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Comment by jtc331 | Hacker News Reader

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.

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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.

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

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?

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.

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

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

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

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, ..

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