4 ms·

Do you need a dentist visit every 6 months? That filling? The data is weak

64 points by jerlam 2y ago

sydbarrett74 2y ago
My dentist said that the purpose of semiannual visits is to bug patients on a regular basis to brush and floss properly. People will treat oral hygiene like going to the gym: they'll be all pumped up for a bit and then slack off eventually. The six-month mark is about when most people need that kick in the arse to get back on track. Scientists have been learning how crucial and vital good oral health is, because it affects the health of every other organ system in the body. Periodontal disease is a direct cause of both diabetes and heart disease. They even recently learned that poor gum health is a causal factor in colorectal cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5159274/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5159274/
- the_real_cher 2y ago
  > periodontal disease is a direct cause of both diabetes and heart disease. I thought that diabetes was glucose processing dysfunction?
  - sydbarrett74 2y ago
    The chronic inflammation from gum disease causes systemic insulin resistance, which leads to T2D. It's a direct and linear pathway.
    - the_real_cher 2y ago
      That's pretty nuts if true. There doesn't seem to be any logical connection there but with nature anything is possible.
      - sydbarrett74 2y ago
        I'll make it even more general. Any chronic inflammation leads to insulin resistance. It's just that with modern western diets, oral inflammation is the one that is almost universal.
- sigmonsays 2y ago
  it seems hard to swallow this connection. How can oral health cause diabetes?
  - sydbarrett74 2y ago
    See my reply to u/the_real_cher.
- tharkun__ 2y ago
  And flossing has ... not been shown to improve anything at all really. Which is why I truthfully tell every dentist that asks: No I did not floss a single time since the last time you told me to. Also: My dad never really brushed his teeth much if at all. No fillings ever. No teeth removed. He used toothpicks "relentlessly" (in the XP sense) like while on the couch, while thinking through some chess moves etc. Turns out that's how our (smart) ancestors "brushed": with sticks.
  - JumpCrisscross 2y ago
    > Turns out that's how our (smart) ancestors "brushed": with sticks If you're eating the diet our prehistoric ancestors ate, are at their level of physique and generally okay with their life expectancy, this is fine advice. For everyone else, there is limited evidence it helps prevent gum disease and halitosis [1]. [1] https://en.wikipedia.org/wiki/Dental_floss#Evidence https://en.wikipedia.org/wiki/Dental_floss#Evidence
    - tharkun__ 2y ago
      Yes that's two different ways to say the same thing. With respect to flossing, this shouldn’t have been news either. A systematic review in 2011 concluded that, in adults, toothbrushing with flossing versus toothbrushing alone most likely reduced gingivitis, or inflammation of the gums. But there was really weak evidence that it reduced plaque in the short term. There was no evidence that it reduced cavities. That’s pretty much what we learned recently. "Surprisingly little evidence for usual wisdom about teeth (nytimes.com)" https://news.ycombinator.com/item?id=19706409 https://news.ycombinator.com/item?id=19706409 (https://archive.is/e1jcB https://archive.is/e1jcB)
      - sydbarrett74 2y ago
        Different types of bacteria cause cavities as opposed to those causing periodontal disease. The former are caused by obligate aerobes, the latter by facultative anaerobes and are far more dangerous. The purpose of flossing is to get at the plaque (which forms tartar within 1-3 days) that exists interdentally and below the gum-line.
duffpkg 2y ago
Former hospital system executive, wrote hacking healthcare for O'Reilly, created the open source ClearHealth/HealthCloud EMR... One of the few times in managing hospital systems I was actually shocked at unethical behavior was when we took over management of a system that through accidents of history included a series of dentistry clinics. Dentists do not have any equivalent to a hippocratic oath, they have no professional obligation to be honest with their "patients". The overriding operational theme of the clinics was how to defraud "patients" with completely unecessary work to maximize profits and borderline defraud dental insurance. I understand that people have a dim view of ethics in american healthcare but this was what I would consider criminal behavior in a medical setting but as further experiences taught me, is the norm in american dentistry. Suffice it to say that we divested from the dentistry clinics asap. Here is one swiss study showing that 30% of dentists committed fraud in the studed visits or were so incompetent that their behavior constituted fraud. I would guess that american dentistry is closer to 50%. Have you had your wisdom teeth out? You are very likely to be the victim of dental fraud. https://pubmed.ncbi.nlm.nih.gov/3135372/ https://pubmed.ncbi.nlm.nih.gov/3135372/ https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573
- moralestapia 2y ago
  >hippocratic oath As if that meant something for regular doctors. Agree with all your post and would like to share a some anecdata in case it's good for anyone here someday. When I was around 16 I lost a premolar (I had an extra one, that messed up the real one, both died and fell down), all dentists immediately suggested I get an implant. Reasons given where: * Your face will deform (no, really) because of your missing tooth * Your other teeth will start moving and will get misaligned and fall as well * Your bone around that area will disappear and you'll need a bone graft and you could die I read a bunch about that online and came to know that implants do massive damage to your mandible and that's not to be taken lightly. Average implant life, if all goes well, is ~20 years, then you have to do it again, each time you do it you weaken your mandible and palate bones significantly. Back then I thought, in 20 years I'll be in my 30s, nowhere near being old and I would start having issues with this for life. I decided not to get it, and guess what? I'm 37 now and have never had a single problem because of that, ever. Every single time I go to a dentist I get the same speech, over and over, "get an implant or you'll die, do you want me to book the appointment now?" "no, I just want some cleaning done, thanks". Dentists are as unscrupulous as it can get.
Waterluvian 2y ago
The part that really engenders distrust of the dental industry is that I’ll get three very different opinions from three dentists. I should write a long post because any time the topic comes up I have a lot to say, but don’t want to wear my thumbs out on my phone. What they did and then further tried to do to my children made me violently livid and completely disenchanted with the industry. Never thought I’d be a conspiracy theorist type person about anything but I do not trust dentists.
- anonzzzies 2y ago
  Yep, I basically stopped going to one dentist when something felt wrong decades ago when he said it was a cavity to be drilled; second opinion said it was definitely not (I didn’t tell him this was a second opinion). Since then I always get 2 or 3 opinions for me and my family if any of us go (definitely not every 6 months); none of us has any cavities or anything else wrong with us: we do brush and floss and none of us eats particular bad food for oral health. I am quite sure there are a very large amount of people who had cavities drilled that never had to be.
- frumper 2y ago
  If you have complex medical issues, you may not find much better results from doctors. It actually may be even more infuriating to be told you medical issues are just in your head.
  - HaZeust 2y ago
    I, for one, cannot wait for medical AI and ML models to be well-suited enough to summarize, suggest and potentially even diagnose patients based on data correlations and conclusions from other patient journeys. I grow tired relying on the potential laziness, ignorance, apathy, and complacency that a doctor might have to help me - or even their own prerogatives getting in the way of their treatment and care. Something more objective, unbiased and empirical would be nice. I often wonder how many lives would have been improved - or saved - if we achieved such technology sooner.
darepublic 2y ago
Yes I have noticed the dentist trying to x-ray my kids every six months. The dentist office near my university would basically point blank tell the students to get the works every visit because "aren't you covered by your student plan?". Yes I am a anti dentite
noashavit 2y ago
This is so subjective. Some have the right genes and behavioral patterns and can get by going on every year or two, while others need more upkeep to maintain their oral health.

64 points by jerlam 2y ago

My dentist said that the purpose of semiannual visits is to bug patients on a regular basis to brush and floss properly. People will treat oral hygiene like going to the gym: they'll be all pumped up for a bit and then slack off eventually. The six-month mark is about when most people need that kick in the arse to get back on track. Scientists have been learning how crucial and vital good oral health is, because it affects the health of every other organ system in the body. Periodontal disease is a direct cause of both diabetes and heart disease. They even recently learned that poor gum health is a causal factor in colorectal cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5159274/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5159274/

the_real_cher 2y ago
> periodontal disease is a direct cause of both diabetes and heart disease. I thought that diabetes was glucose processing dysfunction?
- sydbarrett74 2y ago
  The chronic inflammation from gum disease causes systemic insulin resistance, which leads to T2D. It's a direct and linear pathway.
  - the_real_cher 2y ago
    That's pretty nuts if true. There doesn't seem to be any logical connection there but with nature anything is possible.
    - sydbarrett74 2y ago
      I'll make it even more general. Any chronic inflammation leads to insulin resistance. It's just that with modern western diets, oral inflammation is the one that is almost universal.
sigmonsays 2y ago
it seems hard to swallow this connection. How can oral health cause diabetes?
- sydbarrett74 2y ago
  See my reply to u/the_real_cher.
tharkun__ 2y ago
And flossing has ... not been shown to improve anything at all really. Which is why I truthfully tell every dentist that asks: No I did not floss a single time since the last time you told me to. Also: My dad never really brushed his teeth much if at all. No fillings ever. No teeth removed. He used toothpicks "relentlessly" (in the XP sense) like while on the couch, while thinking through some chess moves etc. Turns out that's how our (smart) ancestors "brushed": with sticks.
- JumpCrisscross 2y ago
  > Turns out that's how our (smart) ancestors "brushed": with sticks If you're eating the diet our prehistoric ancestors ate, are at their level of physique and generally okay with their life expectancy, this is fine advice. For everyone else, there is limited evidence it helps prevent gum disease and halitosis [1]. [1] https://en.wikipedia.org/wiki/Dental_floss#Evidence https://en.wikipedia.org/wiki/Dental_floss#Evidence
  - tharkun__ 2y ago
    Yes that's two different ways to say the same thing. With respect to flossing, this shouldn’t have been news either. A systematic review in 2011 concluded that, in adults, toothbrushing with flossing versus toothbrushing alone most likely reduced gingivitis, or inflammation of the gums. But there was really weak evidence that it reduced plaque in the short term. There was no evidence that it reduced cavities. That’s pretty much what we learned recently. "Surprisingly little evidence for usual wisdom about teeth (nytimes.com)" https://news.ycombinator.com/item?id=19706409 https://news.ycombinator.com/item?id=19706409 (https://archive.is/e1jcB https://archive.is/e1jcB)
    - sydbarrett74 2y ago
      Different types of bacteria cause cavities as opposed to those causing periodontal disease. The former are caused by obligate aerobes, the latter by facultative anaerobes and are far more dangerous. The purpose of flossing is to get at the plaque (which forms tartar within 1-3 days) that exists interdentally and below the gum-line.

duffpkg 2y ago

Former hospital system executive, wrote hacking healthcare for O'Reilly, created the open source ClearHealth/HealthCloud EMR... One of the few times in managing hospital systems I was actually shocked at unethical behavior was when we took over management of a system that through accidents of history included a series of dentistry clinics. Dentists do not have any equivalent to a hippocratic oath, they have no professional obligation to be honest with their "patients". The overriding operational theme of the clinics was how to defraud "patients" with completely unecessary work to maximize profits and borderline defraud dental insurance. I understand that people have a dim view of ethics in american healthcare but this was what I would consider criminal behavior in a medical setting but as further experiences taught me, is the norm in american dentistry. Suffice it to say that we divested from the dentistry clinics asap. Here is one swiss study showing that 30% of dentists committed fraud in the studed visits or were so incompetent that their behavior constituted fraud. I would guess that american dentistry is closer to 50%. Have you had your wisdom teeth out? You are very likely to be the victim of dental fraud. https://pubmed.ncbi.nlm.nih.gov/3135372/ https://pubmed.ncbi.nlm.nih.gov/3135372/ https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573

moralestapia 2y ago
>hippocratic oath As if that meant something for regular doctors. Agree with all your post and would like to share a some anecdata in case it's good for anyone here someday. When I was around 16 I lost a premolar (I had an extra one, that messed up the real one, both died and fell down), all dentists immediately suggested I get an implant. Reasons given where: * Your face will deform (no, really) because of your missing tooth * Your other teeth will start moving and will get misaligned and fall as well * Your bone around that area will disappear and you'll need a bone graft and you could die I read a bunch about that online and came to know that implants do massive damage to your mandible and that's not to be taken lightly. Average implant life, if all goes well, is ~20 years, then you have to do it again, each time you do it you weaken your mandible and palate bones significantly. Back then I thought, in 20 years I'll be in my 30s, nowhere near being old and I would start having issues with this for life. I decided not to get it, and guess what? I'm 37 now and have never had a single problem because of that, ever. Every single time I go to a dentist I get the same speech, over and over, "get an implant or you'll die, do you want me to book the appointment now?" "no, I just want some cleaning done, thanks". Dentists are as unscrupulous as it can get.

Waterluvian 2y ago

The part that really engenders distrust of the dental industry is that I’ll get three very different opinions from three dentists. I should write a long post because any time the topic comes up I have a lot to say, but don’t want to wear my thumbs out on my phone. What they did and then further tried to do to my children made me violently livid and completely disenchanted with the industry. Never thought I’d be a conspiracy theorist type person about anything but I do not trust dentists.

anonzzzies 2y ago
Yep, I basically stopped going to one dentist when something felt wrong decades ago when he said it was a cavity to be drilled; second opinion said it was definitely not (I didn’t tell him this was a second opinion). Since then I always get 2 or 3 opinions for me and my family if any of us go (definitely not every 6 months); none of us has any cavities or anything else wrong with us: we do brush and floss and none of us eats particular bad food for oral health. I am quite sure there are a very large amount of people who had cavities drilled that never had to be.
frumper 2y ago
If you have complex medical issues, you may not find much better results from doctors. It actually may be even more infuriating to be told you medical issues are just in your head.
- HaZeust 2y ago
  I, for one, cannot wait for medical AI and ML models to be well-suited enough to summarize, suggest and potentially even diagnose patients based on data correlations and conclusions from other patient journeys. I grow tired relying on the potential laziness, ignorance, apathy, and complacency that a doctor might have to help me - or even their own prerogatives getting in the way of their treatment and care. Something more objective, unbiased and empirical would be nice. I often wonder how many lives would have been improved - or saved - if we achieved such technology sooner.

darepublic 2y ago

Yes I have noticed the dentist trying to x-ray my kids every six months. The dentist office near my university would basically point blank tell the students to get the works every visit because "aren't you covered by your student plan?". Yes I am a anti dentite

noashavit 2y ago

This is so subjective. Some have the right genes and behavioral patterns and can get by going on every year or two, while others need more upkeep to maintain their oral health.