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Comment by EMM_386 | Hacker News Reader

Please, I beg science ... anything like this.

I do what I'm told to do. Yet as the years pass it's been cavities, root canals, extractions, crowns, and everything else.

The worst part isn't even the procedure, it's the cost (in the U.S. at least!). Thousands and thousands of dollars any time they need to do anything. And that's with dental insurance. They like to deny claims.

Dental should be covered under medical but that's an entirely different story. For now, I hope science keeps working on this.

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The best dentist I ever had was the one we had at the Apple campus. He was paid by Apple and everything was covered by corporate, more or less (whatever the insurance didn’t cover beyond copay was paid by Apple if I recall correctly).

I saw them for awhile and we got friendly. He was a younger guy and told me that he was probably one of the few honest dentists in the area because his pay wasn’t dependent on high dollar procedure to make enough to keep a practice open. Apparently, unlike medical insurance, dental insurance pays pittance for most things, so upselling procedures is how dentists really make money, usually.

Best dentist I ever had. Rarely did I need more than regularly scheduled cleanings and when I did he always started with the least invasive options (I grind my teeth in my sleep and before I realized it and got a guard there were complications)

I miss that guy. I’ve been suspicious of dentists ever since and look for signs.

> his pay wasn’t dependent on high dollar procedure to make enough to keep a practice open

> I miss that guy. I’ve been suspicious of dentists ever since and look for signs.

Now you can imagine how the avg person sees the cloud spaghetti coming out of a trendy boutique - being informed their 'perfectly fine' BSD box and ZFS setup needs to become a latent chain of 900ms microservices.

Some cases it is the play, but often it's RDD from new hires or grifters.

When I first got to the Bay area I saw three dentists, and gave them the same x-rays.

The first recommended I get eight fillings (which is why I went to the others).

The second recommended I get two fillings (which I did get).

And then the third recommended I get none.

Needless to say I'm now also suspicious of dentists.

Ugh I feel like I got so many fillings prematurely due to trusting a doctor when I was young and timid.

In Canada, they're essentially running a business, and one which (decades ago) specifically avoided the socialized health system which we have for regular doctors and such now.

I've got pretty good teeth, but am certainly wary of some of the recommendations I've had. Did have to have a molar out (hole all the way to sinus), no doubts there. The regular dentist said, "hey, you should get a bridge!" The specialist who did the removal and bone graft let me know that was the worst possible choice. Better to leave a gap, or get an implant if I want, but a bridge is caps on the adjacent teeth that will eventually wreck those teeth too. So him, I trust.

Making a bridge is considered malpractice now. This is what my younger dentist told me. I had an older dentist in the past who recommended a bridge.

Making a titanium implant or just leave it is the best option. Only if you are over 80 years or have some other issues (making it more risky to do the implant operation) should you go the bridge route instead of making an titanium implant.

To make a bridge you have to destroy (grind down into cones) two teeth adjacent to the bad/missing tooth onto which they glue the bridge. Crazy. On top of that you will forever have issues cleaning below the bridge which probably also causes your other good teeth to decay as more food and bacterias are sticking around.

CBC marketplace had a great special going to different dentists.

They found all had widely different recommendations on the number of fillings required.

Similar story. Moved to Bay Area, coworker recommended dentist told me I need to pull all 3 wisdom teeth left and get a night guard. Quotes me >$3500.

Funny that I went to the dentist in my home country just before I moved and they said all good. Went to another dentist (which I'm still with and absolutely love) and over past 4 years we haven't pulled a single wisdom tooth and I still don't have a night guard.

And the piece has at the very beginning: "The idea of growing new teeth is every dentist's dream. I've been working on this since I was a graduate student. ..."

I'm not sure how involved this new teeth growing process is, but I can imagine it's not going to suck as much value out of you as a dentist can. Perhaps this isn't even done at the dentist (I hope so actually.)

I always felt like I was getting screwed by my dentist, but then I walked through a, what we'd here call a "volksbuurt", a neighborhood that isn't particularly rich. Saw a dentist, and it seemed more like a community place. I walked in, registered and have loved it ever since. They think along with me, tell me to get insured because something big is coming up next year and they can shift the current work to January (when the new insurance starts), they are very transparent about cost, explain why things are needed. I really appreciate that. They even told me that the pain I experience can go away without any major intervention if I really started to floss daily, it worked indeed.

Similar stories exist for garages (the place where they fix your car).

I have a bad experience with night guards and it seems to be something dentists like to prescribe unfortunately. I got one as I had pain in one tooth and it was due to grinding and closing my mouth hard in the nights.

Once I started with the night guard I got even more pain and after a month or two my tooth cracked and had to be repaired.

As there is even less space (as you have the plastic stuff between your teeth now) it seems you press even harder which damages the teeth even more. Maybe against light grinding movement it can help, but against pressing your teeth hard together at night it does definitely not help.

The best advice I got was to remind yourself at night when going to bed (and during the night when you notice it) to open your mouth a little (still with the lips closed) so that the teeth do not touch. It's a habit thing. I also noticed I grinded/pressed my jaws together more if I went to bed late.

Maybe the pressing the tongue against the palate and practicing proper tongue posture (so called mewing) isn't without merit. The force of the tongue counteracts the jaw muscles.

https://www.rd.com/article/how-honest-are-dentists/

Good read, but

>This article originally ran in the February 1997 issue of Reader’s Digest.

Similar. I saw a dentist in SoCal when I was visiting my family (I live in the UK) and I was under some misguided impression dentistry was better in the US. Very fancy office, took colour X-rays, then told me I needed all 6 of my fillings redone and a mouth solution to protect my gums. Total amount around 3k.

I decided just to go see my local UK dentist. Shabby office, black and white x-rays. They said all my fillings were perfectly fine and showed me on the X-ray what they look at. They also told me the gum wash (which cost $150) was unnecessary.

That was 6 years ago and I haven’t had any issues with my teeth.

There are plenty of honest dentists in the Bay Area (and America). If you're well informed, it's easy to tell based on a combination of Yelp reviews and what they recommend when you come in for an exam. Most of them only take higher paying PPO insurance, or don't take insurance at all (well, they're out of network).

I also grind me teeth. One dentist recommended me a guard. Just really don't like the idea of sleeping with plastics in my mouth 8 hours a day. What type do you have?

I had one dentist put some kind of lacquer type of thing on my molars (so that this material is ground down instead). But I've never been able to find another dentist that does it

Maybe somebody knows what this procedure is called?

Fissure seals?

Fissure sealant was what I think I had as a kid. Teeth were cleaned + dried with air + sealant was `painted on` + cured with UV I think.

yeah, looks like that's it. It's a bit uncomfortable to chew the first few days but I'm guessing it does the trick. Maybe it's suboptimal for teeth grinding? But sleeping with a guard sounds way more of a hassle

> regularly scheduled cleanings

Which appears to be a purely aesthetic procedure.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

That paper only looks at the effects on gum health, not cavities.

Dental calculus also seems unrelated to cavities. It may even have a (slight) protective effect.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950958/

https://pubmed.ncbi.nlm.nih.gov/9776022/

The first one is about just 1 tooth they found in a pool of 1000 extracted teeth. The second one says "there was a high association between gingivitis and plaque status with calculus accumulation" in the abstract, thus contradicting your earlier comment.

The one from my earlier comment is a meta study, so it bears more weight.

Over 2-3 years, which isn't insignificant, and does suggest cleanings can be done less frequently, but it isn't particularly long term.

I'm curious if that still holds over say 5 years. And how does it intersect with other practices. For example are people who don't floss religiously more likely to benefit from more frequent cleanings, etc.

From personal experience I need a regular cleaning every year and since I'm not cheaping out anymore on this as I did as student my teeth related health problems went to 0. I think it is useful if you aren't that disciplined with taking care of it yourself. I forget to floss every other time or simply forget to brush at times when I sit at a longer coding session and might eat during it but then forget to brush teeth afterwards. Procedure always removes plenty of scale/tartar.

My dentist had a Harley Street branch, they were expensive even for a routine check up, but they were the best I ever had, honest, didnt try to push additional treatments on to you, could discuss different treatments and they would explain the pro's and con's of the different treatments. They knew I didnt mind spending money on my teeth and it was out of my pocket not insurance schemes, but they were perfectly frank and honest which was a rarity and much valued quality.

There was no waiting around in waiting rooms, it was a top notch service in every way.

My only concern which I found out recently, was the increased used of xrays to check the teeth can increase the incidence of thyroid cancer.

Another dentist I knew who wrote their own software even said my dentist was expensive.

You get what you pay for.

I am very suspicious of dentists; I recently went to one because an old filling fell out and suddenly, they wanted to do tons of new fillings. I had only 1 visible cavity, but the x-ray showed some decay on the sides of the teeth of others. I had the visible cavity filled and booked to do the rest, but I cancelled it. With the new filling I'm having mild discomfort that comes and goes, but I think that's mostly because I hate how fillings feel. I am still procrastinating on getting a second opinion. The thing is that fillings eventually will fail after 10-20 years, so they are not only getting that business up front they are setting up a future revenue stream. It's hard to know who to trust, even from highly rated dentists.

It is also one of the most heavily sought after physician specialities for PE roll-up. Consolidation of back office functions and technology really drives cost savings as there is little variation between treatments, consolidated purchasing power with supplies and, to your point, a lot of add-on opportunities to upsell patients.

My story is only about my doctor wanting to do additional x-rays because I had new insurance. She saw it as a way to get paid and I was already tired of getting offered another service at every visit. I told the practice I didn’t want another set of x-rays 6 months after my last when my insurance allows every year just because I had new insurance. You would have thought I had offended them, hygienist, front office and dentist all tried to change my mind.

There's also the question of how much dental "care" is really that. I will just throw some random stuff out there.

* It used to be more popular to remove wisdom teeth. Opinions seem to have changed on this over time, I've never had mine removed, in my 40s now and so far so good.

* I had a small crack in one of my molars and saw a dentist who said a crown would be necessary. I was skeptical and got a second opinion. The second dentist immediately said "It's small and I don't think you need a crown for this" and did a filling instead. Eight years later, so far so good!

* Even FLOSSING was removed from the U.S. Department of Health's recommendations several years ago because there is a lack of evidence that it's effective! (I still floss around a couple of teeth every day in places where food likes to get stuck.)

To do a crown the dentist has to grind down your tooth into a stub and irrevocably destroys the enamel in the process. To me an unnecessary crown sounds like borderline malpractice. I wonder how many other unnecessary procedures dentists are doing for the $$$$.

Your first two points seem legit, but if you pay attention to the measurements they're taking it's pretty easy to notice that your periodontal pocket depths increase or decrease based on whether you've been flossing or not (mine do at least). And it's pretty obvious that deep pockets are a decay precursor.

Exactly. IMHO, dentistry has been a scam for 100 years. Every 80 year old I know doesn't have teeth. Anytime you ask for another opinion they act like the last dentist was an alien. I think flossing is important, but when they tried to do a study, nothing worked because all the dentists are lying scam artists -- so if you floss or not is irrelevant.

The lack of evidence for flossing astounds me.

I know that when I don’t floss, my gums will bleed sometimes during brushing and/or they’ll get inflamed. When I do floss regularly, absolutely no issue with bleeding or inflammation.

It’s so clear to me that I can’t imagine what the difference is between my anecdata and whatever actual data is coming from these studies.

>When I do floss regularly, absolutely no issue with bleeding or inflammation.

Do they bleed during flossing though? I used to get bleeding gums after brushing teeth, but switching to a softer toothbrush stopped it. Flossing, at the start, does cause my gums to bleed though.

Only during the first 2-4 times (and lessening each day) after having not flossed for a while.

After that, I never bleed during flossing. And I make sure to get it up between the gum and each tooth, so there’s a decent (but appropriate) amount of floss/gum friction.

For me, flossing causes bleeding during the first week. Afterwards, the bleeding stop and my sensitivity to temperature improves greatly. My halitosis goes away on most days, too.

My dental hygienist knows when I have been flossing and when I haven't.

Yeah, that went away pretty quickly when I started flossing regularly really for the first time, a year or two ago (my dentist having strongly advised that I need to). I do feel like it has made a positive difference, but I have also cut back very significantly on sugary drinks over roughly the same period, having improved my diet a lot, so maybe that made more of a difference...

Flossing or brushing only causes bleeding for me when my gums aren't healthy. For example after getting a proper cleaning my gums won't bleed for weeks or months.

If they start bleeding again it's a sign I've not been doing a good job staying on top of keeping them healthy.

In my observation, flossing does work . The toothbrush can't get to the crevices that a floss can. My gum bleeding only happens when I'm flossing too rough or when I'm starting to floss after a few days of skipping it.

One of the issues in the now infamous meta analysis was that many of the studies analyzed found some benefit, but they were low quality studies.

So this doesn't necessarily mean that flossing doesn't work. It may just mean that dentists are already making money hand over fist and don't care enough to do good studies and validate that.

BTW what was specifically looked at was whether unsupervised flossing works. So another possibility is that flossing properly works but a lot of people do it ineffectively.

All things you would want a conscientious, science-based ADA to care about

Also surprised, it seems to make such a big subjective difference. One tip I got from a busy dentist who did not want more business: smear a little toothpaste on the floss before using it, work through all the places where teeth contact. Gets flouride in places where it normally would not get to.

The high priests of dental religion er.. science is currently holding a trial over evolutionary dentistry

Dr Mike Mew, of 'Mewing', faces misconduct hearing - https://www.theguardian.com/society/2022/nov/14/orthodontist...

Once I went to a new dentist in a new area to do a teeth cleaning. He told me I had 4 cavities that needed filling. I was skeptical so I went to another one the next week. He said 2 cavities. I went to two more that month to see what else they'd say: one said no cavities, the other said 6. That was 8 years ago, I still don't have any cavities.

I know my dentist sees cavities that he just lets be because they are not an issue.

It seems a lot in dentistry of what does or does not need to be done is subjective.

> more popular to remove wisdom teeth

Even the pushy dentists have rarely recommended removal of wisdom teeth unless they are trouble. I mean if it's pushing inside the muscle area towards bones or screwing up things for other teeth you have to. If it's forming a cavity area (like in my case) you definitely should get rid of it.

Wisdom tooth removal is not rite of passage. It's need based and often the needs are real and very much "needed".

> Even FLOSSING was removed from the U.S. Department of Health's recommendations several years ago because there is a lack of evidence that it's effective

This is bizarre because I can feel the change in my mouth everyday with and without flossing. I am not sure there is a need for some kind of empirical evidence here. Especially if there are not gigantic mountain pass like gaps between your teeth.

Yeah the crown job recos are often con jobs. Whenever I have been advised a drastic dental job I visit a Govt or a charitable medical college dental hospital here (India) and get a consultation. I do not get "polite" or "sophisticated" service there :D but I get honest and expert to the point advice.

I'm not suggesting that no one should floss. The opportunity cost is low. You have nothing to lose by doing it, other than a couple bucks spent on floss. It's similar to multivitamins, the evidence on the benefits of those is also low quality, but the most you have to lose is a couple of bucks.

In theory if you think in an evidence-based way your positions on flossing and multivitamins should be about the same, which is interesting.

What's really important though is that the profession of dentistry has not felt the need to fully study and establish the benefits of one of their most foundational recommendations.

Every dentist tells you to floss yet they have not bothered to establish reliable evidentiary proof that it works. If they don't care about evidence when it comes to flossing, what other procedures are they pushing without solid evidence of benefits?

The hot take way of saying this (and I do kind of believe this) is that dentistry as a medical science is in its infancy, and as a result, dentistry as a profession/business is partially snake oil.

All that said I have had one crown including a root canal done in my life, the need was clear and it was done well and professionally and I'm happy with it. So I'm not saying that everyone should ignore dentists but this imho is an important place in your life to consider getting second opinions and steer towards professionals who are less profit-driven when you can.

> The opportunity cost is low. You have nothing to lose by doing it, other than a couple bucks spent on floss.

I have ADHD. I hate flossing, and I'd put off flossing to the point where I wrecked my sleep cycle and tended to end up just not brushing my teeth before bed.

Ever since I stopped flossing, I've basically always brushed my teeth and have kept my sleep cycle more successfully.

Yes, I know this is potentially very bad dentally, but frankly I'm sick of having a catastrophically unreliable sleep cycle due to my mental illness and I'm willing to accept half-assing it if it means it doesn't destroy my life.

That said, I have no particular opinion on the evidentiary base of flossing - my dentist has always recommended I floss, and I believe his recommendation. I would floss if I could.

My situation somewhat overlaps with yours. I ordered a "water flosser" from everyone's favourite ecommerce site, and use it daily in the shower.

It seems to be doing something, and can't possibly be worse than my previous flossing regime which was: "twice a year the day before a dentist visit".

I wasn't willing to shell out for the name-brand water flosser, other options do the same job at the same water pressure for 1/4 the cost.

It took about a month to move up through the power settings. Start on the lowest and click it up when that starts to feel a bit tame.

I've now been using this thing for 6 months, it's just about time to find out whether I get my bi-annual nagging about the importance of flossing. My personal opinion: Cochrane's probably right, flossing is most likely bunk, but I'm pleased to have found a way to do it that I can stand

Sorry, how does flossing impact?

Plenty of other professions have these kind of best-practise recommendations that are not based on quantative data, so it’s likely something more universally human rather than a function of the profession’s age.

Flossing definitely works against bad breath. If you feel that you get bad breath at the end of the work day it might be a good enough reason for that alone.

I do the whole shebang as a curtesy to others, and I hope they will return the favour.

>Even FLOSSING was removed from the U.S. Department of Health's recommendations several years ago because there is a lack of evidence that it's effective!

I think that whether flossing is useful or not is highly dependent on the space between your teeth. I have small gaps between my teeth, and I floss three times a day. I can see the food come off on the floss. My father never flosses (jus brushes0, and never has any problems with his teeth, but he has large gaps between his teeth. Presumably, the bits of food just fall out.

A lack of evidence of course is not the same as no evidence.

First I'll say that I agree with you, there have been various treatments that never seemed to have made it into clinical trial and one that did make it but never became a treatment. Some where laser causing dentine to regenerate, one I remember was a certain kind of sponge filling made with an Alzheimer related treatment that would actually regenerate as the filling itself turned into dentine over time.

But what do you mean with do as your told? What do you use to clean your teeth? What toothbrush to do you use? What are the ingredients of your toothpaste?

What is the average PH of your mouth? Do you have acid reflux often? Do you eat sweet foods or flour i.e. simple carbs often? Do you eat a lot of fruits or salads before sleep?

I've had a long history of cavities until I actually started paying more detailed attention to what I eat, what tooth paste I use etc. None of that is stuff any of the dentists I went to ever told me. I panicked when a piece of my tooth broke off almost a decade ago.

BTW there is a treatment before you have to do root canals, I forgot the name, and most dentists don't do them. There is also a chance that it doesn't work and I assume that that's the reason why dentists don't generally offer it. I forgot the name but you can surely find it by googling. For a lot of people myself included don't an artificial gum transplant for receded gums also massively reduces exposure to dental issues.

There are certain calcium phosphote combinations like the Novamin thing that GSK bought and then forbade everyone else to use or Hydroxyapatite, which is sort of artificial dentine.

What toothpaste do you use? Does it have Hydroxyapatite?

I use the Biorepair night creme(it's actually Hydroxyapatite and Xylitol) and sometimes the sensodyne repair & protect(keep in mind that the German version does not include novamin)

When my root was exposed I did apply clove oil and completely refrained from simple carbs for the treatment and after until it healed.

EDIT: a lot of Japanese tooth pastes also have it by the way and there is no real guarantee that it works, but theoretically it's supposed to fill microabrasions temporarily.

Pulp capping is probably what you're referring to about more conservative treatment before a root canal.

Also in the US, and also frustrated with the cost of dental care. I was poor growing up, so the solution to major dental issues was an emergency extraction. And I’m not exactly rolling in it now, and having to deal with several missing fillings, all uppers needing considerable work after an ill-informed “LVI” veneer experience ~20 years ago, and a decade old temporary implant that I could never afford to have finished with the permanent. And yes, I do my damnedest to take care of my teeth. Issues just keep piling up, and just one procedure for one crown—with dental insurance—would still be >$1k.

It’s depressing, honestly.

It's super rough in NZ as well.

Dentistry (though not optional orthodontics like cosmetic braces) in NZ is free until you turn 18.

The day you turn 18, it becomes private care only, and it's entirely out of pocket - just as you go off to university and have no money for 3+ years.

Unlike the Anglosphere countries apparently, here in Japan dental care is considered "medical" and an essential part of healthcare, and is covered by medical insurance just like any other medical problem. Cosmetic stuff of course is extra, but the essentials are covered no differently than any other procedure.

Yeah— the distinction strikes me as vestigial.

In Germany it used to be that way a long time ago. Then it went into base treatment free(amalgam fillings) and rest paid. Having been in the backend of health policy in Germany I can tell you that German current health leadership has been pushing to move normal care in the same direction as dental care to make more money.

Health insurance in the US makes it super explicit: "health insurance" does not cover dentistry or anything vision related. Because being unable to eat or see is not a health issue?

It's worse than that. Of course, you don't actually "need" teeth to eat: you can just eat baby food all the time I suppose. But a lot of infections in people start in the mouth, and historically tooth infections were the cause of early death for countless people. There's a reason people needed bad teeth pulled in the days before modern dentistry.

And yeah, vision checkups are pretty important to: regular checkups find problems inside your eyes that will cause blindness later.

The US seems to do an absolutely horrible job of preventative healthcare. Here in Japan, everyone gets a free yearly health checkup that looks for all kinds of issues; it includes blood, urine, and stool testing, and also includes hearing and vision checks, abdominal ultrasounds, a chest x-ray, etc.

Yep, we get such a good start, then it's all downhill. At 18 you're hardly a responsible adult.. And it's not exactly cheap out of pocket here either. (though maybe better then the US? maybe)

Why not take a longer holiday to Turkey or Thailand once a year and do all dental appointments ? Should be much cheaper even with a flight and accomodation. I know some of people from UK doing this and flying to Turkey for yearly dental check. Dental clinics very professional there and you have English speaking staff.

If USA based maybe Mexico or Colombia also a good closer choice?

Dental insurance is usually pretty decent in the US, probably not worth leaving the country unless it's significant work. I have no idea with OP is getting done that costs thousands of dollars. Certainly that's an outlier.

No way, I have to get an implant and I was just quoted $4k with insurance.

An implant is certainly "significant work".

Once a year trip sounds totally fine for significant work

An implant involves multiple appointments over like 2-4 months.

Makes me wonder what the insurance company is paying, how much you pay them and if its even worth it.

My dentist (in UK) charges £2500 for an implant. I don't have insurance.

(technically I do have insurance, since NHS dentistry exists which I pay for in my taxes. However I had an NHS dentist and when they got sold on to Bupa they would simply not do things which would be expensive for them, meaning after some years I had fillings falling out and broken teeth all over)

They are paying my dentist what he charges. This isn’t far from other dentists charge.

Dental insurance in the us usually only covers a max of $1000

Without insurance you can often get reasonably priced dental care at dental universities if you have one local.

At least for anything students can work on (fillings, extractions, etc). If you need a root canal, ortho, jaw surgery, or etc then I doubt it'll be a great option.

I strongly urge people to avoid regular dentists for serious work that there are specialists for. They don't have the tools or expertise, and often leave people with broken jaws and infections that lead to more surgeries. Pay the extra; you'll wish you did when your jaw is wired shut, or you have to pay again to re-do a root canal, or go to emergency due to infection.

I’m an outlier. An implant was around $7000 out of pocket, with insurance.

I have had an implant and for me it was around $2.5k with insurance in the midwest.

Not so. Anecdata point: My wife and I dropped our Delta Dental insurance this year. We reviewed what we'd paid in premiums over the prior 5 years vs. the full cost of procedures we'd had done in that time. Full cost would have been ~40% of our premiums + residuals. In this aspect of life, we've decided to self-insure.

Yeah, dental insurance is primarily a tool for companies to provide a tax free benefit to employees. It doesn't make much sense to buy dental insurance yourself, unless you're high risk (get lots of cavities, etc.)

One of my front teeth got broken at a pool party in Thailand. I was able to get it fixed the next day with a walk-in appointment for $75. The fix lasted for something like 5 years.

You also have plenty of American-trained dentists, at least in Thailand, although I'm not sure they're any better than the locally trained ones.

The incentives in oral care actively work against the patient. Our current system focuses on treating the symptoms instead of the root cause.

You should have the knowledge required to advocate for your own outcomes.

I’m not affiliated with them, but I think that bristle health is a step towards that reality.

They offer oral microbiome testing and suggest personalized treatments to fix issues like cavities.

Allot of it is also education. I grew up thinking, if you get a cavity the dentist will fix it, no worries. But you're teeth can only be repaired so much, and every time it's more expensive.

I never asked any questions or tried to understand why I got cavities (in part cos of the cost). It was just... I have bad teeth, it is what it is. But it's not. there is allot you can do, foods to avoid, drinks to avoid (beyond the obvious). But things are getting better, some dental hygienists are on YouTube now, who teach how to look after your teeth.

Definitely, you can also add in foods and supplements to promote beneficial bacteria. But until recently finding objective measures of your interventions was hard.

Can you suggests some names? Unbiased (or some kind of polyphony) information on dental is so scarse its crazy

I came across Teeth Talk Girl a few months ago, allot of informative content, and seems pretty unbiased. There is also "Baseline Dental" and "Dr. Brett Langston" channels. Quality a bit mixed and somewhat promoting there place of work.

But yeah, still pretty dry out there, but better then a few years ago. Probably more on tiktok... but that's tiktok.

Bristle's blog is quite good https://www.bristlehealth.com/pages/blog

In Holland we (used to?) get these fluoride paste treatments when we're young. They reinforce the enamel and it works really well. I've had like 2 cavities and I'm in my late 40s. And I drink a ton of sodas.

That paste used to make me really sick but wow it does work.

Not sure if they still have this though because the neolibs have destroyed the state health system and replaced it with mandatory private insurance that doesn't include dental anymore.

The US has this as well :)

I know many in the US that fluoride treatments that are ridden with fillings. I think you have a tooth shape and oral microbiome, that is resistant to cavities, rather than the fluoride treatments. How can we know what the provided the benefit based on n=1?

Also General Jack D Ripper has concerns about the impact to P.O.E. ;)

Because it's not n=1. Most people from my generation have really strong teeth.

It's something that really helped, my dentist joked about being put out of business :P My parents' generation have really bad teeth that started going bad in their teens already.

It’s called fluoride varnish. The ADA use to recommend it only for children but in the last decade they updated their guidelines to include all ages. My dentist applies it now but my insurance does not cover it.

At least at my place, whilst also not covered, it's a $10 surcharge.

It wasn't applied like varnish though, it was gel in trays that we had to bite on for 5 minutes. Yuck.

It was indeed only for kids, the dentist said the enamel no longer absorbs it when the teeth are fully grown. But perhaps this has been disproven now. I'll ask my current dentist about it.

I completely forgot about those trays. Yuck!

As a US kid in the 2000s my dentist would give some kind of foam fluroide treatment. Foam would be put into two trays and you'd have to keep them on your teeth for two minutes. I remember hating it because it made me nervous I'd swallow some.

I still get fluoride treatments from my dentist but now it's something he paints on, perhaps the same as what you've described.

Anyway, according to a dentist friend, whether you get cavities is also dependent on the natural groves in your teeth. Some people's genetics cause them to have more cavity prone teeth than others.

Yes that's the stuff though for me it was gel in trays, not foam.

I was worried too about swallowing it but it was also the smell of it that made me sick. It was very strong. I really hated it.

And yeah I guess I'm not very prone to them, but it's very clear that the generations before me had much worse teeth than we do.

I used to have all sorts of issues with my teeth, and ended up with 2 root canals, and crowns, and had 1 of them go bad. Ended up with an implanted tooth. Yikes.

Learned later about how cavities work and figured out the best routine for my teeth - floss and then brush (Philips electric toothbrush) every morning. Brush and then fluoride rinse every night. I always floss/brush before breakfast, and wait at least 30 min after dinner to brush/fluoride rinse.

I haven’t even had a cavity in 5+years, and my dentist always says I don’t even have any plaque to scrape off - “you have good dental hygiene, and I don’t say that very often”

Sounds like you're doing great! But why floss in the morning instead of at night to give the longest time without food particles between your teeth?

This is not normal. It is 100% your diet.

Eat a carnivore diet and your tooth issues will go away. At least try to eat only real foods, never add any added sugar into anything and avoid all processed foods (treat rice and pasta as processed foods as well, they are not real foods!).

There are plenty of books out there that show that for all indigenous tribes, as soon as they got into contact with western civilization and started eating a carb heavy diet (beer & grains), their teeth rotted away within one generation.

Is the diet angle related to the contact of the food with the teeth, or is the related to something that happens after digestion?

If it were only related to contact of food with teeth, wouldn't rinsing your mouth after eating achieve the same effect as any diet like "carnivore diet"?

The diet angle is just sugar and carbs.

Immediate contact and for quite a while until you brush again. Leftover sugars are turned to acid by mouth bacteria.

I believe it's much more about nutrition, though there is a difference in oral microbiome too. Explanation at https://wholehealthsource.blogspot.com/2010/12/dr-mellanbys-... (The author, Stephan Guyenet, is not a carnivore-diet proponent afaik.)

Any examples of those books?

And by “carnivore”, do you mean specifically including meat? Or do you mean something completely different, like a ‘varied & balanced’ diet?

I find it odd to list the biggest change in a move from a more tribal to a more westernised diet as being “beer & grains”. I would have expected the increase in sugar and chemicals/preservatives to be the relevant factor.

I hope this doesn't come across as poorly stated, but I would highly recommend looking into possible dietary causes. I don't mean you are eating like a slob, but rather you are eating something which you are not supposed to eat either because it is too processed for your body or it is an allergen. Tooth decay can be cause by the diet you are consuming and if you are not consuming the correct nutrients( bioavailability is based on your genetics and not just the source of food)

To add to this, sugar/sweets aren't the only thing bad for your teeth. Other less obvious things like bread or pasta are terrible for the teeth. Basically the "simple carbohydrates" group of foods. Also acidity matters, try to keep it neutral like water/milk. (things like coffee or wine should be avoided).

Brushing times can also help and always floss at least daily.

If you're interested in learning more I would check out the teethtalkgirl YT channel. It's a great way to learn a heaps about teeth without paying $$$ at the dentist asking questions. (but you should still go to the dentist)

Anyway, that's my 2c, best of luck, teeth are the worst.

If this is all at one dentist, you may want to get a second opinion. It is very rare, but some dentists do more work than is necessary.

OP must have a disease or something. According to some brief research, $25B spent on out-of-pocket dental work in 2021, which averages out to like $70 per person. And I'd guess that a significant number of people don't spend a dime.

It's not a science problem. The system just robes you. For example, to replace one tooth with implant you need about 700$ in Belarus or about 1000$ in Poland. Ok, in these countries dentist has 1800$-3000$ netto. When I installed implant in Belarus, my dentist spent 30 minutes to remove tooth, make surgery to overgrow part of gum and install implant and then 20 minutes (after 3 month) to install new tooth. Let's imagine than in US doctor is few time slower. That means he need 4 hours for this. And let's imagine that ha want 100$ in hour. That still 400$ - nothing special. But I guess that in USA you will pay more then 3000$. As for materials and equipment, in US all this even chipper than in west Europe because all this is produced is US. And at the end you pay for unnecessary thinks like ad.

Do consider travelling to Mexico. There are many first rate dentists at a fraction of the cost in the US

If you don’t get dental insurance through work it’s generally not worth it (premiums > typical expense).

That doesn’t sound necessarily bad — insurance is for the extraordinary events anyway, right? But when my kid had his wisdom teeth out or I was hit by a car and needed a crown to hold a damaged tooth together, my regular health insurance covered it, not dental insurance.

This is expected in the US, the kicker is that even in the comfortably socialist EU dentists generally aren't included in the state healthcare unless it becomes an emergency room issue.

The dentist is in this regard a unique animal.

What are you told to do?

To f*ck your oral health, you need carbohydrate + an acidic environment.

It's weird to me. We've had hundreds of thousands of years with no dentists and toothpaste and now I'm told only way to keep teeth healthy is to brush twice a day with chemicals and an electric tool.

For hundreds of thousands of years people had bad teeth and died before they're 35.

True, also ate a lot less sugar.

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