Dentists reveal new tooth decay treatment | Hacker News Reader

Dentists reveal new tooth decay treatment

theguardian.com

439 pointssethbannon197 comments

This headline is overly sensational — this treatment does not apply for what most people consider cavities (i.e. caries, bacterial decay). It only applies for the very early stage caries process where enamel is just beginning to become demineralized.

Tooth enamel is essentially a matrix that is hardened by mineralization. Caries initially demineralize the enamel, but as they progress they destroy the enamel as well. Once that enamel is gone, there is nothing left to mineralize. You can throw as much calcium, phosphate, electricity, etc at it and you won’t end up with any more enamel. The decay has to be removed and filled with something.

This proposed treatment only works for the very initial stages of demineralization, which are referred to as white spot lesions, since demineralization causes the enamel to become opaque. The current conservative treatment for white spot lesions is to be judicious with cleaning and possibly apply some additional fluoride, as the tooth simply needs to be remineralized. The researchers are claiming to be able to accelerate that remineralization, which is great, but is very, very far from saying that patients won't need fillings.

Source: I’m a 2nd year dental student.

Edit: formatting

> The current conservative treatment for white spot lesions is to be judicious with cleaning

And I'll point out that my current dentist is the only one I've ever had (or known of) who actually bothers to rigorously teach his patients how to clean their teeth well. Most apparently don't believe this is possible or worth their time. Obviously that's not going to take with every patient, but it's really quite amazing the difference between thinking you're doing what needs done (yet having the hygienist grumble all the same), and actually getting the plaque off every time. Put another way, diligence != skill when it comes to dental hygiene.

Care to elaborate what the techniques your current dentist taught you?

Off the top of my head:

* Modified Stillman's

* Floss properly; "scrape" gently with the floss.

* Water rinse after acidic drinks (like red wine). Brush a half hour after that.

One thing that has done a lot for me is I've been doing more brushing without toothpaste. I do use toothpaste, but when I do it I treat it more as a fluoride treatment than as a tool to get off plaque. When I'm trying to get off plaque I use a dry brush.

Toothpaste is more than fluoride, it contains surfactants and mild abrasives to aid in the cleaning process.

As my post above indicates, this effect is really important. The plaque biofilm is really sticky. I'm not sure what's going on in GP's case, but when using a plaque staining dye to see what's going on, it's clear that toothpaste makes a huge difference in the ability to mechanically disrupt plaque. It's amazingly hard to do without toothpaste.

Abrasives on enamel! Yay..

It's all about differences in hardness.

If everything goes as planned: The abrasive is more likely to scratch what's on the teeth; and the teeth are more likely to scratch the toothpaste if everything goes as planned.

I'm not sure I understand, are you basically brushing twice? Once w/o toothpaste and once with?

That's what I do. Once to get rid of food debris. Then start with toothpaste. Then floss, rinse, and a quick brush again with toothpaste. But sadly too little too late with my teeth. They are screwed.

I rarely ate sweets as a child and avoid sugar. I rarely eat processed foods. Drink is another matter. I most likely have harmed my teeth from drinking beer/wine/smoothies and from being too rough when cleaning. I really miss my younger healthy teeth.

My teeth have felt horrible ever since they failed and were drilled and filled. And now bring me a lot of misery. Look after your teeth! Healthy teeth are incredibly attractive. IMHO.

++ on the water rinse. It intuitively makes a lot of sense.

I've always wondered how much decay could be prevented if we just trained people to drink a glass of water after each meal.

One day I'll distribute a cola that includes a chewable calcium tablet to take after each consumption.

For anyone else confused, Modified Stillmans is a brushing technique. Demo video here: https://www.youtube.com/watch?v=5zEDhurn7zY

I usually do a "milk-rinse", because I have the feeling it brings the pH back to neutral a lot quicker than water. But milk contains sugar, so perhaps a water-rinse after that is a good idea.

milk is a slight acid, so no, water would still be a better job of balancing pH, and also better because water contains no sugars or other things that might stick to your teeth.

But milk is a buffer solution [1]

[1] http://milk.polybum.com/the_chemistry_of_milk/basic_physical...

Sorry, should have included that in my original post. The basic protocol is here: http://www.7dentalsteps.com/7steps.htm

The key premise is roughly: disrupt the plaque biofilm every 24 hours. The rest of the protocol is a method for doing that. The change in my gum health was profound after only about three days. Working with Dr. Nigrelle, you get a "process checkup" via plaque staining dye every time you go in. So you get feedback as to where you need to improve technique. I also got some extra dye swabs so I could do self-checks more frequently. The visual feedback is super-useful for dialing in technique, but not critical for that initial baseline boost in dental health.

A big tip for the stim-u-dents or similar cleaning aids. Don't think of them as "toothpicks". Think of them and use them like tiny tootbrushes that can work around the teeth near the gumline and in-between the teeth. It's the lateral faces of the picks that act as scrubbing tools. Also, the parts about lathering with toothpaste are important. The dye tells the story, and Dr. Nigrelle does this comparison with his patients: you learn that you can spend a long, long time scrubbing with a stim-u-dent or toothbrush without toothpaste and kinda sorta get the plaque, or you can lather up some toothpaste and obliterate it in short order.

The graphics on that page are adorably cheesy.

I haven't heard of stimudents before, the principle seems to be the same as the tepe interdental brushes which are more popular here in europe (http://www.tepe.com/products/interdental-brushes/how-to-use/)

With the regular 'brush compliance checks' mine does, an electrical toothbrush made significant difference. And it's not because I spend longer brushing, I even think I brush less in wall-clock time. The electrical one just seems to be more thorough ('seems' as in 'confirmed with dentist-administered plaque and gum health measurements', not 'I really want to believe so in my mind I make it so').

Electrical brush was night and day for me. Until I was 19 or so, I used to have a cavity nearly every check-up. Then, I got an electrical toothbrush, and it just stopped.

Now most of the work is maintenance on all those fillings, damage had been done, unfortunately.

I think the most important thing is teeth take a lot of time to properly clean.

An electric tooth brush is also extremely helpful.

Most apparently don't believe this is possible or worth their time.

Or perhaps they would rather their patients come back with cavities so he/she can charge more to fix them? Here's an experience of mine that's relevant: I once had a dentist who told me I had a cavity and showed me a little black spot on one of my teeth; for whatever reason I declined that day and said I'd come sometime in the future when it was convenient, to fix it. In the meantime I was introduced by a friend to another dentist who was recommended because he was much cheaper, and so I went to him to fix the cavity - to which his response was, "that ain't no cavity", and promptly scraped the spot away with a pick. He also did an x-ray and showed my teeth were in perfect condition with no signs of any decay. This was a few years ago and I've not had any problems with my teeth since.

I recently switched dentist and my new dentist requires that you also have a six monthly appointment with a full-time hygienist also at the same site. I was very skeptical about this but ultimately learnt a lot and my teeth are becoming a lot better for it.

I am not entirely sure if most dentists would be good at delivering hygiene advice to the level of the hygienist (it's a special skill, after all), but I'm also not sure most patients would voluntarily see a hygienist, so it's a tricky problem.

So, how are people a hundred years ago and back into distant past, or even nowadays people of remote villages in South Asia, unaware of the miracles of American dental industry, deat with demineralization issues?

Has it anything to do with a diet, particularly of consuming vegetable roots, such as ginger, or redis, of meat curries as a calcium source? Has it anything to do with gums health, to with consuming chilly pepers is related? How the third world people managed to survive up to this very day without that very costly help of American dental industry?

My guess would be no fizzy drinks and a lot less sugar.

Unfortunately for Americans & the industry, the answer is in fact not, consuming more of something.

Actually, it is not the parts of a plant that matters most, but the soil in which the plant grows. The very same tomatoes grown on fertile slopes of Himalaya or on North Indian Plain has very different compounds in it than hydroponic ones. This why Nepalese or Indian tomatoes are so tasty. Even such a crude instrument as tongue could tell the difference. It also will tell if a soup has been cooked with bones or not.

In a few years I think we will look back on how today's dentists look after teeth with shock, similar to how we do now knowing that they used to treat depression with a frontal lobotomy.

"They used to DRILL your teeth? And if that didn't work they yanked them out of your jaw?"

It all seems so low tech.

No need to wait. A few decades ago in Russia, anesthesia wasn't used during dentistry. That was a fun time period to grow up in.

No need to even go that far, in 2006 I had a root canal in Germany with no anesthesia or pain killers given. Made worse by the fact I didn't understand what it was being done. My German was terrible and the dentist's English was worse.

That's terrifying; I'm guessing that the language barrier resulted in a serious miscommunication?

How was it possible to hold still while having a large nerve drilled out?

I can't speak to dental stuffs, but some local anesthetics don't work on me. I found it remarkably easy, though extraordinarily painful, to maintain stillness while having my foot stitched back together. The grip I had on the bedframe, however, I'm surprised I didn't break it or tear something apart in my arm.

I can't really say how I did it, because I'm not sure. I just knew I had to and didn't move.

I feel like dental work is harder. I've had an ingrown toenail worked on, and every painkiller injection was a) incredibly painful, b) barely useful for dulling the pain. After about seven shots, I decided that the knife-work on my toe was going to be less painful than subsequent injections, and toughed it out.

It's much harder when having dental work done; I've had painkillers not-quite-take, and I always ask for additional injections, unless they're minutes from being done.

Holy crap am I glad I'm extra sensitive to painkillers' effects. For tooth work, I can easily get by on half a shot.

One thing few writers focus on, in terms of the post-apocalypse, is dental care. A cavity can literally kill you if it progresses far enough. David Brin actually addressed this in The Postman; maybe this is why everyone in post-apocalyptic television and most films has shiny white teeth - they know!

Whenever I read or hear about "preppers" or people preparing for a catastrophe, I've always wondered what their plan was for dental care. When I was in my early 20's, my wisdom teeth became impacted. My only symptom was a horrible upper respiratory infection that turned into pneumonia. Without antibiotics and then surgery to remove the teeth, I probably would have died.

And The Postman was a wonderful book.

So far for dental work anesthetics have always taken for me (or I've been knocked out, like when my wisdom teeth were pulled). I only brought it up because the foot happens to be another particularly sensitive area of the body. It's possible to get by without anesthetics, and you may (though I hope no one here ever has to find out) surprise yourself by how much you can tolerate while still remaining still for the procedure.

But in general, I think you're correct that dental work is harder. A bunch of stitches on the bottom of your foot, however, is still some sort of torture. The ones I've had on my head or arms or torso with other non-functioning anesthetics were far easier to take.

The way root canals were handled is by usually killing the nerve via opening up the nerve, putting arsenic in and sealing it with a temporary filling for 2-3 days. After that's all done, there's very little pain felt except when the doctor goes far enough to poke at the gums. The procedure does take longer than with anesthesia in that you need two visits for the whole process, but that's how they did it.

That explains a lot. I had one of these improperly done on a molar about 10 years ago. After the anesthetic wore off from the first visit, the pain slowly grew over the next few days until it was of brilliant, blinding, bang-head-against-hard-object make it STOP!! intensity.

After they took off the temp filling, the smell was nauseating. Apparently it wasn't cleaned very well.

Never went to that guy again.

The foul odor may well have been from an infection.

That is absolutely not normal.

Arsenic? So they not only using mercury in fillings but arsenic too for killing the nerve, nice :(.

This can't be real. I've had a couple root canal procedures done, and even with local anesthesia, sometimes a jolt of pain comes through. It would be impossible to take, I would think.

It really matters at what stage the tooth is in. If the tooth is dead (e.g. you have pain that intensifies to heat, and cold helps)[1] then anesthesia won't make much difference you won't feel a thing anyway.

If you're getting root canal, because cavity is close to the nerve and your dentist don't want to use amalgamated filling then you will need anesthesia, because the nerves are alive.

[1] It gets a bit complicated with molars, which have multiple nerves, if one nerve dies, you'll still need anesthesia for the remaining ones, and you do need root canal, since you can't save part of the tooth and you do need anesthesia, because the tooth is not completely dead yet.

Hmm. Both of mine were on molars and certainly alive, so that explains that.

But I don't know how a dentist could possibly tell the nerves are dead before drilling in. And the way they know is that you say ouch that fucking hurts.

They do hurt you but they don't use a drill at first. I had a root canal done recently and the dentist briefly touched a piece of dry ice to my tooth. He did to a an undamaged tooth first, I guess to see if I could feel pain?

Correct. The doc did it to me.

I had a very dead tooth, and a very alive tooth. Worked like a charm.

I actually lived through all the stages described here (I'm mid 20's) and I live in the Eastern Europe. When I was a child 20-15 years ago, local anesthesia/numbing would not even be even put on the table as an option, then good 10 years ago the doctor would ask if I wanted the numbing - I haven't refused once since then because I knew what the experience was like with no anesthesia. Recently they have been giving anesthesia without asking, which is good.

I've had one done without. It's definitely not pleasant.

My mother had a few done without any kind of anesthesia just few years ago. Painful, but definitely possible to take.

Are you talking about anaesthesia in the sense of general anaesthesia (loss of consciousness and all that)?

Because that's really not needed for a root canal. I've had many and generally the dentist will make an injection to numb the nerve, have you wait 15 minutes, and start working. In case of discomfort they'll give an extra injection.

Must be a thing in German speaking countries? Last year i was asked if i wanted local anesthetic when the dentist was about to drill a back tooth for a crown in Zurich. I blinked with incomprehension - I couldn't believe anyone would NOT want anesthesia. But apparently I had understood correctly and according to the dentist quite a few ask to forego it.

They may have asked because having dental insurance isn't as common in Switzerland (medical/accident insurance is mandatory, but not dental), so many people pay for everything out of pocket. They might opt-out of the anesthetic to save money.

My dad doesn't do anesthesia when getting fillings (we're in the US). He doesn't like the numbness afterwards and the pain doesn't bother him too much, I guess. I tried it once and made it through, but it was a pretty miserable experience.

Drilling and getting a filling isn't that painful and for some people getting a shot is less pleasant.

There even are some dentists in Germany that drawing teeth without anesthesia, but with the help of hypnosis.

Indeed, some people are way more afraid of needles.

And the pain (for drilling+filling a regular cavity) really isn't that bad. The biggest unpleasantness about it is that it's in a weird place, at the back of my tooth, and that it happens at pretty much random intervals beyond my control. Most of the time you don't feel a thing, until the dentist "hits a nerve", sharp pain, but also subsides within the second.

And as far as I've understood they don't actually hit the nerve with the drill, just that the tooth locally heats up from the drill friction, which the nerve feels as a sharp pain, anyone know if that is actually right? I just ... read it somewhere :)

I used to do without (it wasn't offered, I was young and didn't ask either), but nowadays I usually opt for the anaesthetic, I don't mind needles at all, and there's no downside to it, afaik.

It's still not used by many poor/old patients here because mandatory insurance don't cover it.

That's terrifying; isn't it just discouraging people from going to the dentist? How much can dental anesthetic injections cost, anyway?

About few hundreds of roubles.

At least there was vodka :)

The problem is that the anaesthetic dose of alcohol is close to the lethal dose.

What the hell?

Frankly, I would consider foregoing anesthesia if they wanted to hack one of me members with a kitchen knife. But would never, ever, opt out of anesthesia for dental work.

Those tooth nerves seem to have realtime priority or something. These things HURT, and I haven't even done anything other than wisdom teeth extraction and normal cavity drilling. I cannot imagine a root canal therapy done without at least local anesthesia.

Today if you go to the dentist in the Netherlands they'll ask you whether you want anesthesia. At first I was like 'wtf, is that even a question' but it's not that bad. It just compresses discomfort into a smaller time window. I'd estimate the 'total' discomfort to be the same.

Only have experience with fillings, btw. I guess extracting a healthy molar (e.g. to make room for other teeth), or a wisdom tooth, would be significantly more uncomfortable when done without anesthetics.

People still get their wisdom teeth taken out without being put under. I heard one person describe the process inside your mouth sounding like a tree trunk being snapped in half.

That would be Europe. Sounds awful indeed. Especially if they won't budge and an extra tool is placed under the wisdom-tooth to be used as a lever… Root canal is done with local anesthetics as well by the way...

US as well. I was able to be put under for my most recent extraction, but only after shopping around and strong and continual insistence on my part.

Where I live in Europe dentists are pretty effective, I got 2 wisdom teeth pulled out under local anesthesia and truly did not feel a thing. Was even able to eat a light meal a few hours after.

Huh, that's actually pretty accurate.

In fact, 'normal' molars sound the same.

In a former life, a nice American chap yanked one of mine out whilst in Kandahar and it sounded like that - only he also broke a part off the jaw too, so that could have been some part of the sound.

He informed me with a slightly embarrassed: "I'm sorry but I think I just broke your jaw bone."

In a later development, the bone began to be rejected by my gum and was pushed up and out. Broken bone is surprisingly sharp and rather than carry around the little calcium razor one of my Corporals kindly volunteered to pull it out with a pair of needle nose pliers.

Happy to say the latter operation was a complete success.

I had mine removed and opted out of being put under. I get pretty nauseous coming out of general anesthesia.

Local anesthesia and very loud Flogging Molly did the trick for me (and a lot of patience, it took awhile). Didn't really feel anything.

I am one of those people. The oral surgeon offered me the option of being put under for an extra $600 for the 45-minute operation. There are probably things I'd pay $800/hr for, but that wasn't one of them. He seemed kinda irritated; that meant he had to give me something like 16 shots to properly numb everything.

Personally, I didn't mind it. It was an interesting experience. I knew I was made of meat, but the smell of bits of it cooking really brought it home. And as you say, the sound was kinda freaky. But it was a good opportunity to practice keeping the mind centered and following the breath. Plus now I can joke that I learned to transcend dental medication.

> the smell of bits of it cooking

Can you explain this part? I'm considering my wisdom teeth pulled out.

Cauterization of the wound, I'd expect. Stops bleeding via cooking you.

I had crown lengthening done once. The procedure is basically cutting away your gum to expose more of the bottom of the tooth (gives more surface area for a crown to attach). The "cutting" with a laser, so it's basically just burning away the gums. I could see actual smoke rising out of my mouth and it distinctly smelled like cooking bacon. It was very surreal because I didn't FEEL anything.

I also recently had my wisdom teeth removed without sedation. I took some pills that the dentist prescribed to me that were supposed to really put me out of it, but I was 100% with it until about the time we got in the car to leave the dentists office. I pretty much hate having my teeth worked on. It causes me quite a bit of anxiety when normally I'm not very anxious. Whilst numbing my face, he hit a nerve 2-3 times that sent what felt like a powerful electrical jolt through my body. After that, it was a quite a physical process with the dentist even propping himself against my arm at one point to rip those suckers out. I had put the process off for about 6-8 years, but I am really happy its done and in the past. Now every time I have to get a filling, I wince quite a bit waiting for that poked nerve sensation...

But is it safe?

I have always been a champ at the dentist probably because I was used to it growing up with all the orthodontic work. As an adult I had a wisdom tooth removed. At one point he said he had to crack it, brought out an awl-type device and leaned on it with all his weight. A tremendous crack; I saw blood squirt out of my mouth like a jet, and thought it was hilarious.

However, I can't put things into my eye at all. Karmic.

For me this is one of those things that I would definitely spend $800/hour on! Not to mention that the drugs they use to put you under are amazing.

Ironically I had my 4 wisdom teeth pulled without it - wasn't even offered to me at the time. I only had the anesthesia once for a minor dental procedure.

Had two of mine out last year, one impacted, one cracked.

Both under local, first came out in <20 minutes and was entirely routine, 2nd took 40 odd minutes and was on the upper limit of the torque the dentist could apply, it fought her every step of the way - after it was done she asked if she could put it in bleach and send it to the Uni as it was (her words) the largest wisdom tooth I've ever seen.

Neither was fun but the dentist was lovely and the local worked well, I took her a box of chocolates and a card a few days later to say thank you for taking care of me.

I had mine out without general anesthesia, but they were fully erupted and about halfway out into position. The uppers came out in less than a minute (after local anesthesia), but the lowers took a lot of pulling.

Yes. I did. Full extraction of upper right #2 molar.

They did topical numbing, then 4 shots in numbed area. The extractor device is 2 prongs on one side, and 1 on the other. It mates with your tooth's root. There's also a gum separator so they don't cause tissue damage.

The actual extract, if the tooth doesn't break, is about 2 minutes. And yep, it sounds like wet wood snapping, like that tree sound/feel described. If it breaks, it's called a "surgical extraction". Then they drill and pull the pieces as they come out. That can add a few minutes. Mine was in 2 pieces. They drilled for 3 seconds, and used a tweezers or something like that size. Little noticeable sound on that.

After that, you put gauze in your mouth so the area stays moist. Simple, crude, and effective.

I was in a great deal of pain with that tooth, as I had infection/cavity down to the root. I was glad to part with it, given the extensive damage.

I had a heavily impacted wisdom tooth removed from my lower mandible.

Local anesthetic only, was a lot of work and as the surgeon got his leg up to get leverage I could feel my front teeth moving a little from the pressure.

> without being put under

Local anesthetic is more than sufficient.

Yes it's loud. Since my father is a dentist, and he was keen to encourage my sister to follow in his footsteps, he had her "assist" during the procedure. (She was in high school at the time. She's now a very good dentist.) My clearest memory of the procedure is the comment, "hey let's see if he can get by with less lidocaine than usual."

I'm from Scandinavia, where this is the norm.

I've had 4 wisdom teeth removed with local anaesthetic. I felt absolutely nothing during the procedures, though the sound of my teeth being hammered into pieces (two were lodged horizontally and had to be manhandled) was certainly unnerving.

After it was done I got up and got home, no side effects. I have no idea why it's apparently so common for a general anaesthetic in the US. (On the other hand, without it we wouldn't have hundreds of YouTube videos featuring hilariously rambling, drugged-up teens.)

When I got mine done (in the US) they gave me an IV of something that took care of the pain but didn't make me unconscious, and afterwards it gave me amnesia, so I can remember the fact of being aware, but not the details. Kind of like when you wake up from an epic dream, then ten minutes later you can't remember anything but how epic it was.

I had mine taken out while awake (all 4 at once). I was 28 at the time.

Surprisingly, it wasn't that bad of an experience. I was back at work briefly the next day and then fairly normal within 48 hours.

Personally the idea of going under seemed like an unnecessary risk given that being awake was an option. Price didn't have much to do with.

I had two wisdom teeth removed in one session and it took the dentist just a couple of minutes, with local anesthesia and I didn't feel that much. Not sure why anyone would want general anesthesia unless it's a complicated case. As always, try to find a good dentist who has a lot of practice pulling teeth.

I have had the same exact experience. I even toughed it out with no pain killers after. It only was bothersome the first night. Needless to say I recommend this dental surgeon to anyone when the subject comes up. He was awesome.

I had to have a cracked tooth pulled a couple years back after it led to an abscess. They did the procedure under local anaesthetic only.

Oh my god, did it hurt. I have a pretty high tolerance for pain and even I was praying for it to be over as soon as possible. I can only imagine what people who are more sensitive go through.

(I would have happily taken general anaesthetic instead, but they didn't even offer me the option.)

Reading some of these makes me grateful to have gone to an oral surgeon to have all four wisdom teeth removed at once while under general anesthesia.

It amazes some people when I tell them I had my wisdom teeth removed with only the local anesthetic, and managed the pain for the next few days with over the counter painkillers. It actually wasn't that bad. I had more pain from the braces I wore half a decade before.

Of course, my case was totally routine. Your mileage may vary.

I did, and even though it wasn't impacted or anything, it was still one of the worst experiences of my life. I hated every second of it. I was especially annoyed because I was 16 or 17 at the time and begged my mom to let them put me under, but she was paranoid about the anesthesia and wouldn't let me. Being a teenager, a gave her crap for a really long time afterwards, and she eventually relented and let all my siblings be put under.

I sometimes wonder if being put under is really all that much better, since it seems a large component of the experience is the amnesia drug they give you. I had some weird experiences after an oral surgery after I was awake but the amnesia stuff hadn't quite worn off yet. My sister had a similar experience after an orthoscopic surgery. It's a weird idea—can a somewhat traumatic surgery affect you if you can't remember it?

> I sometimes wonder if being put under is really all that much better

For me, it was fantastic. My wisdom teeth had to be pulled just as they started to surface, because letting them grow out all the way would have just wrecked years of brace work. So they had to cut into the gums to fish them out. And apparently the guy said one shattered in the process and they -really- had to dig that one out.

From what I remember, I counted from 100 to around 90-80, and the next thing I knew, "okay we're done." Was a bit out of it for a while, but very little pain. Kept on the pain medication for the next few days; worked great.

Aside from the mandatory cleaning you have to do after having wisdom teeth removed, I didn't really experience much pain at all. And I'm the kind of person that's extremely on-edge even about simple cleanings (very low pain tolerance.)

I would wholly recommend the general anesthesia. I don't even care if I ended up being awake for the whole thing but just don't remember it. Ignorance is bliss :)

It is all low tech. I've been undergoing significant dental work over the past year and I always come back to this same thought. The reason the "brutal" techniques works is because of the amazing resiliency of the mouth. Wounds heal quickly, and teeth are rooted so deep they take a ton of punishment before giving out.

I've been lucky to find an orthodontist whose not afraid to do something advanced. Previously, I had 5 or 6 consultations from different orthodontists who, in some cases, wanted me to return within the hour to install metal braces.I knew that my mouth was a bit of a special case (impacted canine), but I refused to believe that metal was the end game. I always asked for Invisalign, but they all said it wasn't possible - until I met my current orthodontist. After a quick consultation, he comes back saying "we're going to try something different".

The man is a genius, as far as I'm concerned. He proposed a solution to straighten my teeth with Invisalign while making space to pull the canine into place with a cantilever. The cantilever is hidden behind my teeth, attached to my molar and secured with trans-palatal arch. He actually bent the wire around the top of my mouth to minimize its obstruction of the tongue. Painful, simple, but effective. I barely notice it. He cuts my Invisalign retainers by hand so they still fit in.

In the dental world, this is really advanced. I had to repeat the procedure several times to my oral surgeon (who did great work) before he understood that the chain pulling my tooth into place isn't destined for a metal bracket, and must be sutured to my gum pending installation of the cantilever. Quick call to my ortho cleared everything up. Likewise, my dentist was equally surprised. Both said it was a great idea. According to my orthodontist, my treatment would be the subject of a paper, if he was still inclined to write them.

None of it seems very modern to me.

I had the same diagnosis 20 years ago. And I had the old-fashioned treatment for it: oral surgery to expose the tooth, metal braces, canine winched into place by means of weekly tightenings over several months. Glad to hear things are beginning to improve.

And sad that the improvement won't become common practice because the practitioner doesn't feel the need to publish it...

I dislocated a limb, once, while playing some sports ball. The fix at the ER? A heavier doctor wrapped some ropes around me and leaned back with all of his weight, while the other doctor grabbed my limb and pulled really damn hard. Some medical treatments feel absolutely medieval...

Well, there's no modern way of solving what's essentially a misplacement of your limb

It's going to involve pulling and readjusting

At least dental techniques work, even if they might not be very sophisticated or pleasant. Lobotomies just destroyed people. They were only successful in that they made the victims more compliant and less of a hassle for their caretakers, they didn't actually fix the problems.

When you get a chance, take a look at a photo of an orbitoclast (think ice pick). Hammer it in behind the eye socket, give it a good whack, and swing it around a bit. Walter Freeman, the asshole who invented the device, used to drive around the country in his little van performing lobotomies for $25 a pop. He had a nasty tendency to kill his patients; he even killed one when he stopped to have his photo taken with the pick in the patient's brain and accidentally rammed it in a bit too far. These things, of course, happen when you can't see what you're doing.

http://projects.wsj.com/lobotomyfiles/?ch=two

https://40.media.tumblr.com/995323300444f99ee37ffffaa834cfb1...

http://www.sculptorshop.com/oddities/lobotomy-walter-freeman...

People like to say that "learning is fun," but I find that with the internet this is often not true.

All too true at times.

Comparing frontal lobotomies (FLs) with cavity fillings is not an appropriate comparison, IMHO. FLs were always quite controversial because of the serious impairment side-effects and the danger inherent in the procedure (5% death rate during procedure). The operation caused serious brain damage to most - that was its modus operandi.

On the other hand, drilling holes in teeth seems like a low-tech solution (though I suppose that humans from years past would view it as a marked improvement from tooth-pulling), but it ultimately gets the job done, more or less, with minimal negative side-effects.

Yep yep yep yep. The fact is that this will "heal" the tooth rather than effectively putting a cork in it. This will also eliminate root canals because rather than a cork pushing against the nerve, you will have calcium replacing lost... calcium. Boom. Real healing.

Remember when a bad cut = cut the arm off? Now we have so much treatment that it is very rare to remove healthy tissue.

Similar things are coming with that new artificial eye lens. "Why would we cut off healthy tissue, when we can just replace the bad tissue"

The problem with new techniques is that, being new, they are (1) hard to find and (2) more expensive. Combine that with miserly dental insurance and it's hard for advances to get traction.

I actually have an example of this from my own life. I grind my teeth while I sleep, apparently, and since none of the dentists I saw during the first 30 years of my life ever figured that out (grr) my teeth are pretty ground down. These days I wear a dental appliance while I sleep to reduce the damage, but it is only a case of "reduce", not "prevent." The teeth are still getting worse, just not quite so fast.

The word I'd gotten from several dentists was that this was as good a solution as I could realistically hope for. But last year I switched to a new dentist, and when I was telling him all this his eyes got all big, like I was telling him that the plan had been to drill a hole in my head to let out the Evil Spirits. Modern dentistry, he told me, actually had a way to stop the grinding altogether using a course of mild, painless electrical stimuli. Do a few rounds of that, he said, and it'd be problem solved.

Which sounded great! Except that my dental insurance refused to cover even one dollar of such a procedure, which meant it would have cost me about as much out of pocket as a small car. And I, being a layman, have no way to tell if this one dentist is really right, or if all the other ones were and this one is peddling snake oil. So I ended up not doing it, out of fear of a worst case scenario where I went broke paying for treatments that didn't actually do anything.

This outcome is sub-optimal for everybody -- even the health insurance company, since the more I grind my teeth down the more often they'll end up having to pay for extractions, root canals and the like as the teeth crack and fail. But combine lack of information with high costs and change-averse insurance, and it's difficult to see how you get to any other outcome.

Stents and angioplasty are pretty low tech, too, in much the same way. Bodies are messy.

> It all seems so low tech.

This is because the alternative is very high tech. A living part of the body that isn't self repairing needs to be regenerated somehow. The tooth -under the enamel- is a complex living structure that doesn't self-repair. Much of our medical practice, esp. w.r.t. trauma, is based on the premise that the body can repair itself if perhaps given some assistance. But that premise fails with cavities.

At first blush, I was hoping that this work was going to be an advance that would promote repair in the deeper layers of the tooth. Sadly, we're not there yet.

The way they treat depression is still very low tech. They make it sound modern, but electroshock therapy still has the the highest rates of remission. I'm a nobody, so listen to your psychiatrist though.

I do agree they have a long way to go in dentistry. A year ago, I was browsing a scientific grant site. They still don't know why fluoride ions seem to protect teeth.

As to keeping your teeth as long as possible, I'm an old dude who's missing one tooth. It could be genetics, or luck, but here's my regimen. Brush with a electric tooth brush(the original one, that one that vibrates. Get in the habit of using tooth picks. I'm a former smoker, so the habit came easily. (Don't throw the tooth picks on the ground. Birds can swallow them, and other trash concerns. I won't mention a company. They are all the same.) Try not to eat sugary stuff before sleeping, even napping. Buy a few dental scraping instruments. (if you are somewhat coordinated, you can scrape your teeth. You can even get 1 to 2 mm below the gum line. Because you are doing this extra work, just believe you are saving your teeth. (Yea, why not use the placebo effect on your own body?). Drink tap water.

When I was younger, I looked into making chewing gum, but with a safe substance in it that would neutralize the acids on you teeth. Never got around to it. I recall a French company hit the market with a gum like the one I wanted to make, but unsure if it was successful, or even worked.

There's a part of me who believe's tooth decay is more about enzymes, and immunity, but who know?

More than anything it shows how terrible a lot of modern diets are for health. Virtually no one would go around eating lemons, but we've found a way to combine it with sugar to create the worst of both worlds for our teeth.

Sugar isn't easy to come by in the natural world but it's in so many foods now that bacteria in the mouth never go hungry.

More recent article says they still haven't actually used the technique on a human being, only on extracted teeth.

http://www.reuters.com/article/2015/08/25/us-dental-device-i...

Still, sounds very promising.

Interesting.

There was another unique treatment that hit the news perhaps ten years ago, but didn't happen apparently? The idea was awesome, they genetically re-engineered the "tooth-decay" bacteria in your mouth to stop producing acid, combined with a mild antibiotic to out-compete the original form. I've been waiting a long time for it, unfortunately.

I think this was it: http://www.oragenics.com/?q=cavity-prevention

And you'll wait forever b/c the governing bodies are all corrupt. (ADA, FDA, etc.)

I've read about this previously, and would love to see it take place.

But would kissing spread the non-tooth decay version of the bacteria, or the tooth decay version? Testing must be done!

Also, TIL that bottled water promotes tooth decay (by displacing flouridated tap water consumption)

" there are several factors that are likely to increase the incidence and frequency of tooth decay, including increasing consumption of both dietary sugar and bottled water. Bottled water generally does not contain fluoride, and thus does not impart any of the protective effects of fluoridated water from public systems."

> TIL that bottled water promotes tooth decay (by displacing flouridated tap water consumption)

The elite-branded bottled water that go to lengths to set themselves apart from tap water (spring-fed-only, or rain-only, or some other esoteric, "natural" source) will not have fluorine. But many a budget-brand is simply expensively-packaged municipal tap water, and about 2/3 of municipal tap water supplies in the US are fluoridated. I suspect it is a relatively safe bet that when at a department/grocery store, if you simply pick up the house brand bottled water, it will be sourced from municipal tap water and fluoridated.

Serious question: How does fluoride in the tap water help mineralize tooth enamel? Does it enter the body through drinking and then carried to the teeth via the bloodstream? Or is it somehow helpful for teeth by simply being present in the mouth when you drink tap water?

Good layperson overview:

https://en.wikipedia.org/wiki/Remineralisation_of_teeth

Important bit: "It could be available within three years."

So it might be available in 10 years or so.

That's still pretty good news for my kids, and moderately good news for the handful of remaining teeth I expect to have at that point.

20 years. You have to wait for any patents to expire.

Are waiting for patents to expire to use a cellphone?

Or never

Article is from June of 2014. Any updates on this technology?

Looks like they're working on bringing it to market; http://www.reminova.com/faqs

> A two-step process first prepares the damaged area of enamel, then uses a tiny electric current to push minerals into the repair site.

Does anyone know how long this process takes compared to the current solution?

Novamin is a great way to remineralize teeth. Similar to Recaldent (found in Trident Extra Strength.) It's basically a type of micro-glass that slowly remineralizes teeth with continued use.

GSK bought Sensodyne a couple years ago and removed it from all the US Sensodyne toothpastes. Only way to get it in the US is to order from overseas, or to get a prescription from a dentist.

As much as I don't like to be that "conspiracy guy" it's kind of convenient for them to buy the product, remove it from over-the-counter, mark it up, and allow insurance to pay for a prescription strength version..

https://en.wikipedia.org/wiki/NovaMin

Why'd GSK do that, I wonder?

money.

Well, obviously. But how does it make them money? I can't imagine the market for prescription toothpaste is very large.

I would imagine that the margin on a 150 dollar toothpaste is quite a bit more than a 6 dollar toothpaste. It's possible that the margin makes up for the smaller number of sales.

From the FAQ[1]:

The conditioning step takes about four minutes to perform currently and, once optimized, the remineralization step will take about 20 minutes. The whole treatment will be comparable to the typical time scheduled for current drill and fill procedures.

[1] http://www.reminova.com/faqs

I am 32 and have never had to havea filling or root canal. I do not brush my teeth very often or do anything special, except possibly limiting sugar intake somewhat, and maybe rinsing once in a while.

I went to a dentist a year ago and they said I am developing a cavity inside one of my upper treth, and should get it treated. Since then it's been a year and I feel no pain there and nothing is visible on the outside. I don't know.

Is this at all typical?

I wouldn't call it typical, but I didn't have any fillings until I was 33. Everyone's biology is a bit different — salivary flow, composition, etc. Probably the most important thing that you mentioned is the limited sugar intake. Carbs => acid => cavities.

Keep in mind that these things tend to deteriorate as we age, so you might not be able to get away with rarely brushing forever.

> have never had to havea filling or root canal

> they said I am developing a cavity inside one of my upper treth, and should get it treated.

So, in fact, you DO have to have a filling, you've just declined to have it. And if you keep on that path, you'll probably end up needing a root canal (far higher cost, much more annoying procedure, far higher chance of eventual failure) as well.

I'm 30, and had never previously needed fillings, but was recently told by the dentist I needed a few. So I got them. Just because you didn't have much tooth decay until now doesn't mean you're immune; you really should get it treated.

That's neat. If it's just a few microamps, I wonder if they could create a mouthguard to remineralize your teeth while you sleep?

I've often heard conspiracy theorists say that if dentists ever learned of a way to cure cavities more cheaply and without drilling, they'd suppress the information as it would endanger their business. I think this is insane, but can anyone offer a sound economic argument for why dentists would embrace the new technique instead of cartelling up to suppress it?

Why don't dentists recommend drinking more soda and eating more candy?

I don't know, but if you find some, let me know so I can give them my money.

Because people don't need any encouraging to do those things. From a dentists point of view there's no scarcity of poor dental decisions, so they don't need to artificially try to create them.

They aren't outwardly evil. Put on a happy face and turn the screws where the customer can't see or control. Like all capitalist companies that want to maximize profit.

For the same reason a real estate agent does not try to sell you the first house they show you: their motives would be way too obviously transparent if they did that and people would see through it.

I don't understand the downvotes. I'm not suggesting that dentists actually want to harm peoples' teeth. I'm simply pointing out that dentists recommending sugar and soda is too obviously nonsensical a position for anyone to actually take, regardless of their true position.

I have a dentist friend that says he should install a soda machine, and if you have a cavity free checkup, you get coupons for free refills of soda... "And have a free piece of sticky candy!"

Because capitalism. Dentists are not a cabal but a loosely affiliated set of individuals. As soon as one local dentist start filling teeth pain-free with great long-lasting results, all the other dentists had better adapt or they will go out of business.

It'd be impossible for a dentist to go rogue if the main lobbying group for the dentists wasn't allowing any new treatments to get government approval.

Also, I'd argue that capitalism is what causes the entrenchment of industries that get addicted to their profits and don't care about the customers.

It'd be possible for public to mount enough pressure on government to allow for that.

Given a few assumptions, of course - enough information, attentive enough government, enough energy in the society etc.

Wouldn't the government approval issue be more of a socialist factor? Would a socialist government, who's dental representatives want to protect their slice of the public pie be more or less powerful than a capitalist leaning government who wants to limit interference in the market? For instance, is the teachers union more or less powerful than the dental lobbyists?

>Wouldn't the government approval issue be more of a socialist factor?

One uses money to manipulate the people in charge of socialist government programs. I'd bet that the dental lobbyists are stronger in their niche than the teachers union is because there's less public knowledge and interest there.

I'd argue that capitalism is what causes the entrenchment of industries that get addicted to their profits and don't care about the customers.

No, this is human nature. People with power and wealth act to protect it. This is true whether they get their power and wealth because they are high-ranking politicans, party officials or bureaucrats, or whether they earned it in the private sector.

That's not capitalism, that's market economics. Often (arguably universally at this point in history, but watch this space) found together but not at all the same.

Your point stands, nevertheless.

https://en.wikipedia.org/wiki/Market_economy

First section.....Capitalism. Capitalism is certainly a type of market economy.

Squares are rectangles, but not all rectangles are squares.

"In state capitalist systems, markets are relied upon the least, with the state relying heavily on either indirect economic planning and/or state-owned enterprises to accumulate capital."

Your own link doesn't support what you're saying.

State Capitalism may be an actual thing. But no one means it when they say "capitalism".

"State capitalism is usually described as an economic system in which commercial (i.e. for-profit) economic activity is undertaken by the state, where the means of production are organized and managed as state-owned business enterprises"

I find this response to be curious. Why not simply assume that the other person up there does include State Capitalism under the umbrella of "capitalism" when they say that capitalism and free markets don't always go together, rather than assume that they intend a definition of "capitalism" that automatically excludes the very thing they were saying?

Because the person I was responding to was saying that capitalism didn't include a group of "loosely affiliated" people competing for business. It obviously does.

State Capitalism would be if the government started a dentist company and, in this case, didn't offer new services in order to keep the profits artificially high.

It's not even remotely obvious that capitalism must include any competition. You might try reading the Wikipedia entry you linked.

Maybe to a pedant. But in the common usage of the term it is interchangeable with a free market, where competition is always allowed.

Isn't it pedantry when a person links to Wikipedia and insists on using the meanings therein?

Yeah, because capitalism means socialism, right? That's what state capitalism is, so let's just use the same word for both, then everyone will be on the same page and all the confusion resolved.

I find it very confusing that you link to a Wikipedia article, pull a statement from it, then spend all of your replies arguing against what that article says.

Because this fixes a cavity; it doesn't prevent it. Even with treatments like this, we'll still be going to the dentist.

And further, I'll go to a dentist that offers this treatment before I'll go to one that doesn't.

Because "cartelling up" is much, much harder and more rare than people think. See e.g. https://en.wikipedia.org/wiki/Cartel#Long-term_unsustainabil...

The researchers say the device can also whiten teeth. So the dentists will be fine.

Because patients will flock to the dentists who do embrace it, and others may even sue the ones who don't.

I wonder if quick checkups are any less profitable per unit time than doing fillings. Not much in the way of materials required, and you can get a good throughput, with each visit likely to be of predictable duration.

(My teeth are in good shape, and my average dentist visit takes all of 15 minutes: check teeth for basic soundness, scrape off tartar, remove tea stains from upper incisors. Still costs me £55.)

There is also orthodontic work.

Since you used pounds I'm assuming UK, NHS dentists charge £53 for extractions/most work, a check up is less than £20 and mine always include a cleaning/scaling if required.

Unless you are strictly private in which case that sounds more sane.

"Quick Checkups" are less profitable. However, Scaling and root planing (periodontal treatment) is super profitable which is just a more time intensive version of a checkup. I do know of some dentists that tell their hygienists to not do a good job so they can get the periodontal treatment and charge $400 a quarter instead of $150 every 6 months.

Source: Wife was a hygienist before she burned out from contortionist body pain and having to make commission.

> Source: Wife was a hygienist before she burned out from contortionist body pain and having to make commission.

Note to self: find out what dentists make their hygienists work on commission and don't go there.

In the U.S., checkups are primarily done by the (less-expensive) dental assistant doing the X-rays, the (moderately expensive) hygienist doing the cleaning, followed by a quick inspection of mouth and X-rays by the (expensive) dentist. I imagine that the predictability and minimal time use of the dentist would allow it to be quite profitable.

However, as teeth become drastically less susceptible to disease, people will feel much less need to have regular dentist visits...

That kind of already happened, though it's only suppressed in the sense that no dentist ever hinted to me that nutrition might matter beyond avoiding sugar: http://wholehealthsource.blogspot.com/2010/12/dr-mellanbys-t...

My dad, grandfather, and sister-in-law are all dentists. This was something we'd chat about every now and then, and the answer inevitably came down to "whatever is better for patients is good for me".

Sounds a bit like a platitude, but there are so many different treatments and procedures modern dentists do that I think it the profession would generally be fine for quite some time. In a large sense, there'd probably be a transition towards more emphasis on repair and fixes of traumatic injury rather than preventative procedures, but it would likely take awhile before things dramatically change for the profession.

This is amazing news. I wonder if this can be extended to treat osteoporosis.

The article is from over a year ago, and the project has since been stopped. I was told it apparently does not work in humans.

In 1939, the book Nutrition and Physical Degeneration was published. In it Weston A. Price explains that you can avoid cavities by eating a good diet. I wonder if most people will ever become aware of this. Probably not - they don't read much, and certainly not non-mainstream stuff like that book.

Edit: I would also recommend reading The China Study by T. Colin Campbell, since Weston A. Price did not get everything right.

I'm really confused by your comment - isn't it general knowledge that poor diet causes cavities? I remember being taught this in public school as early as kindergarten, and having my dentists reinforce it my entire life.

However, I do believe that genetics also plays a large role in predisposition to cavities, with or without a healthy diet.

It's not the content of the book that this person is talking about, but rather their disdain for some constructed "people" for not reading. Not sure where the ire is coming from, but it's more of a "you're not wrong, you're just an asshole" comment.

But, here I am writing this and here you are reading it.

I believe that study shows that the correct diet will actually heal cavities, not just prevent them. I don't know if it has been shown to be true though.

Ok, it's probably general knowledge that soda, candy etc. can cause cavities. What obviously is not common knowledge is that, with a good diet, it's possible to go through your whole life without getting a single cavity. Weston A. Price travelled around the world and looked at the teeth of many primitive tribes (still quite a few of them back in his days) and they had perfect teeth.

I would say genetics have larger role in this, you can have good diet and still have cavities.

Just example, a person with hyperthyroidism will have much more issues with teeth than someone who doesn't.

Streptococcus mutans + sugar = biofilm (plaque) + lactic acid

Lactic acid + tooth + time = cavity

Sufficient mineral content in saliva and replacement of hydroxide by fluoride in the bioapatite tooth matrix affects the time factor.

So there are four ways to completely avoid cavities.

  - Annihilate the mutans-type bacteria in your mouth, and prevent recolonization.
  - Do not eat sugars.
  - Remove all your teeth.
  - Die.

Obviously, the latter two solutions can have significant negative side effects on your lifestyle. The mutans biofilm plaque makes it difficult to eradicate the bacteria.

If your saliva is well buffered and mineralized, it would be very rare for pH to dip below 5.5 and have minerals leach out of the teeth. Diet would certainly also help in this respect, especially with regard to calcium, phosphate, fluoride, vitamin D, and vitamin K.

http://www.cnn.com/2014/07/03/health/tooth-decay-causes/

> About 60% of the risk for tooth decay appears to be due to genetic factors, says Mary L. Marazita, director of the Center for Craniofacial and Dental Genetics at the University of Pittsburgh School of Dental Medicine.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267319/

> Twin studies provide the opportunity to dissect the relative contribution of genetics and environment on dental caries variation. Accordingly, these studies can often suggest, but not prove, biological inheritance. Current evidence supports the notion that there is an inherited variation in enamel development that is associated with increased occurrence of dental caries. At present, these results are limited to specific populations with overt recognizable syndromes.

http://www.utimes.pitt.edu/?p=19115

> Personal habits, fluoride and genetic factors all play a role in the development of cavities. Age is a factor as well, said Vieira, who has devoted some of his research to uncovering which genes have an influence.

That just means that food commonly eaten in the US doesn't allow you to avoid cavities. It doesn't mean there are no such diets, nor that there aren't diets typical for some regions that avoid cavities.

Caries is also an infectious disease. It's extremely common but not everyone is infected. There are tribes that simply don't have it.

It's bizarre how many people seem to think that "eating a good diet" is easy. They may be under the impression that "easy to describe" and "easy to implement" are the same thing.

"It could be ready in 3 years." Yup, right with flying cars. Move along, nothing to see here.

If this turns out to be cheaper than fillings, I get the feeling my dentist probably won't adopt it haha.

Not to worry, our duty-bound ADA/FDA cronies will make sure this never sees the light of day.

P.S. There is something you can already do btw. If your teeth are still good then go get them sealed. Most dentists won't do it, and will give you some lame excuse. Just go find another dentist. There are a few out there that aren't full of sh*t and they will do it and it will save you thousands of dollars over the course of your life (and a lot of pain too).

Wow, I've never heard of this option before. What are the potential drawbacks?

Primarily just limitations - only applies to chewing surfaces, not sides or between teeth, and can only be applied to non-filled healthy teeth. Approx 5-year lifespan, should be checked at regular dentist visits.

http://www.webmd.com/oral-health/guide/dental-sealants

Thanks.

One reason I've heard is, that it;s still possible to get caries below the the sealing but the dentist (or you yourself) won't be able to see it by a purely visual inspection.

At least here (Germany) you won't get an x-ray at every checkup.

Um, isn't getting one's teeth sealed a typical procedure done for all children once their permanent teeth are in?

This was SOP for me and my siblings, I assume for everyone else, no?

You're thinking of fluoride applications.

No, he's actually thinking of sealants. My sister and I both had it done when we got all our permanent teeth, it was SOP among military dentists in the 80s. The sealants wear off eventually, but it offers some protection for some time.

http://www.knowyourteeth.com/infobites/abc/article/?abc=C&ii...

Were your folks in the military? Everybody of my generation who grew up on military bases overseas had sealants applied when all their permanent teeth came in.

Yeah my first though reading this story was this won't happen in the US anytime soon. Reminds me of how Gordie Howe recently had a stroke and was days from dying before the family flew him to Mexico and to receive stem cell treatment.

Mr. Howe has recovered enough to walk and resume public speaking which, if you know anyone that's had a stroke (my mother and mother-in-law both recently died after strokes) this is not the norm.

http://www.nhl.com/ice/news.htm?id=751450

Weird, I thought all dentists recommended sealing as a matter of course. Maybe I was just lucky.

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