Reports of the death of dental cavities are greatly exaggerated
mcgill.ca
mcgill.ca
"Guarantees" are not strictly needed. What matters most is whether there is a substantial reduction of future caries, not whether it makes you totally immune to it.
Say, if Lumina/BCS3-L1 "only" reduces cavities by 50%, it is already half as good (arguably) as a drug which prevented 100%. This would already be large progress for such a massive global problem. The article author does not seem to recognize the potential of such a drug.
There is an existing 'probiotic' that has been around for years and works the same way, and promises the same benefits, as the one described in the article, it is called Streptococcus salivarius M18, there are quite a few studies that indicate it does work to some extent [1]. You get them in the form of lozenges that you put in the mouth while sleeping and they dissolve by themselves, so not a very invasive treatment if one wanted to use it.
[1] https://www.google.com/search?q=Streptococcus+salivarius+M18
Yeah, emphasis on "plain". It's proposed as an addition, not an alternative, to conventonal tooth brushing.
Streptococcus salivarius M18 seems also interesting, but its results in preventing caries are much more limited, from what I can tell. It also has be taken continuously (once per day), instead being a one-time application like BCS3-L1.
That's what the clinical trials and studies on the early adopters are for. There's lots of interesting commentary on the early research, such as Scott Alexander's write-up, that are much better than this article.
Putting my conspiracy theory hat on, the dental hygiene industry in the US is for-profit, like the pharmaceutical, and would rather sell you a treatment than a cure.
I tried to have a dialog with my child's dentist about nano-hydroxyapatite. I was interested in their thoughts about it, not as a replacement for fluoride based therapies, but in addition to them. Rather than having a discussion about the merits of both treatments or discussing any concerns about compatibility, the dentist adopted an attitude that was belittling and made me feel like I was an anti-vaxer. The suggested we could just not do any fluoride therapies at all.
It was very odd and alarming.
It's really confusing, and quite tiring.
So not so much perfect being the enemy of the good, fluoride isn't perfect either, but it is good. This is potentially extremely harmful, and possibly even a source of something like a new AIDS pandemic...
Yet another example: In early 2020, for a few weeks many news sites claimed that face masks don't help against coronavirus transmission because there was "no evidence" that they did. Of course this wasn't true (the evidence was just limited, and the protection wasn't optimal), and they changed their tone quickly once multiple non-Asian countries started to introduce mask mandates for visiting public places.
That isn't a great sales pitch.
It’s not even a question of whether it would spread, but whether it might spread. There’s a reasonable chance that this bacterium would, in fact, spread, and nobody has proven otherwise.
The FDA is doing its job here: it’s protecting the masses from people who believe they’re just consenting for themselves.
We should all be quarantined, all the time, by this criteria. Regulatory bodies have a great cognitive bias towards fictional 'purity' of systems that are in actual scientific fact, messy and routinely contaminated in various ways.
Lumina is a genetically modified bacteria. It has no research supporting its effectiveness because the original inventors never bothered to conduct a human trial; they just said that it probably works based on testing in a petri dish. (Note: lots of drugs work in petri dishes and laboratory animals. Very few go on to have success in humans.)
Notably, the founder of the current company selling it has does not have a background in dentistry or microbiology and does not understand how his company's product actually works.
If you had read the article you would know that they did bother but the regulatory body set requirements for such a study so high that they couldn't perform it.
With endemic organisms (or viruses) they just are going to run wild regardless of how we feel about it. There's no point in banning a naturally occurring algae because excluding it from the environment is not a practical option.
The only time when we have any strong control over what organisms are in an environment is when they don't yet exist there, but we have the ability to introduce them. This is our only technical choke-point, so it makes a lot of sense to make a big deal of that decision, and probably to be quite conservative about it. You can always let the cat out of the bag later, but you can never get it back in.
“So to start, they’ll be selling Lumina in Prospera, a libertarian charter city in Honduras. Prospera allows the sale of any biotech product under an informed consent rule: as long as the company is open about risks and the patient signs a waiver saying they were informed, people can do what they want.”
https://www.astralcodexten.com/p/defying-cavity-lantern-biow...
If you need more information, we recently developed a free website to get you started: https://lifelongsmiles.hk/
For example, just the order of how you present information matters. Compare these two approaches:
1. "If you don't floss enough, then <BadThing> may happen. Here's tips on how to floss: A, B, C."
2. "Here's tips on how to to floss: A, B, C. Btw, this can help prevent <BadThing>."
The first is better. "Boring" information ceases to be boring and instead becomes compelling when you have a strong reason to want to know the information. Thus, it's important to hook people by giving them that motivational reason to watch/listen before you jump right into a video or article. Otherwise, you will likely only retain viewers who already arrive with their own personal motivations.
The site follows approach 1 as you suggest (at least it does today).
Thanks for sharing these!
The interdental brush video is a bit more "intense" than the rest. Can't be helped: you need to show someone with teeth gaps. Perhaps move that one down in the list so newcomers start with a more gentle video?
I wanted the interdental cleaning part to come first, because it usually gets neglected and it's just as important as tooth brushing.
But I like your suggestion to change the order, as that would indeed give a gentler introduction.
The problem with the interdental brushing video specifically is that we can't show how to use larger brushes on young healthy patients, as they don't have the spaces for it. But I will think about how we can improve that video (the comment above suggested moving it down in the page, to start with the 'gentler' videos).
Quote:
The water companies that are currently required by the Secretary of State to fluoridate some or all of their water supplies are:
United Utilities
Northumbrian Water
Anglian Water
Severn Trent Water
South Staffordshire Water
Second, you'll get water poisoning before you'd get fluorosis from tap water. I challenge you to find anyone who has gotten fluorosis from tap water alone
https://www.adn.com/alaska-news/article/where-water-turned-d...
Clearly there’s a lot more to this than what you’re claiming.
Unless you’d propose that all of my current problems are due to conditions while I was child or similar.
We know that caries are caused by acid eroding the teeth. And we know which bacterial species produce this acid, how quickly they secrete it, and how common they are. The most significant source is Strep. Mutans. Sugar is an input to this process, and Xylitol (a sugar alcohol) can kill this bacteria selectively.
Diet is probably the most significant way to affect gum disease. Gum disease is associated with systemic inflammation and auto-immunity. The same dietary interventions that are used to treat those conditions also treat gum disease.
Generalizations are usually not helpful, I think it really depends on the dentist. I'm not sure there are proven benefits to oral microbiome testing, except in some very specific cases.
> The most significant cause for caries is S. mutans.
The 'Beyond Streptococcus mutans' section in TFA explains that the situation is much more complex than this; even if it is, good oral hygiene and reduced sugar intake (both in quantity and frequency) are still the best way to reduce the amount of biofilm present on teeth (which is a requirement for caries formation, whether S. mutans is there or not).
> Diet is the most significant way to affect gum disease.
The current clinical treatment guidelines for periodontitis[1,2] only mention that the benefit of weight-reducing diet and lifestyle changes is unclear (for treating periodontitis, obviously), and that oral hygiene is still the most important thing you can do yourself for the prevention, and, once established, to assist in the treatment of the disease.
[1] Infographic: https://www.efp.org/fileadmin/uploads/efp/Photos/Continuing_...
[2] Source article: https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13290
Good job with your daughter! FYI, we are working on expanding the instructions to children, so watch this space ;)
I once had a dentist who claimed I had a cavity every visit. I saw him once a year, and he did little more than look at my teeth. I've since switched dentists three times as I moved around the country and my dental insurance changed, and with all three, I've gotten nothing but rave reviews about the state of my teeth. I see my latest dentist twice a year, and he does an X-ray and an intraoral scan every other visit, and on my most recent visit, he discovered that one of those alleged cavities my first dentist had filled was filled improperly and appeared to have become reinfected. Unfortunately for me, I was busy at the time and postponed treatment for too long, and now the filling has fallen out and the tooth has collapsed in on itself, requiring a root canal and a crown, which in addition to being somewhat painful, will likely set me back several thousand dollars.
If you have access to the Journal of American Medicine (JAMA), I highly recommend reading this recent review of overdiagnosis and overtreatment in dentistry[1]. If you don't have access to JAMA, you can find pertinent excerpts in this Reddit post[2], along with some interesting backlash from some thoroughly offended dentists (all of it without any real supporting evidence, of course, though some of the points brought up are worth considering).
[1] https://doi.org/10.1001/jamainternmed.2024.0222
[2] https://old.reddit.com/r/Dentistry/comments/1cql9a8/interest...
I skipped the dentist for 18 years, and during the earlier part of that span I had pretty sparse dental habits. I went in expecting the worst, but I had 1 cavity, and it was shallow enough to be drilled no novocaine. Nowadays I just brush once a day.
Thank you for letting me brag, because the other parts of my body, like heart and lungs, are total shit.
My ADHD makes brushing my teeth daily impossible. Yet, I went to the dentist today (first time after a decade)and had only one small cavity.
My partner on the other hand brushes multiple times daily and had surgery last year, because she had a particulary bad cavity.
Some dentist say, they don't kiss their kids, so they don't infect them with the cavity bacteria, but I kiss my partner all the time for decades and my teeth never got worse from it.
There were times when I drank energy drinks and ate sweet snacks daily, didn't make it worse either.
This seems absurd. Almost all microbes we consume (including in supplements) are transient. It takes a LOT for a community to actually establish itself. They have to be pretty well adapted to the human oral environment
https://www.sciencedirect.com/science/article/pii/S266714762...
https://www.nydailynews.com/2016/08/03/flossing-has-no-prove...
Also, the New York Times magazine had a piece on the Prospera island in Central America last weekend, was interesting as well. Supposed to have fewer regulations but the previous government is trying to reclaim it.
https://www.nytimes.com/2024/08/28/magazine/prospera-hondura...
I tracked down the chain of citations here. The directly cited article (https://www.nature.com/articles/sj.bdj.2018.81) says the following:
"These caries ecological concepts have been confirmed by recent DNA- and RNA-based molecular studies that have uncovered an extraordinarily diverse microbial ecosystem, where S. mutans accounts for a very small fraction (0.1%–1.6%) of the bacterial community implicated in the caries process.[20]"
Note the sudden conversion of "implicated in the caries process" to "cause caries".
The next step in the citation chain is https://www.cell.com/trends/microbiology/abstract/S0966-842X....
"In recent years, the use of second-generation sequencing and metagenomic techniques has uncovered an extraordinarily diverse ecosystem where S. mutans accounts only for 0.1% of the bacterial community in dental plaque and 0.7–1.6% in carious lesions[14,15]."
Now the claim is merely one of prevalence!
The next steps in the citation chain, https://karger.com/cre/article-abstract/47/6/591/85901/A-Tis... and https://journals.plos.org/plosone/article?id=10.1371/journal..., do seem to plausibly provide evidence that there are other mouth-colonizing bacteria which would perform the same function as S. Mutans when it comes to causing caries, such that fully eliminating S. Mutans probably wouldn't eliminate caries entirely.
But, importantly, the citation in the McGill article doesn't much support the original claim, and this citation chain could easily have bottomed out in a completely different set of results which didn't happen to lend some (weak) evidentiary support to the high-level claim.
Also importantly, this article is committing the sin of figuring out some reasons why a treatment might not be perfectly effective in all cases, and implicitly deciding that justifies ignoring any non-total benefits (i.e. cases where S. Mutans would have been counterfactually responsible for causing caries, that could be prevented). Questions that would have been appropriate, but were apparently uninteresting:
"Does this intervention also happen to chase out other acid-producing bacteria that fulfill a similar ecological niche as S. Mutans?"
"What percentage of caries cases would be prevented by chasing out just S. Mutans with this intervention, while leaving other acid-producing bacteria untouched?"
Likely this is because answers to those questions would not really have changed the bottom line. That bottom line was written by the "unanswered" safety concerns (reasonable in the abstract, less obviously reasonable in this specific case). All of the listed safety concerns have evidence pointing in various directions. Very little of that evidence is listed, probably because it's not in a format that's legible to scientific institutions. The article does note, earlier on, "The toxicity of this Mutacin-1140 compound had not been tested. What would be the consequences of millions of bacteria in the mouth releasing this compound? The answer wasn’t clear, even though the archetypal compound in the family Mutacin-1140 belonged to was known to be very safe." This is obviously relevant evidence about the safety of Mutacin-1140. _How much_ evidence? Unasked, unanswered. (I have no idea how predictive the safety of other compounds in the same family is of another unstudied compound in that family, I'm not a biologist. But this is not an _unanswerable_ question.)
(Marginal conflict of interest: I know the Lumina founder socially. I have no financial interest in that venture or any of his other ventures. I have not taken Lumina myself.)
Why not just let people experiment on their own with the original low acid bacteria if they want? It’s already there in the wild. You’re already “painting your teeth” with different bacteria when you kiss people, so why not at least let some people pick which naturally occurring bacteria they can expose themselves to instead of letting it happen by random chance?
A lot of the hype about Lumina seemed to be goofy, but the hand wringing over “painting your mouth with bacteria!” is just as bad if not worse.
That was after they decided it needed to outcompete the existing bacterium and added a mutagen to kill it off.
1. Better bacteria is found in the wild, it might be able to significantly reduce cavities. People could be randomly passing it to others through kissing, and no one is concerned about it since it doesn't seem to be harmful.
2. It’s not given to people for replacement therapy because (as the article states) people decided that a replacement therapy “needs to meet a number of criteria."
3. Except meeting that criteria makes people think the replacement isn’t safe and shouldn’t be tried.
The article is saying “of course we needed to add X characteristics to the bacteria, they were necessary in order for it to be a good replacement” and then goes on to say “of course people shouldn’t be using the bacteria with X characteristics, X characteristics might be dangerous.”
I think you're confused about which changes to the bacteria were natural and which were engineered. A strain in the wild was discovered that produced a weak antibiotic that it had also developed a resistance to, but it still had the original metabolic pathway that produced lactic acid. Researches took that strain and genetically modified it to produce ethanol instead of lactic acid, and then relied on the natural antibiotic-related mutations to get this strain to replace common S. Mutans in the oral microbiomes of test subjects.
The useful non-acidic property of the strain is entirely artificially introduced. The natural mutation in the wild just allowed for outcompeting and replacing bacteria that lack it. There would be no benefit from personally experimenting with the natural non-engineered strains.
Like sure that won't answer all questions, but it seems like it would shed some light on if other bacteria cause cavities or not, and if nothing else a basic starting point.
And all my teeth aches are gone, one less problem to worry about.
This matches reports by others that K2 seems to pull calcium out of your saliva and into your gums/teeth where it should be and makes them stronger. Maybe. It does seem to keep teeth more "squeaky clean".
The word “cause” seemed to be doing a lot of lifting
how are you going to make any progress if you block research and experimentation consistently into areas that conveniently line the pockets of the state-protected dental guild?
More generally, am highly skeptical of this whole genetic modification drive for replacement of undesirable creatures like mosquitos and screw worms and now bacteria. Sure, sounds like a great idea and may work for the advertised benefits, but look who's funding it and how keen they are on developing vectors to human blood and what other tampering may occur that would be undetectable to anyone without millions of dollars of sequencing equipment. It fits in with the biosynthetic technology drive towards transhumanism alongside nanotechnology, worth researching before jumping on the "Homo Deus" bandwagon that paints us as 'hackable animals' whose soul is due to be extinct (quoting the top transhuman posterchild N. Harari). Worth deeply investigating the other side of the story, most clearly outlined by Prof. Anita Baxas, but also see Dr. Edward Group, Dr Ana Mihalchea, Karen Kingston and Dr. David Nixon.
Oh come on.
There’s a good chance all it’s doing is rinsing away or diluting existing acid.
If I can do that for $250 I don't see why not. They're pretty clear it's not a replacement for brushing. I think of it as preventative care (assuming it is actually safe of course).
1. infecting yourself with this bacteria may not do what it is marketed to do
2. may result in suppression of beneficial microbiota
3. is not safe against lateral acquisition of a gene that is beneficial to the microbe but pathogenic to the human host
4. there is no real kill switch
for a lot of money, you might just end up buying a lot of health issues.
Either you didn’t read the article, or you’re blatantly ignoring that we don’t understand the long term implications of having this bacteria in your mouth and gut microbiome.
There may be no problems at all… but we don’t know. This is why FDA regulations exist. The product being sold in Prospera to skirt regulations should be a red flag anyway.
I’m not saying that it can’t or won’t work. I’m saying, be careful. If you can prevent cavities by brushing with fluoridated toothpaste and flossing, why would you adopt a potential risk that could affect your health?
[0] https://www.prospera.co/en/visit
[1] https://www.nytimes.com/2024/09/15/podcasts/the-daily/prospe...
Archive: https://archive.is/fwjcD
I think this company's latest news is the version of their toothpaste that has fluoride [2] is now FDA-approved for sensitive teeth, so they're going to be able to sell it in the United States specifically labeled to help with sensitive teeth. If you live in Canada or the UK [3], it looks like you can order this now.
Just noticed a blog post on the UK site: Why you shouldn’t over-prescribe fluoride to your patients - https://biomin.co.uk/news/article/why-you-shouldnt-over-pres...
[0] https://news.ycombinator.com/item?id=26669660
[1] https://drcollins.com/collections/toothpaste/products/biomin...
[2] https://biomintoothpaste.com/
[3] https://www.biomin-toothpaste.com/products/biomin-f-75-ml / https://biomin.co.uk/
Bought just this past Sunday and delivered this morning, had zero issues finding and ordering it :)
You can do your own experiment: $10 for a tube, plus $6 shipping. If you have sensitive teeth it’s worth a trial.
Here's another from 2022 that compares Colgate fluoride toothpaste against BioMin F(https://shorturl.at/M4hiQ).
Been doing this for years and have nearly perfect teeth due to it, flossing, and non alcohol based anti-gingivitis/anti-plaque mouth washing.
Also, people who think fluoride is bad for you or think it's not effective for teeth are exactly the kind of people I'm terrified of paying in the context of developing software. I really wish people would wear their love of homeopathy, and other psudo-scientific bullshit more clearly so they can be more easily avoided.
The issue is people (rightly imo) oppose the latter and throw the baby out with the bathwater
20-30 years later and humanity has had precisely zero benefit because of the FDA's simply absurd, technically impossible level of overcaution in this scenario.
It is incredible how much medical innovation is being held back because of these sort of politics. I hope the people that constantly cheer on more regulation or the FDA itself take a look at cases like this and hundreds of other similar cases where companies have simply given up on safe, promising approaches due to the regulatory red tape.
Enabling medical progress is far more important in the long term for our species (and to reduce suffering) than adding the umpteenth killswitch/safeguard for an ostensibly safe medicine.
But FDA regulators have no incentive in the positive direction, only in the negative direction. The more drugs they deny, the less likely they can be blamed if something goes wrong; the more requirements they add, the more secure their careers - humanity's medical progress be damned.
There is an entire political party representing something like half the population of the US dedicated to shrinking the regulatory apparatus, including the FDA. That doesn't sound like career security to me.
Go take it to some other country if the FDA is the problem.
Why didn't that happen here for many decades?
There was a slight, statistically significant decrease in cavities. That's meaningful at the population level, but at the individual level you're better off just using mouthwash or flouridated toothpaste.
Source? The article says something else.