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Comment by mishu2 | Hacker News Reader

It may still take us some time to reach that goal, but the good news is that we have an effective solution available right now: keeping good oral hygiene is known to prevent both caries and gum disease, and takes less than 10 minutes a day for the average person.

If you need more information, we recently developed a free website to get you started: https://lifelongsmiles.hk/

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My wife seems to be basically immune to cavities; I get them easily. I brush very carefully; she brushes only quickly. Our diets are the same — if anything she probably gets more sugar. We have the same water source. Etc.

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.

While there are indeed many factors (genetics, the specifics of the microbiome in your mouth, probably some we don't even understand at the moment) at play, oral hygiene (and diet for caries, but not gum disease) is currently considered by far the most important modifiable risk factor.

Considered by who? Dentists, or scientists? Dentists seem to be about 5-10 years behind the research on this topic. I know of a single practice that has started doing oral microbiome testing.

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.

> Dentists seem to be about 5-10 years behind the research on this topic.

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

Well, don’t forget genetics. Apparently 60% of tooth decay swivels on your genes.

That is frustrating. Does she drink more coffee, tea, water, during the day? Are your stress levels higher? Did your parents have similar cavity issues?

I'm the same, I brush and floss regularly, occasionally use chx mouthwash, dental disclosing tables and oral probiotics. She forgets to brush sometimes, eats more sweet. She had only one or two cavities in twenty years we've known each other. I've had two root canals and have fillings regularly. Truth be told, she doesn't drink coffee at all, I drink several cups a day. She also doesn't drink much alcohol, I have one or two beers every week. In addition to bad genetics (both parents smokers and developed gum disease) I attribute this to poor oral hygiene when I was a kid, parents didn't really control my brushing, so ended up with a lot of fillings. In contrast, we brush our kid's teeth every day religiously, almost 5, no cavities whatsoever, and she eats plenty of sweets.

I'm sorry to hear that. Like you correctly mention, genetics play a big role and are unfortunately (currently?) not modifiable, and there is plenty of evidence that a restored tooth is at higher risk of further issues/loss, so prevention is the best thing you can do.

Good job with your daughter! FYI, we are working on expanding the instructions to children, so watch this space ;)

How many different dentists have you been to in the past twenty years? Does she see the same dentist as you now?

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 think my current dentist might be overdiagnosing a bit, we were doing a bunch of work even though another dentist said everything was fine just a year before. My biggest regret currently is a decade old root canal done by my previous dentist that was never good and kept getting sore and inflamed in the gums. The new dentist eagerly redid the root canal a year ago but we eventually had to pull it out since a big abscess formed. Looking back, I should've extracted it sooner, since the bone was basically eaten away by lingering bacteria and I'll have to do some bone augmentation for an implant.

Did you have asthma as kid? I know a couple of people whose teeth are wrecked from inhaler usage. Now they tell you to rinse your teeth after using them, but didn't in the past.

No, but I do have a smaller lower jaw and wear a night guard because I do sometimes clench and grind (depending on stress levels, caffeine intake, etc). This might cause excessive wear. My mother also suffers from bruxism.

I'm the same as your wife.

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.

Same.

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.

> 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.

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

not a specialist, but diet is quite overrated for health, even for teeth health. Other important factors: BMI, exercise, sun exposure (natural vit D), life style/stress, sleep, ..

My wife and I are the same way. Wife maintains very good hygiene and has much more cavitities than I do.

You both probably have different mouth topologies. Maybe the wife's teeth spacing are such that the bristles in the toothbrush get in more effectively under the gumline, whereas yours need more work to reach the same nooks and crannies. it depends on how much enamel you have left as well.

I brush and floss every day but the cost is not trivial. Saving ten minutes EVERY day for everyone who brushes would be a massive, massive success. Not to mention it would improve health for people who can't get into the habit.

I suspect you'll still want to brush your teeth for reasons besides cavities.

A simple salt water rinse is enough to deal with halitosis. Much easier and the effects seem to last longer than prescription mouthwashes at a sufficient concentration.

https://www.sciencedirect.com/science/article/pii/S266714762...

The study you cited actually shows that salt water was only effective for 3 hours, vs 5 hours or more for the prescription mouthwashes. Furthermore, all concentrations of the prescription mouthwashes showed significantly reduced bacterial populations with continued usage (meaning, they got more effective over time.) while the salt water rinse did not.

My parents both have fillings in almost every tooth, my sister and I have none. Neither of us did anything particularly special, my parents were quite strict about sugar (for the UK in the 80s/90s) and we brushed our teeth twice a day. I never flossed regularly, though I have started doing it more in the last few years.

Fluoridated drinking water may explain the difference.

UK tap water isn't fluoridated

Not strictly true: https://www.dwi.gov.uk/consumers/learn-more-about-your-water...

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

This isn't entirely true: https://www.gov.uk/government/consultations/community-water-...

Fun fact: I'm visiting Uruguay right now, and they have fluoridated salt here! (it's iodized as well)

Fluoride treatments at the dentist and fluoridated tooth paste are a big factor in my area. A commenter also mentioned fluoridated water, which had the same objective, but it causes demineralization of teeth (fluorosis) and possibly behavioural / hormonal changes (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520156/, https://www.sciencedirect.com/science/article/pii/S001393512..., https://ec.europa.eu/health/scientific_committees/opinions_l... ). I'm glad fluoridization of water isn't a thing where I live.

"Have you ever seen a commie drink a glass of water?"

First, fluorosis isn't demineralization of teeth, it's hypermineralization, way on the other side of the spectrum.

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

So long as the tap water is correctly treated, it's not going to give you fluorosis, but in the event the plant breaks and no one is testing the water, it can happen

https://www.adn.com/alaska-news/article/where-water-turned-d...

Sure, their can be industrial accidents. But just because some company made a radiation therapy device that accidentally fataly irradiated people, doesn't mean that radiation isn't an effective treatment for cancer

Anti-fluoride people say the weirdest things.

Your parents probably weren't brushing with fluoride toothpaste when they were young, since it only became near-universal in the late 60s in UK.

Kids ate like crap in the 60s and 70s. Everyone in my family from that generation has dental issues. Both sides of the family. Just from drinking soda like its water.

Yes this is exactly my point. Simple lifestyle changes are really all that's necessary. I still see kids walking around drinking soda, I have to fight tooth and nail to prevent my little one from being given sweets and fizzy drinks on an almost daily basis (we moved to Czech republic, I don't want to be rude about my adopted home but the truth is they are quite behind on children's health and nutrition)

What's interesting is that there is no strong proof that flossing actually helps. The U.S. Health department had to take down their recommendation to floss because they couldn't produce evidence of its efficacy.

If you want to be inspired to floss more often, just smell your floss after not flossing a few days. Disgusting, and that's convincing enough for me.

Counter point: that's the stuff you're shoving deeper into your gum line. And to reiterate, I do floss. However, I can see potential issues with it that may counter its effectiveness.

Citation needed.

Flossing IS important:

https://www.nidcr.nih.gov/health-info/gum-disease/ask-the-ex...

https://www.ada.org/resources/ada-library/oral-health-topics....

https://eclkc.ohs.acf.hhs.gov/oral-health/brush-oral-health/...

None of your sources are studies with a strong causal link between flossing and dental health. People who floss do have other good dental habits, so there's definitely a correlation that exists. And remember, I'm making no claims either way, I'm specifically stating the current scientific evidence. I personally floss.

https://www.nydailynews.com/2016/08/03/flossing-has-no-prove...

My motto is you only have to floss the teeth you want to keep

Your heart's in the right place, but these videos are hard to watch.

Which one? I was looking forward to some awkwardness but all I can find are tutorials on teeth hygiene.

Dunno that it's awkwardness so much as the discomfort of watching someone with pretty messed up teeth forcing too-large ID brushes in between them

This exactly. I don't think the average person is as comfortable as a medical professional at starting at videos/images of messed up teeth, injuries, disease, etc. It's not exactly what we want to stare at when learning.

Also, while I'm at it, I'd suggest maybe putting an hour or two of research into how to make content… exciting? I know you're a dentist and a software engineer, not a YouTuber, but it's worth looking up a bit about what YouTubers and entertainers know about how to hold an audience's attention. Just a few small changes can probably result in a 1.5-3x improvement in the number of people who make it to the end of a video.

Another perspective, I don't feel like these informational videos need to be exciting. For this, I feel like 'just the facts' are a breath of fresh air.

Maybe exciting is the wrong word, but compelling is a better one.

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 very first video, pinned to the top, is titled "Why is oral hygiene important?" and lists both <BadThing> and <GoodThing>.

The site follows approach 1 as you suggest (at least it does today).

Thank you all very much for the feedback, it gives me a new perspective on things. We wanted to show a real case, rather than animations, because we thought it would be clearer for our patients; but we are probably desensitized to watching stuff like this. Would you prefer to see a 3D animation instead, or something else?

I actually really prefer the videos of real people doing the thing! I've literally never seen a video of how to floss - even at the dentist they show you how on a little model.

Thanks for sharing these!

I'm glad they were useful to you.

I watched all the patient videos and found them helpful. There's no substitute for seeing examples with a real mouth.

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?

Thank you for the feedback, I'm glad you found them helpful!

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.

We want clean, healthy and attractive teeth and mouths to stare at. Rather than the e.g. inter-dental mouth that triggers disgust even if realistic. Use the attractive models in the video if they have healthy teeth ideally.

Thank you for the feedback, that's a point that several commenters have brought up.

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).

Another perspective, I don't mind the real videos. They are helpful. It might be easier to for some watch if the subjects had fairly nice teeth. I think animations would be less helpful.

I would be curious to know if you have any knowledge from older books on how diets affected the bacteria in the mouth?

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