentist make me promise to take it up again for just two weeks, which I did. At the end I thought, "Finally, I can quit this stupid annoying waste of time once and for all." I stopped for one night and the next morning I woke up with the most disgusting taste in my mouth I had ever experienced. I haven't missed a day of flossing since then, and it has been 30+ years. 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.
- drewg123 8y ago
mrob 8y ago
There's also evidence that brushing with toothpaste ("dentifrice" in scientific papers) does not remove plaque any more effectively than brushing with plain water: https://www.ncbi.nlm.nih.gov/pubmed/27513809 https://www.ncbi.nlm.nih.gov/pubmed/27513809 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.
- notabee 8y ago
  You can use toothpaste with some of the other enamel supporting materials popular overseas, like nano-hydroxyapatite.
BlackFly 8y ago
That there are no randomized control studies is hardly surprising: nobody would ethically assign a person into the "no dental care" control group. 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.
- jerf 8y ago
  The study page: https://www.bmj.com/content/363/bmj.k5094 https://www.bmj.com/content/363/bmj.k5094 The study PDF: https://www.bmj.com/content/bmj/363/bmj.k5094.full.pdf https://www.bmj.com/content/bmj/363/bmj.k5094.full.pdf
- BeetleB 8y ago
  >That there are no randomized control studies is hardly surprising: nobody would ethically assign a person into the "no dental care" control group. 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.
lurquer 8y ago
Anecdotal comments, in my opinion, are particularly unhelpful when it comes to dentistry. Many people have teeth prone to all kinds of problems despite perfect hygiene and brushing. Others have, essentially, indestructible teeth. The last time I went to the dentist was 27 years ago. I was told I had three cavities that needed filling. Never got it taken care of. Nearly 30 years later, teeth are working great. But, like I said, I don’t draw conclusions from this as there are others — apparently — who brush twice a day, see the dentist regularly, and nevertheless have a mouthful of problems.
- gist 8y ago
  > The last time I went to the dentist was 27 years ago. I was told I had three cavities that needed filling. Never got it taken care of. Nearly 30 years later 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?
  - sebazzz 8y ago
    Wouldn't that opportunist mindset go against the oath you pledge when you become a doctor?
    - dennisgorelik 8y ago
      The pledge does not matter as much if you got five kids to feed. https://www.youtube.com/watch?v=_dhjmSp30jc https://www.youtube.com/watch?v=_dhjmSp30jc
  - lurquer 8y ago
    27 years ago is nearly 30 years. 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.
ashton314 8y ago
I have never seen so many ads for tooth-related things on a single web page.
paulpauper 8y ago
It's mostly genetic. George Washington took fastidious care of his teeth yet they still all fell out anyway
rdiddly 8y ago
Good dental hygiene does what it's supposed to, but the biggest factor is basically luck - you either "have good teeth" or you don't. There's evidence that your mom's prenatal diet (and not strictly genetics) may be a salient factor. https://www.amazon.com/Nutrition-Physical-Degeneration-Weston-Price/dp/0916764206 https://www.amazon.com/Nutrition-Physical-Degeneration-Westo... 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.
- taeric 8y ago
  I don't know. Chalking things to luck seems... like an admission that we don't actually understand the causal factors that well. Especially combined with your other evidence that there was a clear delineation between folks with good/bad teeth. 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?
  - rdiddly 8y ago
    The luck aspect, under this particular hypothesis, would be that either your mom ate well or she didn't.
    - taeric 8y ago
      But it literally goes against the other argument. That isn't luck, that is prior choices having a larger impact than current choices. 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.
andrewl 8y ago
For some history of teeth (not just human teeth) try the BBC In Our Time podcast episode The Evolution of Teeth: https://www.bbc.co.uk/programmes/m0003zbg https://www.bbc.co.uk/programmes/m0003zbg 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)
colordrops 8y ago
I've found through personal experience that diet and general health are most important for teeth. I used to get a cavity a year. Once I cut sugar out 100%, reduced carbs, and started eating healthy, I've had no cavities for 10 years. I don't even use a fluoride toothpaste, and sometimes forget to brush. The dentist always compliments me on my teeth.
wsdfsayy 8y ago
When I switched to a low/no carb diet my gums were much less inflamed and stopped experiencing bleeding in my gums (w/ regular flossing). I also stopped getting that "filmy" feeling in my mouth when I'd occasionally sleep/take a nap before brushing after a carb-heavy meal.
thedentist1 8y ago
Dentist here, 35yo, ask me anything.
- Scoundreller 8y ago
  Why the huge variation in interventions for the same inputs? 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.
  - thedentist1 8y ago
    A software analogy would be: if a client asks for a simple website with a shopping cart and a newsletter, and you ask 10 programmers, you're almost guaranteed to get 10 different platforms (different CMS, different language like PHP vs Ruby vs .net) 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
- Scoundreller 8y ago
  And is there evidence/theory for "whitening" procedures as preventative care? Peroxides are potent sterilizers and getting them deeper into teeth may clean deeper than any surface treatments, right?
  - projektfu 8y ago
    They prevent you from having yellow teeth.
    - Scoundreller 8y ago
      ... I'd say they're reversal agents. They make the yellow part not yellow anymore.
thedentist1 8y ago
Dentist here, AMA 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
- skookumchuck 8y ago
  I stopped using a powered toothbrush because: 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?
  - reneherse 8y ago
    Have you tried SmartMouth "DDS strength" mouthwash and toothpaste by chance? It contains a zinc formulation that inhibits baterial growth. So far, it's the best I've come across.
    - skookumchuck 8y ago
      I did try a prescription-only DDS mouthwash. No difference.
thedentist1 8y ago
Also, regarding the guy that doesn't trust dentists that posted below...consider this - You had a very good dentist for several years that never suggested you do unnecessary procedures 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?)
- Someone1234 8y ago
  > 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).
- GalacticDomin8r 8y ago
  I think we can all agree insurance is something of a racket, but are you implying in-network dentists struggle financially? I would find that difficult to believe considering the limited hours many dentist office's hold in the midwest coupled with the month+ wait time for an appt.
tomohawk 8y ago
Sample size of 1, but I've done several A/B tests to see what works better for me. Works: 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.
- balfirevic 8y ago
  > 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.
  - tomohawk 8y ago
    No cavities since I found this toothpaste. Also, greatly reduced tooth sensitivity. I go to the dentist every 6 months.
andai 8y ago
Surprised to see nothing about carbohydrates in the article, nor here. I have been following a diet very low in carbs recently, and one thing that surprised me is that my teeth never hurt anymore. It wasn't the reason for my diet, but it's a really nice benefit. 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%.
HocusLocus 8y ago
How come no one has mentioned that image? That QUIVERING image? That SWAYING image? That WOBBLING image? I cannot accept we now live in a world where such things go without saying.
- flycaliguy 8y ago
  These quirky, looping 3d renders have become fashionable in the illustration world.

160 points by wallace_f 8y ago

This recent article on the Atlantic is more interesting read: https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/ https://www.theatlantic.com/magazine/archive/2019/05/the-tro... Covers both lack of evidence-based science in dentistry, and also culture (thankfully doesn’t seem to be the norm) of over treatment.

usgroup 8y ago

I think individual dentists will often go on anecdotal evidence. A single dentist may fix 10k+ teeth or more and treat the same patients over 20 years or more and is therefore often well placed to consider what worked in their practice. 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.

majewsky 8y ago
Anecdotal evidence is widely considered inferior to controlled studies, and for good reasons: Confirmation bias, survivorship bias, etc. are incredibly hard to avoid for a single person even if they're aware of them.
- naringas 8y ago
  it just occured to me that natural selection is basically survivorship bias. hahah
- usgroup 8y ago
  Anecdotal evidence doesn’t have to have any of those qualities but I do think that’s exactly right, yet most decisions just won’t have a basis in controlled trials due to the variation in the patient group and because you just can’t have controlled trials for most things . 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.

barbegal 8y ago

I tried to find studies for the effects of teeth brushing frequency but the only ones I could find were cohort analyses as opposed to randomised trials. It seems like despite a lack of evidence, it would be very hard to ethically approve a randomised trial of teeth brushing over a long period. I honestly believe brushing teeth twice a day is very much a ritual which achieves very little on a per effort basis. 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.

abtinf 8y ago
> It seems like despite a lack of evidence, it would be very hard to ethically approve a randomised trial of teeth brushing over a long period. 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. https://utswmed.org/medblog/aspirin-heart-disease/ https://utswmed.org/medblog/aspirin-heart-disease/
- hn_throwaway_99 8y ago
  > When the question was finally studied, it all turned out to be nonsense. 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.
- whycombagator 8y ago
  I am pretty sure that low dose aspirin has some benefits for some people/conditions. At least I remember reading studies that suggest as much. 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.

gibolt 8y ago

I've read similar articles before, and yet I still feel the need to follow all the suggestions. 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.

gerbilly 8y ago

The main differences in outcome, like the anecdote the article leads with, might be due to different micro-flora in the mouth. 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.

caprese 8y ago

I met some dentists the other day that waterpicks may be doing more harm to gum density, while still helping get food particles out to avoid plaque building (which itself will do harm to gum density and cause other forms of decay) 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.

BeetleB 8y ago
When I first discovered Waterpiks a year ago, I was extremely frustrated at the fact that all dentists hate it, and that there were very few studies on it. The universal belief, found all over the Internet, is that Waterpik is good for removing food particles, but is ineffective at removing the film, which regular floss does. 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?
- nickjj 8y ago
  My dentist and his team of hygienists are big fans of waterpiks, but not as a substitution to anything. You would still brush and floss (with string) as usual. 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.
  - BeetleB 8y ago
    >My dentist and his team of hygienists are big fans of waterpiks, but not as a substitution to anything. You would still brush and floss (with string) as usual. 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 Evidence? 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.

hn_throwaway_99 8y ago

At least with flossing, regardless of whether there are double-blinded controlled studies for it, it makes my mouth feel much cleaner when I do it, I can see a lot of plaque coming out when I floss, and there certainly doesn't seem to be any evidence against it. 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.

pbhjpbhj 8y ago
[Please check my numbers.] 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.
- projektfu 8y ago
  Banana equivalent doses assume that the radiation is distributed over the body. This is true for backscatter and other nonspecific radiation. It is not true for collimated radiation such as an x-ray. One explanation for "cell phone cancer" is that people who have annual dental radiographs have develop neuromas which are then (probably incorrectly) blamed on cell phones. https://www.ncbi.nlm.nih.gov/pubmed/23211211 https://www.ncbi.nlm.nih.gov/pubmed/23211211

deleted 8y ago

[deleted]

dwighttk 8y ago

I had dental insurance a couple years back and went to the dentist for a cleaning after probably 10 years and the dentist and the cleaning tech both said my teeth looked about like I skipped my last 6month visit (before I told them it had been a decade) 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.

blfr 8y ago

Surely the twice-a-year teeth cleanings matter? In 2005, Evidence-Based Dentistry highlighted a systematic review on the effects of routine scaling and polishing (you call it teeth cleaning). 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.

paulsutter 8y ago

Bogus headline, article confirms basic beliefs are true: > 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

mikeash 8y ago
I guess people wouldn’t click on “Most of the standard advice about dental health is spot on but there’s some doubt around the edges.” I wonder how many people will toss their toothbrushes after only reading the headline and develop problems as a result. Seems like journalistic malpractice.
- gist 8y ago
  > Seems like journalistic malpractice. 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..)
  - mistermann 8y ago
    Obligatory: https://medium.com/@addictiondocMD/a-new-corollary-to-the-gell-mann-amnesia-effect-3578a37ed3e9 https://medium.com/@addictiondocMD/a-new-corollary-to-the-ge... 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.

js2 8y ago

A similar article in The Atlantic was submitted a few days ago: https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/ https://www.theatlantic.com/magazine/archive/2019/05/the-tro... There's even less evidence for pulling wisdom teeth: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963310/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963310/ ("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. No smokers. I see my dentist twice a year but they only take x-rays every 18 months.

nickpeterson 8y ago
I'll add one. I had bad cavities and several root canals by the time I was 22. Dentist told me to start using a fluoride mouthwash. I use it occasionally (few times a week?), no new cavities for 10 years straight. Seriously no other change.
- deleted 8y ago
  [deleted]
- ricardobeat 8y ago
  No change in diet at all?
  - nickpeterson 7y ago
    Nope, if anything it's worse.
lazyjones 8y ago
> Never had braces. Straight teeth. = 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. ;-)

nobrains 8y ago

"To recap, there’s good evidence that brushing twice a day with fluoride toothpaste is a good idea, especially with a powered toothbrush. For children, there’s good evidence that the use of fluoride varnish or sealants can be a powerful tool to prevent cavities. The rest? It’s debatable."

ufo 8y ago

I have read that one of the reasons for the lack of evidence is that it is really hard to run randomized the trials for these things. Getting a cohort to brush or floss exactly according to instructions fof a long period of time can be challenging.

dazc 8y ago

As a 20-something I often skipped brushing, never flossed and would rather have a leg amputation without anesthetic than visit a dentist. 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.

seanmcdirmid 8y ago
I’m in a similar boat, but my teeth are pretty good. The one thing to look out for is bone loss caused by inflammation, which is why flossing is so important. Bone loss won’t cause your teeth to fall out until you are 60+, so it’s easy to ignore even if it shouldn’t. 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.
- lisper 8y ago
  My parents made me floss, but I hated it, so when I went to college I quit. Then I had a dentist make me promise to take it up again for just two weeks, which I did. At the end I thought, "Finally, I can quit this stupid annoying waste of time once and for all." I stopped for one night and the next morning I woke up with the most disgusting taste in my mouth I had ever experienced. I haven't missed a day of flossing since then, and it has been 30+ years. 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.
drewg123 8y ago

mrob 8y ago

There's also evidence that brushing with toothpaste ("dentifrice" in scientific papers) does not remove plaque any more effectively than brushing with plain water: https://www.ncbi.nlm.nih.gov/pubmed/27513809 https://www.ncbi.nlm.nih.gov/pubmed/27513809 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.

notabee 8y ago
You can use toothpaste with some of the other enamel supporting materials popular overseas, like nano-hydroxyapatite.

BlackFly 8y ago

That there are no randomized control studies is hardly surprising: nobody would ethically assign a person into the "no dental care" control group. 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.

jerf 8y ago
The study page: https://www.bmj.com/content/363/bmj.k5094 https://www.bmj.com/content/363/bmj.k5094 The study PDF: https://www.bmj.com/content/bmj/363/bmj.k5094.full.pdf https://www.bmj.com/content/bmj/363/bmj.k5094.full.pdf
BeetleB 8y ago
>That there are no randomized control studies is hardly surprising: nobody would ethically assign a person into the "no dental care" control group. 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.

lurquer 8y ago

Anecdotal comments, in my opinion, are particularly unhelpful when it comes to dentistry. Many people have teeth prone to all kinds of problems despite perfect hygiene and brushing. Others have, essentially, indestructible teeth. The last time I went to the dentist was 27 years ago. I was told I had three cavities that needed filling. Never got it taken care of. Nearly 30 years later, teeth are working great. But, like I said, I don’t draw conclusions from this as there are others — apparently — who brush twice a day, see the dentist regularly, and nevertheless have a mouthful of problems.

gist 8y ago
> The last time I went to the dentist was 27 years ago. I was told I had three cavities that needed filling. Never got it taken care of. Nearly 30 years later 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?
- sebazzz 8y ago
  Wouldn't that opportunist mindset go against the oath you pledge when you become a doctor?
  - dennisgorelik 8y ago
    The pledge does not matter as much if you got five kids to feed. https://www.youtube.com/watch?v=_dhjmSp30jc https://www.youtube.com/watch?v=_dhjmSp30jc
- lurquer 8y ago
  27 years ago is nearly 30 years. 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.

ashton314 8y ago

I have never seen so many ads for tooth-related things on a single web page.

paulpauper 8y ago

It's mostly genetic. George Washington took fastidious care of his teeth yet they still all fell out anyway

rdiddly 8y ago

Good dental hygiene does what it's supposed to, but the biggest factor is basically luck - you either "have good teeth" or you don't. There's evidence that your mom's prenatal diet (and not strictly genetics) may be a salient factor. https://www.amazon.com/Nutrition-Physical-Degeneration-Weston-Price/dp/0916764206 https://www.amazon.com/Nutrition-Physical-Degeneration-Westo... 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.

taeric 8y ago
I don't know. Chalking things to luck seems... like an admission that we don't actually understand the causal factors that well. Especially combined with your other evidence that there was a clear delineation between folks with good/bad teeth. 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?
- rdiddly 8y ago
  The luck aspect, under this particular hypothesis, would be that either your mom ate well or she didn't.
  - taeric 8y ago
    But it literally goes against the other argument. That isn't luck, that is prior choices having a larger impact than current choices. 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.

andrewl 8y ago

For some history of teeth (not just human teeth) try the BBC In Our Time podcast episode The Evolution of Teeth: https://www.bbc.co.uk/programmes/m0003zbg https://www.bbc.co.uk/programmes/m0003zbg 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)

colordrops 8y ago

I've found through personal experience that diet and general health are most important for teeth. I used to get a cavity a year. Once I cut sugar out 100%, reduced carbs, and started eating healthy, I've had no cavities for 10 years. I don't even use a fluoride toothpaste, and sometimes forget to brush. The dentist always compliments me on my teeth.

wsdfsayy 8y ago

When I switched to a low/no carb diet my gums were much less inflamed and stopped experiencing bleeding in my gums (w/ regular flossing). I also stopped getting that "filmy" feeling in my mouth when I'd occasionally sleep/take a nap before brushing after a carb-heavy meal.

thedentist1 8y ago

Dentist here, 35yo, ask me anything.

Scoundreller 8y ago
Why the huge variation in interventions for the same inputs? 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.
- thedentist1 8y ago
  A software analogy would be: if a client asks for a simple website with a shopping cart and a newsletter, and you ask 10 programmers, you're almost guaranteed to get 10 different platforms (different CMS, different language like PHP vs Ruby vs .net) 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
Scoundreller 8y ago
And is there evidence/theory for "whitening" procedures as preventative care? Peroxides are potent sterilizers and getting them deeper into teeth may clean deeper than any surface treatments, right?
- projektfu 8y ago
  They prevent you from having yellow teeth.
  - Scoundreller 8y ago
    ... I'd say they're reversal agents. They make the yellow part not yellow anymore.

thedentist1 8y ago

Dentist here, AMA 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

skookumchuck 8y ago
I stopped using a powered toothbrush because: 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?
- reneherse 8y ago
  Have you tried SmartMouth "DDS strength" mouthwash and toothpaste by chance? It contains a zinc formulation that inhibits baterial growth. So far, it's the best I've come across.
  - skookumchuck 8y ago
    I did try a prescription-only DDS mouthwash. No difference.

thedentist1 8y ago

Also, regarding the guy that doesn't trust dentists that posted below...consider this - You had a very good dentist for several years that never suggested you do unnecessary procedures 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?)

Someone1234 8y ago
> 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).
GalacticDomin8r 8y ago
I think we can all agree insurance is something of a racket, but are you implying in-network dentists struggle financially? I would find that difficult to believe considering the limited hours many dentist office's hold in the midwest coupled with the month+ wait time for an appt.

tomohawk 8y ago

Sample size of 1, but I've done several A/B tests to see what works better for me. Works: 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.

balfirevic 8y ago
> 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.
- tomohawk 8y ago
  No cavities since I found this toothpaste. Also, greatly reduced tooth sensitivity. I go to the dentist every 6 months.

andai 8y ago

Surprised to see nothing about carbohydrates in the article, nor here. I have been following a diet very low in carbs recently, and one thing that surprised me is that my teeth never hurt anymore. It wasn't the reason for my diet, but it's a really nice benefit. 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%.

HocusLocus 8y ago

How come no one has mentioned that image? That QUIVERING image? That SWAYING image? That WOBBLING image? I cannot accept we now live in a world where such things go without saying.

flycaliguy 8y ago
These quirky, looping 3d renders have become fashionable in the illustration world.