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Comment by svantana | Hacker News Reader

I find it strange that there is so little innovation in the field of everyday tooth care. Particularly the inefficiency of brushing one tooth at a time. I like the idea of https://blizzbrush.com/, has anyone tried it? It's a bit suspicious that the single-pack is "sold out", but the 5 and 10-packs are not.

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I think it's because incumbents in the space have played a huge role in preventing adoption of new technologies that actually prevent disease. Dentists make money not from preventing disease, but from performing procedures when disease has already progressed to the point of no return.

Cavities and gum disease are bacterial infections that are completely preventable. I feel the need to plug what we've been building at https://www.bristlehealth.com/. We've built an at-home test that leverages the microbes in the mouth to detect disease, and provide actionable and personalized recommendations that can reduce your risk of gum disease, cavities and persistent bad breath.

> Dentists make money not from preventing disease, but from performing procedures when disease has already progressed to the point of no return.

I find that hard to believe as dentists wouldn't be the group of people I'd imagine developing those new ideas and products. How would that work?

Nobody wants to go to the dentist until it’s too late, because it’s so expensive nor covered by health insurance.

Even if it’s not intentional, dentists aren’t R&D specialists. They’re a service, at a premium price, whose livelihood depends on people going for treatments.

What lever do they have to prevent new products from being developed that help people take care of their teeth?

The lever is the lack of funding and motivation brought about by the previous factors. It’s not an individual choice, rather a medical industry wide systemic issue.

They don’t have one. There is no lever. This is conspiracy theory nonsense, but even if there was a lever they wouldn’t need to pull it.

I move in social circles with a lot of people from the dental care industry and I can tell you that no one is worried about running out of treatment opportunities.

I’ve met hundreds of dentists over the last 18 years and they all spend their days asking patients to brush and floss. It’s a simple thing, it's pretty cheap, and prevents almost all oral diseases regardless of diet or genetics. It's easier than changing your diet. It's a LOT easier than changing your mouth biome. It's practically a miracle cure when done regularly with decent technique.

And… the vast majority of people simply don’t brush and floss like they should. I'd guess that the group that does is about the same size as those who actually get enough exercise, which is about 23.2% in America[1]. People consume mind-boggling amounts of refined sugars and generally don’t take care of their teeth.

There is no sinister cabal keeping people in cavities and gum disease because, it’s simply not needed.

[1]https://www.cdc.gov/nchs/fastats/exercise.htm

This seems a pretty likely reason, especially when you see this sort of thing even for regular medicine: https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie...

Dental is so much more profit oriented that it would be actually insane to think they're devoting R&D towards something like preventative medicine.

If you are in the US, like me, you might not be aware of Novamin toothpastes. They are available in other countries. It is my understanding that it can enclose dentin tubules exposed by enamel loss.

This article provides some background:

https://medium.com/@ravenstine/the-curious-history-of-novami...

I've had bad teeth since adulthood, partly due to a medication changing the pH of my saliva, and partly due to a Pepsi addiction.

I swear by the Novamin tooth paste, my life has gone from always having small aches and icing in my teeth to my teeth hardly being a factor anymore.

I was considering this recently based on a thread from last week:

https://news.ycombinator.com/item?id=31954800

Do you have a reliable source to purchase? I've no interest in purchasing via Amazon, wouldn't feel comfortable trusting the content.

I have, after years of deliberatng, decided to use an electric toothbrush. Its been 2 years and I want to know what I should be expecting. Maybe I am sleepy when I a brushing so I don't notice but asking still.

Novamin sounds interesting. Its available here on amazon so I might splurge on it but again, what I am to expect out of it as opposed to regular Colgate ?

For me it removed that icy feeling.

been doing nano-hydroxyapatite for the same reason. I use stannous fluoride based toothpaste in the morning and nhdpa at night before bed.

CPP-ACFP (a.k.a. Recaldent) is better than Novamin, at least according to one study:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006878/

Isn’t Biomin the same thing

There is quite some innovation, but consumers are slow to adopt IMO.

Last year, my dentist warned me I have quite severe receded gums. This was due to me pushing my toothbrush too hard.

So, after doing some research I bought an ultrasonic toothbrush. These have a static head (it does not oscillate/rotate) which emits ultrasonic waves to clean your teeth. Same principle of an ultrasonic parts cleaner. The head is still a traditional brush, though very soft. The brush is used to transfer the sound waves, you do not use it to 'scrub' your teeth. There is not friction involved.

From my experience, I can highly recommend an ultrasonic toothbrush. It takes some time to get used to, but personally, I will never go back to a traditional 'friction' type brush (manual or electric).

The model I have is the Silkin' ToothWave. Prices have come down significantly since I bought mine (I paid >€200 IIRC, now they are ~€90).

Note that some vendors sell traditional 'friction type' oscillating electronic toothbrushes with ultrasonic as a feature. In my opinion, these do not offer much benefit, it is better to go for a fully ultrasonic model.

Interesting. I've also had success using a Sonicare but always moving from the gums to the tooth (instead of along the gumline as the manual suggests).

Looks like 250 EUR on their website?

Looks like that pricing has not been updated for a while. I paid something like 200 euros, that was about a year ago. Most online retailers in my country now list them for less than 100 euros.

Weird. In Dutch (https://silkn.nl/toothwave-black) it’s €119.

In English (both EU and GB), French, Spanish, and German ( e.g. https://silkn.eu/toothwave-black) it’s €249.

Huh, interesting!

I'm not sure if I am comfortable with the idea of sending ultrasonic waves into the brain every day ...

This isn't a totally crazy concern: focused ultrasound (fUS) can be used to modulate brain activity non-invasively (or even make therapeutic lesions).

However, a toothbrush is almost certainly not going to do that. The skull's impedance is way too high for the dinky transducer in your toothbrush and even if it weren't, you need to do all sorts of clever corrections to focus the ultrasound on a particular spot.

Maybe it prevents Alzheimer’s?

Where do you get them for 90? I only see them at 190 in Germany.

https://www.idealo.de/preisvergleich/ProductCategory/3233.ht...

You can get it here for 99 euro in the Netherlands: https://www.bol.com/nl/nl/p/silk-n-toothwave-elektrische-tan...

https://silkn.eu/toothwave

This site has them for 250 euro. I assume that's the cheapest for a US customer that is ordering?

Oh, they don't ship to the US. How do US customers buy this?

They have a US page here: https://silkn.com/products/toothwave-1

I see thanks. How do they compare with the much cheaper phillips sonicare toothbrushes is the question.

How often do you change brush heads? They are quite expensive at $15/piece.

I have used it for about a year now, and haven't need to change them yet. It comes with 2 brushes in the box, and I'm still using the first brush, it is not showing any signs of wear.

The main thing is that you do not need to brush with any friction. You just move the brush gently over your teeth, so they barely wear.

For me this is also why I like it. With traditional hand brushes, I'd wear them out in 3 months or so. In hindsight this was a clear indicator that I was pushing way to hard on them.

Is this different technology? I have one of these but haven't used it in years.

https://techcrunch.com/2010/07/09/solar-powered-toothbrush/

Are these ultrasonic toothbrushes actually using ultrasonic waves? I have an expensive sonicare toothbrush and a cheap noname $10 "sonic" toothbrush from the supermarket and can't really tell the difference between both. Both feel like a standard toothbrush with a phone vibrating motor put inside.

FYI, at least one review of multiple studies have shown that ultrasonic tooth brushes are no better than sonic toothbrushes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175112/

This sponge you put in your mouth made me think for the first time about how much bacteria is potentially on a normal toothbrush.

I'm betting this product is even less hygienic since it's a sponge instead of only bristles.

Why not leave your toothbrush in hydrogen peroxide overnight?

Good idea, it's just I never thought twice about the cleanliness of a toothbrush. I guess it's been ingrained in me to think it's normal to run a toothbrush under water to "clean" it.

You are supposed to change the brush every few months precisely for this reason.

I thought it was because the hairs on the brush get 'blunt' from erosion on your teeth. The 'applied science' guy had an electron microscope capture of new and old toothbrushes and it was the differences between needle sharp edges and worn out clubs.

I remember a myth busters episode where they demonstrated that toothbrushes left in open air will easily get fecal matter on the brush hairs due to aerosolized poop from when you flush an open lid toilet. Definitely a great conversation ice-breaker.

Are toilets in the bathroom common in your country ? Here, in France, they are a separate room - which also helps with multiple simultaneous uses.

They're common in North America, maybe because having bigger houses and therefore having multiple bathrooms is also more common.

I've never seen a bathroom without a toilet in it in France. Is it regional? Or could it be a matter of the types of lodgings like flats v.s homes?

I've seen the splitinh in actual house in the Netherlands and Belgium so maybe some Northern France houses also split?

It's considered luxury in the united states to have the toilet enclosed in a smaller room inside the bathroom. Most American cities are expensive enough per sqft that it's certainly not standard to have a larger bathroom capable of enclosed toilets.

Even growing up in a lower cost of living area, I would associate a master bathroom with an enclosed toilet room as a luxury or wealthy amenity.

Good to know. I've always wondered why my bathroom has a separate little closet-sized room with a toilet. I always thought it was worse because you can't wash your hands until after you've touched the flusher handle and the door knob. Of course any reasonable person with two hands will use separate hands, but it's just weird to me.

Additionally, there was a towel rack in that room. I took it down because, again, it makes no sense. Why would anyone need a towel in the toilet room?

   After confirming that a toilet flush does emit an aerosol spray, Adam builds a rack to hold 44 toothbrushes at various distances from the toilet in the shop, as well as two controls kept in the office. Each day, Adam and Jamie exposed the brushes to toothpaste and rinsed with distilled water, with brushing with a pair kept right above the toilet bowl. Fecal coliforms were indeed found on all the test brushes, including the control ones, but none at a level high enough to be dangerous. A microbiologist from UCSF confirmed that such coliforms were impossible to completely avoid, and that there was no significant difference in the number of bacteria based on where the toothbrushes were placed in respect to the toilet bowl. This surprising result prompts the narrator to proclaim "Some myths are best left unanswered!"

Since the controls were kept in his office... it does seem like it's impossible to avoid fecal coliform bacteria.

If that's the case, I'm going to convince myself that I'm doing my immune system some good exposing it to such horrors in minute quantities..

It has bacteria that was already in your mouth right? Unless the bacteria multiplies and grows outside of your mouth I don’t think it’s much of an issue.

It isn't but some people want things 100% germ free so they'll jump through hoops to sanitize. I wash my hands, rinse the head of the brush, and use a peas sized bit of toothpaste, brush a couple minutes. Twice a day. Electric toothbrushes are too complicated and annoying. Toss after three months. You can also use a stannous fluoride based tooth paste as well as it has germ fighting capabilities over and above regular fluoride based toothpaste if that's your jam. I use boka which is a nano-hydroxyapatite based toothpaste like is commonly used in japan. No cavities in the past decade and hygenist always complements me on making her job easy. I use stannous fluoride in the mornings and n-hdap at night before I go to bed.

My wife uses those denture cleaner pills. They work amazingly well.

Do you refresh the H2O2 every day?

I don't do it personally, I would if I was paranoid about germs.

I got one of those little spritzers, like for putting perfume or febreeze in, filled it with 3% h2o2, and spritz my electric brush every day after I rinse it, cause it was getting a little grody in the crevices. Works great, dirt cheap.

The point of brushing your teeth isn't sterilizing them. The point of brushing your teeth is to reduce the number of nutrients for bacteria to feed on, and to physically disrupt their environment - like running a lawnmower over an anthill.

Isn't there something about changing the ph balance?

For me the "unbreakable" floss string combined with a floss pick in this particular product: https://www.amazon.com/DenTek-Triple-Clean-Floss-Picks/dp/B0... was a massive innovation that finally allowed me to regularly floss easily at the age of ~30.

Prior to that I couldn't handle the floss string well, and all other floss picks (even nearly identical ones from the exact same brand) just snap apart between my very closely-spaced teeth.

Totally agree there's too little innovation in this field.

I hadn't heard of the Buzz Brush and it's fascinating to me, although it does look half-baked and too indie at the moment for me to trust it with my dental health.

Also it's too expensive to try as a throwaway test.

Any other cool innovative products that replace standard brushing?

Not that replace standard brushing, but I worked with a company in Denmark called Novozymes. They produce enzymes for a variety of applications including dental care. They have a set of enzymes that they license to Unilever for a toothpaste called Zendium, which has some market share in Northern Europe. The enzymes break down microfilm that develops on teeth, making brushing more effective. There was RCT done on it I believe, I read the paper years ago, can't seem to find it now though.

Any concern those enzymes would get swallowed and break down membranes in the digestive tract?

Seeing as they pass through the acid in your stomach (and will denature there, which is the point of your stomach) you must be primarily worried about any of the bits before that. These enzymes are made to go in your mouth. If they dissolved the tissues in there they wouldn't be appropriate for that, so this is not a concern.

Based on the video, I wouldn't implicitly trust the brush to have enough precision to hit the small chunks of food at the gumline.

Not buying it. That would only work if it were firmer because as it is now I'm extremely doubtful your teeth will magically fall into those grooves when the sponge has so little structure. On top of that it seems hard to clean, A toothbrush is open and has short bristles and often after rinsing it I'll look and still find debris where I need to clean again and deliberately get pieces out.

In grad school, one of my friends worked for a US medical device manufacturer. They had several dental innovations that they did not bother to market in the US because the regulation to get approval out weighed what they felt the market offered. They made their profits in other countries and were happy with that.

Have you seen how much it costs to get crowns or implants? There’s zero incentive for innovation, people keep bringing their money.

I would like to think that most dentists like their patients to have healthy, cared for teeth and that they play in important role in it. I would not like to think that most of them actually work to our detriment so that they can do more expensive, painful procedures on our mouths and teeth. That’s a pretty cynical outlook I’d need to see evidence for.

I’d like to think that, but my dentist makes about $170/year from me having healthy teeth. They make $1500/crown (in addition to the $170 for cleaning).

I’ve been to three dentists this year. I find it interesting that one said I had an emergency and needed a crown right away (a year ago), one said they’d watch the tooth, and one said nothing.

Cynically, I don’t like agency issues where experts make lots of money off their advice and it’s difficult to double check.

I had a dentist for several years and everything was normal just clean and go. A new hygenist shows up and suddently "You have severe plaque below the gum line we need to do a deep cleaning (root scaling/planing)" so they do that and it's almost $500, next time rolls around and she says it again and dentist concurs. I had been brushing and flossing diligently (probably too much) since the last time and just looking at my teeth saw nearly no plaque. I left and said I'd call them back to schedule. I go to a new dentist the following week and they say I have lovely teeth and it looks like I've been taking great care of them, then I tell the dentist what the previous one had said and he's like "listen, I'm not going to bad mouth anyone, but your teeth look great, they just need a typical cleaning that you came in for". That's when I knew something was really wrong with the other place, so it happens. I know my story is anecdotal. Personally I think my old dentist got rid of her previous hygenist that wouldn't agree to hornswoggle patients and they tried to get me to do expensive treatments.

Both myself and my partner had similar experiences at the dentist. They found work that needed to be done, we got second opinions, and were told something completely different.

I stopped trusting dentists since then. If I can feel or see a problem (in the mirror or in xrays), then sure, I'll get it fixed. But, if my teeth feel perfectly fine, I'm not going to rush into getting them drilled out.

I had four different opinions in the last two years:

- It gets inflamed because other teeth keep pushing on the gums. You need to get them pulled

- I don’t know why, let’s just apply antibiotics for the 10th time

- It’s a cavity, let’s wait till it grows

- Use these tiny between-teeth brushes for your gums

The last one actually helped.

All you need to do is visit the dentistry reddit sub and look at threads like this: https://www.reddit.com/r/Dentistry/comments/vnv25a/how_is_he.... They all operate on "production" because billing is top priority.

I don’t doubt that money is their highest priority, as that is the case for most people when it comes to their job. But the implication that they are sabotaging our teeth or giving bad advice in order to be able to bill us for bigger procedures down the line is a much bigger claim.

It happens. From https://www.theatlantic.com/magazine/archive/2019/05/the-tro... :

> Year after year, Lund had performed certain procedures at extraordinarily high rates. Whereas a typical dentist might perform root canals on previously crowned teeth in only 3 to 7 percent of cases, Lund was performing them in 90 percent of cases. As Zeidler later alleged in court documents, Lund had performed invasive, costly, and seemingly unnecessary procedures on dozens and dozens of patients, some of whom he had been seeing for decades. Terry Mitchell and Joyce Cordi were far from alone. In fact, they had not even endured the worst of it.

Of course it happens. I didn’t say, “it never happens.” I’m saying most dentists don’t behave that way.

They don't have to sabotage people, all they have to do is nothing - in terms of researching new better ways to prevent issues - and they're already set.

No incentive to innovate is very different from sabotaging. I’m sorry you see it this way.

A close friend of mine is a dental hygienist. He once worked for a dentist in Ketchum, ID who had all the hygienists on a commission structure. Basically he was told to “sell” procedures that were virtually not necessary. Some of his coworkers were making $250k/yr as hygenists… Needless to say, he couldn’t stomach it and left the practice. He’s worked for many dentists and he ultimately left the field because the majority of clinics he worked for tended to be a business first and look after your best interests second.

Generally, I would agree that most dentists want their patients to have healthy teeth. In my dentists they seem relatively thorough and consistent in what they observe with my teeth as far as health and function. And they are pretty specific with preventative measures that don't make them money (recommendations on possible problem areas to make sure to focus on for flossing brushing) and some that do (mouth guard to prevent grinding).

HOWEVER, all of the dentists that I have had push cosmetic procedures really hard. Teeth whitening, alignment (cosmetic only), caps (cosmetic only).

You’d be surprised but dentists care about making money to provide for the family. Just as most of us who work. They don’t sabotage anything, there’s no master plan. They just come in, see your cavity, make a 300$ filling or 1000$ crown. Rinse and repeat. Then they clock out and go home.

So who’s actually going to actively work on creating new groundbreaking dental products? What would the incentive be?

You could say this about almost every job. I like to think that the entire population isn't trying to actively sabotage things to generate more work. I certainly don't go seeding bugs or complex situations in to software to create more demand for my job.

It’s not about sabotage. Just that there’s no incentive to invent a new generation of dental hygiene products.

My daily tooth care consists of 3 steps:

1. Clean between teeth by using an interdental brush

2. Clean between teeth by using a water flosser

3. Clean teeth surface by using an electric brush.

I am not sure how would the sponge replace these 3 steps.

I remember some articles about good bacteria outcompeting bad bacteria in the mouth and preventing cavities. Seems like it probably didn't pan out.

Nah it did, the problem is you have to take a pill every day and they cost way too much for that sort of frequent usage. Like $60 per 20 pills kind of price, which is hard to justify without hard proven evidence of actual benefit.

How did you get this price? Can I get them somewhere? $3 per day to never have teeth issues again is an absolute bargain.

I think I saw it on amazon a few years back? It's possible there wasn't enough demand to keep selling it, but I've also no idea what it was called anymore.

I want something that I can use in the office (i.e., without easy access to a sink).

idk, I think the 1 pack means that people are wiling to try it but have not decided as a mass if they want to continue use. It doesnt mean its a bad product

It’s just an over regulated industry where it’s too expensive to try new things.

Dentistry exists all over the world...

Capitalism only creates innovations where there is potential for expanding profits. Permanently fixing teeth is infinitely less profitable than keeping them in a constant state of disrepair.

This looks like a really bad dropshipping site...

Especially considering the fact they've imported reviews from elsewhere, like AliExpress (even has the same name format, C**e).

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