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Whatever progress it may provide, I am certain that dentists and dentists' associations will slowly and surely entomb any process that reduces the sum of their

• dannyw 6y ago
  It's so sad that most dentists optimise for billable revenue, even at the detriment of long term patient health. Fillings for example always degrade and need repairs after X years. Drilling and filling even the smallest cavity puts that teeth on a lifetime progression to bigger and bigger fillings, eventually a root canal, eventually an implant. Cavities, on the other hand can be arrested (stopped), and if small can even be remineralised. Yes, most dentists don't tell you that! Careful monitoring and patient education on the other hand can lead to permanently keeping that natural teeth, as our teeth are living and can heal. My personal lived experience: a dentist told me I must fill 2 cavities six years ago. I got a second opinion. That dentist told me I should wait, focus on oral care, chew xylitol gum, and use a toothpaste with novamin. Both cavities have "arrested" and need no restorative work. Disclaimer: Not a dentist. Listen to your dentist you trust, and get second opinions if you have doubt.
  • donatj 6y ago
    Novamin toothpaste has been life changing for me. Cannot recommend highly enough. A tooth that was deteriorating and the dentist wanted to cap is now fine enough for them to simply keep an eye on.
    • blackrock 6y ago
      I have never heard of this Novamin toothpaste before. Nor has any of my dentists ever recommended it. It looks like the popular brand is Sensodyne.
      • elsonrodriguez 6y ago
        Sensodyne does not have Novamin in the USA(insert conspiracy theory here). You'd either have to import it from a reputable supplier, or try an alternative like Apagard or Biomin F(both of those have to be imported too, but are more readily available).
        • spyder 6y ago
          Article from 2018 about that: "As of the time of this update, Sensodyne toothpaste with NovaMin is now available on Amazon to buyers in the USA, directly from Sensodyne/GSK." https://medium.com/@ravenstine/the-curious-history-of-novamin-toothpaste-620c6bef8881 https://medium.com/@ravenstine/the-curious-history-of-novami... https://www.amazon.com/Sensodyne-Protect-Whitening-Toothpaste-Packaging/dp/B008VPSTOA#customerReviews https://www.amazon.com/Sensodyne-Protect-Whitening-Toothpast...
          • throw1234651234 6y ago
            That article really helped me understand what this is all about, ty!
      • bemmu 6y ago
        Quick googling found a funny metastudy: "The articles from the database obtained for further review was N = 1. According to the study..."
        • boruto 6y ago
          Haha, I read the same after googling. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068624/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068624/
      • ClumsyPilot 6y ago
        I never heard of Novamin, but I used Sensodyne for years becase it tastes better.
    • Benjamin_Dobell 6y ago
      I just started using toothpaste with nano-Hydroxypatite after a recommendation from a friend. Obviously I can't say much about its effectiveness long-term. But it feels amazing. Feels like there's a protective layer over the enamel - hopefully there actually is! Apparently, nano-Hydroxypatite is even more effective than Novamin (which is still good): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121804/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121804/ If you're in Australia and struggling to find toothpaste with Hydroxypatite, Chemist Warehouse stock "Healthy Care Sensitive Propolis Toothpaste". So far, highly recommended.
      • social_quotient 6y ago
        Totally agree! The brands I use are - Apagard - Boka - CTx4
      • kristofferR 6y ago
        Another interesting teeth restoring substance I just discovered: Oligopeptide P11-4 [1] [1]https://en.wikipedia.org/wiki/Oligopeptide_P11-4 https://en.wikipedia.org/wiki/Oligopeptide_P11-4
    • social_quotient 6y ago
      I’ve had similar success with toothpastes containing “nano-hydroxyapatite” Amazon has several good ones. I also have 2 kids, the youngest (4 yr old) had cavity issues which required intervention and then we started using the hydroxyapatite toothpaste and had no issues since. I also headed down this path via looking for Novamin. I wish there was a reliable way to get it without the “is it fake” on Amazon. I’d gladly accept any reliable sources.
      • Black101 6y ago
        I ordered some from Canada, made in Canada, using Ebay (about as reliable as Amazon but it doesn't come from India and it is cheaper).
        • nickspacek 6y ago
          I went looking on Ebay but couldn't find anything in Canada, do you mind sharing the brand or keyword?
          • Black101 6y ago
            Sorry I was talking about the Novamin one... I think the nano-hydroxyapatite one is available in the US.
    • dharma1 6y ago
      Have you checked out Biomin? It’s meant to be an improved version of Novamin.
  • logicchains 6y ago
    >Cavities, on the other hand can be arrested (stopped), and if small can even be remineralised. Yes, most dentists don't tell you that! >Careful monitoring and patient education on the other hand can lead to permanently keeping that natural teeth, as our teeth are living and can heal. Do you have any sources for this? I'm not disagreeing; I hope it's true.
    • tablespoon 6y ago
      > Do you have any sources for this? I'm not disagreeing; I hope it's true. My dentist prescribed/sold me this for some decay: http://www.mi-paste.com/whyMIP.php http://www.mi-paste.com/whyMIP.php She said it works sometimes. I definitely like this conservative approach better than my last dentist's, who filled 4 teeth unnecessarily because his DIAGNOdent beeped once.
    • deleted 6y ago
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    • drawfloat 6y ago
      I'd be suspicious of those claims – anecdotal but, unless US doctors differ greatly, neither of those are secrets that have been withheld from me by dentists in 3 European countries. In fact the second statement is surely the basis for most modern dentistry...? (I said US there because it's an assumption that the US approach to dentistry may be different to rest of the world. From afar, seems more cosmetic focused with a lot more emphasis put on whitening/straightening/veneer/fixing procedures than over here)
      • blamestross 6y ago
        Well it isn't like dentists in the US are real doctors like in other countries
    • tmamic 6y ago
      https://youtu.be/3zL4Hou1P-c?t=187 https://youtu.be/3zL4Hou1P-c?t=187 Mineralisation of tooth is a constant process with a tug-of-war between pathogenic and protective factors [3:09]. If it's in the balance, of the remineralisation factors prevail, you can stop the progress of the cavity. But deeper the cavity, this is harder to achieve. Arrested dental caries is an official diagnosis recognized by ADA: https://www.icd10data.com/ICD10CM/Codes/K00-K95/K00-K14/K02-/K02.3 https://www.icd10data.com/ICD10CM/Codes/K00-K95/K00-K14/K02-...
  • Duckey 6y ago
    Interesting, I knew of someone who also claimed they reversed a cavity by focusing on oral care, and drinking a ton of milk. Personally, I had a chipped tooth in my early teens and it went away after a decade. I was also drinking about a gallon of milk a day, but I don't know if that's what really fixed my tooth. I wasn't actively doing anything special with my teeth to try to fix them. I just really like milk. The problem just seemed to go away on its own.
  • deleted 6y ago
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  • airhead969 6y ago
    Orthopedic surgeons do the same thing. Inject steroids repeatedly, degrading joints in order to do joint replacements. And those joint replacements aren't great, so they need to be replaced periodically.
  • deleted 6y ago
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  • throwaway57832 6y ago
    > It's so sad that most dentists optimise for billable revenue I've heard this so often as well as the more general statement that doctors optimize for revenue. I think it's nonsense and even dangerous. People are more likely to die from deadly diseases like cancer because they avoid doctors. The anti-vaccination movement is also very likely linked to this sentiment. > Cavities, on the other hand can be arrested (stopped), If they are really small. And even if, teeth with rough surface require multiple times more effort to take care of. (So you really need to chew a lot of gum) Only exception are deep holes, those you sometimes don't want to fill so the tooth can "breathe", at least for some years IIRC. > and if small can even be remineralised. Yes, most dentists don't tell you that! 2 out of 3 dentists told me to buy remineralization tooth paste and use it once a week. Also I'm getting urged nowadays to go twice a year for tooth cleaning including professional remineralization treatment. Disclaimer: Not a dentist either. I think medical advice should be taken from people that have actually studied that stuff.
    • tmamic 6y ago
      > optimize for revenue. I think it's nonsense and even dangerous. As with everything, there are caveats to the kind of doctor you are talking. The key distinction is that most dentists keep the residual income: the difference between the fixed costs and income. It can be a quite large sum and high % of dentists' earnings. So a dentist has a very strong incentive to increase it. Overtreating patients is the easiest way to do it since increasing the prices is not an option due to competition. Who isn't keeping the residual income? It's the doctors who work only for a fixed salary. They can't earn more by overtreating. In fact, if they have less work, they are at profit since their salary is fixed. They don't care about increasing the residual income since they don't get it. So, this is not some conspiracy theory. It is based on economic facts. I've analyzed this in more details here: https://documentation.denther.com/docs/industry/inefficiencies https://documentation.denther.com/docs/industry/inefficienci...
  • rexf 6y ago
    > Listen to your dentist you trust Sure, but it's tough to find a dentist since: > most dentists optimise for billable revenue I find it hard to trust dentists since they may exaggerate cavities to put money in their pocket.
    • deleted 6y ago
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  • HWR_14 6y ago
    My dentist friend claims he makes far more money per hour from cleanings than from fillings. This is because most of a cleaning is done by a relatively lowly paid hygienist but still requires him popping in for 5 minutes and a filling requires him to be there the whole time.
    • kwhitefoot 6y ago
      That's really strange. Here in Norway I visit a dentist roughly once a year and usually only see my dentist if the dental hygienist has found a problem.
      • HWR_14 6y ago
        5 minutes may be a bit long for the US. I don't know if it's a legal requirement that the dentist pop in (to supervise) or because people will balk at paying as much without a Doctor appearing. I'm not aware of the dentist usually finding things that the hygienist missed.
  • xenadu02 6y ago
    My dentist simply put me on toothpaste with high fluoride (IIRC 8%?). Two caries remineralized over the span of about a year and I didn't need fillings. Unfortunately high fluoride toothpastes require an RX.
    • ClumsyPilot 6y ago
      Whats an RX?
      • zeta0134 6y ago
        For some reason, that's short for "prescription." English is weird.
        • monocasa 6y ago
          Well, Latin. It's short for 'recipere'.
    • kristofferR 6y ago
      I just take fluoride pills after brushing in the evening. Common here in Norway a least. Tastes great too, it's like a small treat before bedtime. Has worked great, have never had a cavity.
  • raducu 6y ago
    I've had multiple dentists(including my wife) tell me not to work on certain small cavities, or to use sensodyne. Some have been under observation for more than 20 years. I'm also sure they have re-mineralization treatments they do on site, if it was really worth it, they'd be glad to take your money for that. I'm sure they have exact procedures for when to work on a cavity or not.
  • wmeredith 6y ago
    > Cavities, on the other hand can be arrested (stopped), and if small can even be remineralised. Yes, most dentists don't tell you that! What is with this sentiment about evil dentists wrecking peoples' teeth prevalent in this thread? Any dentist will tell you that if you brush and floss daily and consume sugar responsibly, that your teeth will be healthy and happy for the vast majority of your life. A VERY small percentage of the population actually does this. There is no big dental conspiracy to destroy our teeth. We do that just fine on our own.
• nostromo 6y ago
  Consumers would beat a path to the door of the dentists that offered this. They would make tons of money. The dentists not offering this product would lose customers and go out of business.
  • dannyw 6y ago
    I don't know. We see pharma companies killing one-time cures to not cannibalise recurring treatments, even if another company makes the recurring treatments.
    • mjewkes 6y ago
      Where have we seen this? Genuine question.
      • ArkanExplorer 6y ago
        https://en.wikipedia.org/wiki/Reversible_inhibition_of_sperm_under_guidance https://en.wikipedia.org/wiki/Reversible_inhibition_of_sperm...
      • jtsiskin 6y ago
        I don’t have a specific example of openly stopping production of a cure, but it’s hard to imagine that research isn’t shaped by this profit drive: https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie... If the profit incentive was removed (let’s say government paid same flat rate for a lifetime supply of treatment, whether it be a cure or a reoccurring pill) I have no doubt more cures would be discovered
      • Joeri 6y ago
        Not exactly an example, but the pharma industry has shown a complete lack of interest in pursuing phage therapy, even though it could help solve the problem of antibiotic resistance, because phages cannot be patented.
        • 6y ago
• 0xcde4c3db 6y ago
  Smith actually used the tendency toward collusion within trades as an argument against certain kinds of regulation (and corporations, to boot): "People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices. It is impossible indeed to prevent such meetings, by any law which either could be executed, or would be consistent with liberty and justice. But though the law cannot hinder people of the same trade from sometimes assembling together, it ought to do nothing to facilitate such assemblies; much less to render them necessary."
• pixel_tracing 6y ago
  Then let this be a callout for all you HN types let’s disrupt the shit out of these dentists
  • deleted 6y ago
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• nanis 6y ago
  > I believe Adam Smith called it "the invisible hand" (w/o explicitly noting that the "invisible boot" is jammed into the "invisible customers"' collective asses). It is useful to actually read what Adam Smith said and understand it[1]. In fact, I thoroughly recommend reading Ricardo, Mill, Knight, Hayek, Keynes, and von Mises to understand the important conceptual battlegrounds in the history of economic thought. Smith's problems were mostly about confusing value and price (and thinking there is a well defined, universal "the value" of something -- in this he is joined by Ricardo. Marx merely took those ideas and confused himself due to his lack of knowledge of linear algebra). Note by "corporation" below, he is referring to trade associations. He is arguing, at the same time, against both licensing requirements AND subsidies for education at the same time (among other things). He understood the nature of what you call the "invisible boot". > People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices. It is impossible, indeed, to prevent such meetings, by any law which either could be executed, or would be consistent with liberty and justice. But though the law cannot hinder people of the same trade from sometimes assembling together, it ought to do nothing to facilitate such assemblies, much less to render them necessary. > A regulation which obliges all those of the same trade in a particular town to enter their names and places of abode in a public register, facilitates such assemblies. It connects individuals who might never otherwise be known to one another, and gives every man of the trade a direction where to find every other man of it. > A regulation which enables those of the same trade to tax themselves, in order to provide for their poor, their sick, their widows and orphans, by giving them a common interest to manage, renders such assemblies necessary. > An incorporation not only renders them necessary, but makes the act of the majority binding upon the whole. In a free trade, an effectual combination cannot be established but by the unanimous consent of every single trader, and it cannot last longer than every single trader continues of the same mind. The majority of a corporation can enact a bye-law, with proper penalties, which will limit the competition more effectually and more durably than any voluntary combination whatever. > The pretence that corporations are necessary for the better government of the trade, is without any foundation. The real and effectual discipline which is exercised over a workman, is not that of his corporation, but that of his customers. It is the fear of losing their employment which restrains his frauds and corrects his negligence. An exclusive corporation necessarily weakens the force of this discipline. A particular set of workmen must then be employed, let them behave well or ill. It is upon this account that, in many large incorporated towns, no tolerable workmen are to be found, even in some of the most necessary trades. If you would have your work tolerably executed, it must be done in the suburbs, where the workmen, having no exclusive privilege, have nothing but their character to depend upon, and you must then smuggle it into the town as well as you can. > It is in this manner that the policy of Europe, by restraining the competition in some employments to a smaller number than would otherwise be disposed to enter into them, occasions a very important inequality in the whole of the advantages and disadvantages of the different employments of labour and stock. > Secondly, the policy of Europe, by increasing the competition in some employments beyond what it naturally would be, occasions another inequality, of an opposite kind, in the whole of the advantages and disadvantages of the different employments of labour and stock. > It has been considered as of so much importance that a proper number of young people should be educated for certain professions, that sometimes the public, and sometimes the piety of private founders, have established many pensions, scholarships, exhibitions, bursaries, etc for this purpose, which draw many more people into those trades than could otherwise pretend to follow them. In all Christian countries, I believe, the education of the greater part of churchmen is paid for in this manner. Very few of them are educated altogether at their own expense. The long, tedious, and expensive education, therefore, of those who are, will not always procure them a suitable reward, the church being crowded with people, who, in order to get employment, are willing to accept of a much smaller recompence than what such an education would otherwise have entitled them to; and in this manner the competition of the poor takes away the reward of the rich. [1]: https://www.gutenberg.org/files/3300/3300-h/3300-h.htm https://www.gutenberg.org/files/3300/3300-h/3300-h.htm