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Comment by epgui | Hacker News Reader

As a biochemist, this seems to be a very complex issue that has been unnecessarily politicized. What happened with this report is interesting in and of itself, but I would not draw any conclusions (or make any inferences) from this, frankly.

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As someone who comes from an area with clean fresh water, that does not contain added fluoride, this is not a complex issue. It's simply not a question that comes up. People have good dental hygiene here.

To my mind, yes sure you can over complicate the entire debate, but all of that is irrelevant in the face of these basic points:

- Is there a chance that fluoride ingestion could be detrimental to human health? - Can tooth decay be prevented by diet and brush/floss with good quality toothpaste?

Presumed safety of chemicals (at the behest of organizations) to human/environment until proven otherwise is shocking to me.

They irony of all this is that if you want to buy good quality toothpaste you are forced to import it from overseas, due to the FDA limiting ingredients in toothpaste.

> but all of that is irrelevant in the face of these basic points:

> - Is there a chance that fluoride ingestion could be detrimental to human health? - Can tooth decay be prevented by diet and brush/floss with good quality toothpaste?

When evaluating those points, be sure to assess what actually happens, in real life, to real people, and not what could happen in theory.

For example, even if tooth decay could be effectively "prevented by diet and brush/floss with good quality toothpaste" in theory, the effect might be smaller (possibly much smaller) in practice, as people in general suck at lifestyle changes, dieting being a prime example, and then a noticeable subset of the population has problems with regularly brushing their teeth (for some reason, this is surprising to many). Unless you have a way for fixing that (so far no one has), this may well make fluoridated water come out ahead in comparison.

EDIT: The above is similar to the argument for, e.g., opt-out health insurance and social retirement savings plans - you're still free to choose an alternative or decide to stay with the default, but if for some reason you can't understand the choice or can't be arsed to make one, you and everyone else are better off with you having some insurance and savings by default. The similarity is that we know for certain that the "incapable of making a choice" bucket will contain a substantial segment of the population, so at policy level, making health insurance/retirement savings opt-in with nothing as default, is just deciding to screw all those people over.

Nobody is screwing anybody over when the water supply is not poisoned (which is the case for nearly every European country). The basis of "contract over status" that let us advance beyond feudalism is mutual assent (or do no harm to the counterparty). What you're describing is essentially centralized tyranny and comes in many forms ("think of the children!")

And no, your health insurance / social retirement example doesn't fit. Sticking to the default in these cases does not amount to willingly poisoning oneself.

My understanding is that some water sources naturally contain fluoride anyhow so this isn’t a great comparison. From the sources I read awhile ago they started fluoride additives because it was known that certain areas like Texas had bad teeth.

It’s a circle that all people talk about in regards to caries is fluoride.

And literally, no one will talk about molybdenum. Maybe Texas has low levels of molybdenum?

https://journals.sagepub.com/doi/pdf/10.1177/222941122016020...

    They irony of all this is that if you want to buy good quality toothpaste you are forced to import it from overseas, due to the FDA limiting ingredients in toothpaste.

I never heard such a thing. Can you be more specific? Plus you can buy Darlie toothpaste in most Chinatown's around the world, even if unapproved by local dental orgs.

International versions of Sensodyne contain Novamin, which is a teeth-material-like compound that layers over your teeth to protect it.

It has been proven in many clinical trials to not only reduce sensitivity, but also protect against tooth decay and cavities.

Ever since I started brushing with Novamin my dentist has started being really positive about the condition of my teeth in a way I’ve never experienced - even though I haven’t had a cavity in at least 20 years. I didn’t tell him what I’ve been doing.

Interesting. I use Sensodyne for a completely unrelated reason: it does not contain Sodium Laurel Sulfate. I have not had a cavity in my entire life, and I'm over 45.

What's the connection between the first and second claims you make? does SLS cause cavities?

Toothpaste with SLS causes ulceration (canker sores) in some individuals (myself included). See https://en.wikipedia.org/wiki/Aphthous_stomatitis

SLS does not cause cavities.

I mention that I like this toothpaste due to the lack of SLS - not for the cavities prevention. But I've not had any cavities, so that is another datum on top of the others who mention using this toothpaste and not having dental problems.

Not sure for them but SLS can irritate sensitive skin.

I guess you need to pay more attention when you read:

> I use Sensodyne for a completely unrelated reason

Why isn’t it in the US?

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

Basically FDA won't let them label it without studies. Other countries consider toothpaste a cosmetic and don't requite studies.

You can get it on Amazon, since they don't do a ton of vetting or enforcement. You can also get toothpaste with Biomin, a substantially similar deal (its manufacturer claims it's better).

For me, novamin/biomin didn't seem to make a difference with tooth sensitivity.

I always thought anti fluoridation sentiment in Utah was related to them having the highest dentist count per capita. It’s the only state that I know of where fluoridation isn’t common.

Dentists are the ones who are pro-fluoridation … at least it was a dental trade group that fought the release of this report (maybe they are funded behind the scenes by a different interest group)

The cynical position would be that dentists in areas without fluoridation have more work.

Maybe. At least the Dental academy and association of LDS Dentists thinks so:

https://www.deseret.com/2000/9/29/19531458/fluoride-brochure...

It was a weird position against back then similar to the anti-vax position today.

It seems pretty simple. Stop putting toxic waste in the water. If you’re worried about dental health, cut the sugar and use those little interdental brushes in addition to flossing and brushing well.

In theory, obesity can be solved with diet. In practice, it is a complex issue.

What do you consider necessary for “good quality toothpaste?”

I’m not OP or american, but i can comment. >1,500ppm concentration of fluoride is prescription only (so you either pay for a pointless dentist visit or get it on the grey market), despite being safe and much more effective at remineralisation. There are also experimental ingredients such as nanohydroxyapatite and Novamin which are difficult to find on the american market due to the FDA

Novamin works wonders. It took me the last 30% of the way to not being sensitive to heat/cold/acid.i got about 20% there with just normal sensodyne toothpaste and another big chunk with vitamin k complex and vitamin d supplementation (this took about six months to be really noticeable). The order was dictated by me figuring out what i wanted to try and general availability in the case of novamin. So i cant really say if the relative help from each intervention would be different if tried in a different order unfortunately.

For the record, the only clinical evidence about Novamin is very vague.

For the record, the rest of the stuff I mentioned has middling evidence for effectiveness as well, it's just the things that worked out of the myriad of things I tried that didn't. The vitamin k complex and d thing especially has limited evidence (and recently a paper came out that showed k2 increasing artery calcification, which is concerning but maybe not as bad as one thinks since the really dangerous part of arterial calcification is when it is in process. it also didn't control for vitamin d status and the hypothesis of k2 causing bone/teeth remineralization and not soft tissue mineralization usually hinges on d status being adequate).

Reminds me a lot of my struggle with migraines before the recent, good treatments came out. I was facing a certainty of at least one migraine per day everyday of my life. Led me to trying all sorts of stuff. Not exactly the best experience but better than migraines.

I just tinker as a hobby. If i live long enough even the minor annoyances in my life will eventually get iterated on and improved. The teeth thing was a medium to major annoyance so got attention first.

Just try it for a week. The glassiness feeling it imparts to your teeth is real.

Warning: Excessive fluoride is known to stain teeth with white steaks. You see it a lot in people who drink certain types of Chinese tea, high in fluoride.

This is called fluorosis and it only affects children. Ingestion of excess fluoride in early life changes the development of permanent teeth and causes white speckles.

Novamin used to be available via Sensodyne Pronamel in Canada. I was surprised to see that at some point it disappeared from our market - no longer able to buy at any grocery store or pharmacy or on Amazon, whereas it used to be available in all of these places.

It's still available, look for "Sensodyne Repair and Protect" (no other name). Shoppers Drug Mart has it, Superstore, Walmart, etc. Most everywhere. We also have other options here with nanohydroxyapatite that are easy to get too, from X-Pur to Davids Toothpaste. Those products tend to be more expensive though due to higher %, whereas Sensodyne tops out at 5% Novamin.

Also as a Canadian you should avoid Amazon for groceries and most hygiene goods, they're overpriced even compared to Shoppers Drug Mart most of the time, half of the time the goods aren't even offered by the company but instead by a random middleman charging absurd markup.

It's now in Sensodyne repair and protect and I usually buy it from walmart.ca 6-10 tubes at a time. There was about 2 years there where I had to buy it on ebay shipped from India though. I did try Biomin and I think that even if the material performs better than novamin, the rest of the toothpaste is so inferior to sensodyne that as a whole it works worse, for me at least.

IME high fluoride can agitate the digestive system, so perhaps the limit is for good reason?

Don't swallow the toothpaste!

I don't.

> >1,500ppm concentration of fluoride is prescription only

Man that's silly. Where I am (Australia), 5000ppm is chemist-only, but doesn't need a prescription

Carifree sells (expensive) hydroxyapatite toothpaste in the US.

My wife comes from a country that did not add fluoride to the water. She has very good dental hygiene but here teeth are not in good shape for her age. That's one data point that I have observed.

>That's one data point that I have observed.

As with many things genetics plays a big part.

I neglected going to the dentist for 15 years and take just ok care of my teeth (brush at least once per day, don't floss).

I was expecting bad news, lots of cavities, but my teeth are perfect. After some plaque removal, not a single cavity.

Asked the dentist about this, he shrugged and just said "genetics".

I'm sure they do, but the dentists here have told her that lack of fluoride is her problem. She is using a night time fluoride paste to help.

It might not be a fluoride, it might also be a lack of molybdenum.

https://journals.sagepub.com/doi/pdf/10.1177/222941122016020...

Interesting, I didn't know about molybdenum.

Her home city of Hanoi doesn't have tap water that the locals like to drink. Even after boiling I think it can taste bad. So she grew up with heavily filtered water or bottled water. I would guess her diet was lacking in many trace minerals from this.

Dentists don’t do genome sequencing, so they have no way of ruling out genetics.

Sometimes you don't need to rule everything else out to be confident in a diagnosis.

In this case it’s more “when all you have is a hammer (fluoride)…”

The therapy appears to be improving her teeth. Is there something I am missing?

Just because a treatment works doesn't mean it's the best treatment, or is treating the "cause." To say that a lack of fluoride is the cause of their bad teeth is silly. Not eating sugar/acidic foods, Novamin, or a different set of bacteria in her mouth would also improve her teeth.

We used a toothpaste with novamin in it. That didn't help her. She doesn't eat much sugar. She's 40 something kg and eats very healthy.

I’ve noticed the same thing living in Taiwan. They don’t fluoride the water, and in general people have pretty bad teeth with caries and decay that I never see in Americans in their 20s and 30s. The highly sugary diet probably doesn’t help either.

Citing: https://pubmed.ncbi.nlm.nih.gov/24308394/ which recommends flouridating salt.

"Children and adults of the low socio-economic strata tend to have substantially more untreated caries than higher strata. Salt fluoridation is by far the cheapest method for improving oral health."

Sure, good for you that you're in one of the higher socioeconomic strata who can take care of their teeth. Not everyone else is.

>recommends flouridating salt

That is a scary recommendation. Would be very hard to avoid fluoride if restaurants, packaged food etc all used fluoridated salt

It’s not particularly scary. In fact almost all salt has added iodine for public health reasons.

Iodine and fluoride aren’t really the same thing.

Iodine is essential, you cannot survive without it, and it is added to supplement a deficiency.

Fluoride is not essential, you can survive without it, and its addition is purely therapeutic, not due to some deficiency

As a biochemist, I know this perfectly well. But the motivation behind your “this is terrifying” was left as an exercise to the reader, so there was no way of distinguishing it from “omg the chemicals”.

It already is that way. Your steak came from a cow that drank fluoridated water, the salad was watered constantly with fluoride. Your bread was baked with fluoride water, same with your coffee/beer/tea. Your Mayonnaise even.

Doubtful on the steak and salad. That water typically gets pulled from different kinds of wells, not municipal drinking water supply

Besides being politicized, views on this issue will also be affected by personal experience. I've lived much of my life in Oregon, where there is no fluoridation. It seems to be widely believed by dentists here that people growing up in Oregon have poorer teeth and that it's largely because of the lack of fluoridation. I'm not arguing the merits, just pointing out the cultural belief.

What you’re pointing at is a scientific question of fact though, not a cultural belief. It’s the (or a) conclusion you’d likely reach after completing dental school.

There is a cultural/political side of the question, however: given that we know water fluoridation is safe and relatively efficacious at preventing caries, are we willing to pay for it and actually do it, and how much do we want to listen to people’s arbitrary feelings on the matter? That is a valid political question.

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