| ▲ | asdff 10 hours ago |
| If you ever get treated at say a dental school, where they will have roving faculty each giving their own opinion to the dental student over your open mouth, you will learn there is so much subjectivity in dental practice. One point of contention is about when to do intervention. Some doctors want the procedure done because they believe the risk of not doing so is large. Others might say you've gotten by this far alright and maybe only intervene if things turn for the worse, better to keep your real tooth as long as you can. Some dentists might want to see a lot of x ray imagery and retakes until their ideal perspectives are captured, others weigh the risk of irradiation and favor taking as few as possible. Any restorative work is very much an art vs a science, some hands are genuinely more skilled and some might take a few redos to get a repair to not break in 2 days from the demands of your natural bite. They might even look at the x ray image of a past root canal from knowledgeable hands like we might the statue of David, showing it to other staff in amazement. About the only thing that seems to be in agreement across the board is flossing and brushing your teeth. |
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| ▲ | jchw 10 hours ago | parent | next [-] |
| With modern X ray imaging devices I feel like the dangers of irradiation from dental imaging are probably quite low. If nuclear hormesis holds up, you may actually be better off getting the imaging done. The problem is the same as the CT scan: as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing, while leaving other things that can't show up on imaging unnoticed, potentially diverting attention and giving you a false sense of security. YouTuber and doctor Dr. Bernard "Chubbyemu" Hsu recently covered an upsetting example to demonstrate how doing additional routine scans wouldn't have helped and may have harmed in a specific sort of scenario that I'm sure many of us fear from time to time. It doesn't prove or even assert that such scans would be useless, only that they are far from a panacea and that it isn't settled science that we'd be better off with it. https://youtu.be/YDYMMgyN4k0 And to me, I think that ties into how we're doing dentistry wrong: I think taking routine X rays for patients with healthy mouths, no history of issues and no symptoms is reckless. Maybe it is sometimes beneficial, but every single year as a requirement seems insane. Why not every 3? Are we really catching things early or are we drilling into teeth that are fine? I question it. Of course, I'm just some chuckle fuck on the Internet with zero dentistry experience, but my knee-jerk is that something seems off here. |
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| ▲ | cj 6 hours ago | parent | next [-] | | > as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing I personally have a preference for having the maximum amount of information available to make a decision. “Don’t get that “unnecessary” test, it might give you a result that might lead to treatment you don’t need” — hearing this blows my mind every time. | | |
| ▲ | hibikir 6 hours ago | parent [-] | | The treatment you don't need might be zero risk, but it might also have quite a bit of it. And some tests carry risks too: See how different countries have very different protocols. The US system, which is colonoscopy first, and where polypectomies will be done at the same time, can end up with bowel perforations when the polyp was not even cancer. So the diferente treatment protocol is not just about costs, but about balancing different risks. The unnecessary test, leading to an unnecessary intervention, which gets you unnecessary long term issues is a real risk in many cases. It's not just a matter of doing a bonus blood test here or there. | | |
| ▲ | cj 6 hours ago | parent [-] | | To take it to the extreme: If there were a risk free button that you could click to see a full breakdown of all illnesses no more how early stage, would you click the button? It would include a report of cells that may eventually turn into cancer (or may not). It would include things like polyps, and every other diagnosable condition. Do you avoid pressing the button? Why? | | |
| ▲ | jchw 6 hours ago | parent [-] | | Unnecessary medical treatments can have serious consequences. Even if you are absolutely certain you have a given condition, some treatments are very not worth it. More importantly, any given scan misses tons of important potential health issues. Not just the fact that CT scans don't show signs of MS vs MRIs, but neither of them will tell you about many cardiovascular conditions. So time spent treating made up issues from CT scans you don't need may be better spent doing other regular exams instead. Meanwhile, many aggressive cancers will be far too fast for any reasonable scan interval to catch in time. (And CT scans, to my understanding, can miss tumors early on, since it can't see as fine of detail as MRIs.) | | |
| ▲ | tempestn an hour ago | parent [-] | | But surely the mistake is doing the unnecessary treatment, not getting the information in the first place. In the above hypothetical where I could get an impossibly detailed fully body scan result for free, I would absolutely do it. I understand that in practice getting more information often leads to unnecessary treatment, so that in some cases the real world results are better if less investigation is done. But that's not inevitable; it depends on the choices made as a result of that information. |
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| ▲ | NetMageSCW 5 hours ago | parent | prev | next [-] | | The ADA no longer recommends routine x-rays - they should only be taken when there is something specific that needs to be investigated. | | |
| ▲ | jchw 5 hours ago | parent [-] | | TIL. That's good to know, makes me feel a bit better. I'm sure my dentist will want an Xray anyway next time I come in. |
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| ▲ | bawolff 9 hours ago | parent | prev | next [-] | | Hmm, googling it, it seems like a cross country flight is equal to 40 dental xrays. had no idea it was that low. | | |
| ▲ | warunsl 8 hours ago | parent [-] | | There is a reason why Los Algodones has 1000 dentists for a city with population of 5000. It is called Molar City. | | |
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| ▲ | Terr_ 7 hours ago | parent | prev [-] | | > If nuclear hormesis holds up TIL of that theory: https://en.wikipedia.org/wiki/Radiation_hormesis | | |
| ▲ | jchw 5 hours ago | parent [-] | | It's fiercely debated but as time goes on it seems like it is at least partially true. I'm guessing that some effects of radiation really do map better to LNT whereas others map better to radiation hormesis; why and when is a mystery, I think. Maybe some folks more vested in this topic have an idea. The most fascinating example of hormesis I can think of is that after the atomic bombing of Hiroshima, some people who would've received a relatively small dose of radiation seemed to have a slightly lower cancer risk than people who wouldn't have received any additional radiation. https://pmc.ncbi.nlm.nih.gov/articles/PMC6937943/ I'm sure there is plenty of debate about these studies and their methodology, but I have some suspicions. There seems to have been a lot of handwaving and intentional omission to explain away or ignore why LNT didn't seem to match reality. Radiation hormesis may be an illusion itself, but as it stands it appears LNT is unable to explain experimental evidence sufficiently. We're clearly missing something, and there is a lot of potential conflict of interest, especially given the obvious incentives for the energy sector... But also, I just read Wikipedia and watch YouTube causally, so hell if I know. | | |
| ▲ | Vachyas 3 hours ago | parent [-] | | > after the atomic bombing of Hiroshima, some people who would've received a relatively small dose of radiation seemed to have a slightly lower cancer risk than people who wouldn't have received any additional radiation. What if this is survivorship bias selecting for some common trait that correlates with better radiation tolerance and lower cancer risk (like age). | | |
| ▲ | jchw 2 hours ago | parent [-] | | IIRC, it's based on the distance from the blast radius. The confounding thing about it is the fact that there is apparently a range of distance from the explosion where people have lower incidence of cancer than people who were even further way. That seems hard to explain. |
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| ▲ | motionlessveloc 8 hours ago | parent | prev [-] |
| Last I checked, actual evidence that flossing is helpful seems pretty limited. " In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence." https://pubmed.ncbi.nlm.nih.gov/19138178/ |
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| ▲ | ikrenji 5 hours ago | parent | next [-] | | https://pubmed.ncbi.nlm.nih.gov/35451656/ Conclusions: Interproximal gingival inflammation may be significantly reduced by toothbrushing alone, the effect being significantly enhanced when toothbrushing is combined with dental floss. | |
| ▲ | nidnogg 8 hours ago | parent | prev | next [-] | | I have always been an infrequent flosser, but deep down I've hoped for something like this to reach mainstream scientific consensus for a while so I no longer beat myself over it. Fingers crossed this is not a skewed study | | |
| ▲ | throwaway2037 2 hours ago | parent | next [-] | | There are two tricks to mostly avoid flossing. Before you brush your teeth, use a interdental brush in the gaps between your teeth. Depending upon the shape of your mouth and tooth placement, there might be one or two gaps that you cannot reach. Next, brush your teeth. Finally, one or twice a week, after you brush your teeth, floss the gaps that your interdental brush cannot reach. Why after brushing? So your flossing won't smell bad. That is one of the biggest complaints about flossing when people are surveyed. | |
| ▲ | NetMageSCW 5 hours ago | parent | prev | next [-] | | At my dentist’s recommendation I’ve been using Proxabrush every day. It is very important not to force it, and my teeth are very tight so I had to get the smaller ones (I even have trouble flossing between some) but I had some early decay between some teeth and these seem really good with trapped material before regular electric brushing. | |
| ▲ | drowntoge 7 hours ago | parent | prev [-] | | Water flosser. | | |
| ▲ | skirmish 7 hours ago | parent | next [-] | | I told my dentist how much I liked my water flosser, and he immediately said "that's fine but it's not very effective, you still need to use regular floss too". | | |
| ▲ | Daneel_ an hour ago | parent | next [-] | | I use both, and I can say that I definitely get more out from between my teeth with the water flosser. These days string floss is just for when I have something big stuck tightly that I know the water flosser won't be able to shift. | |
| ▲ | panopticon 5 hours ago | parent | prev [-] | | Meanwhile my dentist said I should be using a water flosser instead of regular flossing. |
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| ▲ | contingencies 6 hours ago | parent | prev | next [-] | | Came to post this. These things are frigging amazing and like $20. Absolutely everyone should have one. Really you can floss and brush and it still gets stuff. I wish they existed when I was younger! Buy one! Thank me later! On the 'dentists don't really know what they're doing' front, my kid's orthodontist ($$$$) describes himself as a "fencing contractor". Conversely, I got the water flosser tip from an Indonesian dentist who I hired opportunistically on holiday for a clean; he turned up in flip-flops but decanted to bare feet during operating and gave the most sage advice I've ever had in 40+ years of dentists: BUY A WATER FLOSSER. Terimakasih, Doktor! | |
| ▲ | 6 hours ago | parent | prev [-] | | [deleted] |
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| ▲ | luipugs 8 hours ago | parent | prev | next [-] | | I regularly get food particles out of my molars using floss that brushing wouldn't have been able to, so for me it works. | |
| ▲ | 7 hours ago | parent | prev | next [-] | | [deleted] | |
| ▲ | 2 hours ago | parent | prev | next [-] | | [deleted] | |
| ▲ | vmg12 7 hours ago | parent | prev | next [-] | | > actual evidence that flossing is helpful seems pretty limited If I don't floss my breath smells terrible because of bacteria and bacteria causes tooth decay. I'm pretty certain I'm not special. | | |
| ▲ | aeonik 6 hours ago | parent [-] | | It depends on the bacteria living in your mouth. Some people get lucky, and even with low brushing, won't get cavities. | | |
| ▲ | naishoya 3 hours ago | parent [-] | | 50+, terrible at brushing and oral hygene in general. Actually lived in the jungle for years, almost like a caveman. 25+ years without a single dentist visit. Was in Thailand last spring, went to a dentistry shop in the mall as a walk-in, paid about 45 dollars for a deep cleaning and panoramic x-ray. Other than some startlingly crunky plaque in the rinse and spit cycles, zero cavities, zero need for intervention. It all comes down to the microbiome. I blame the complete lack of 'antiseptic' mouthwash and other interventions that skew the microbial populations, combined with just plain good luck. I refuse to use antibiotic soaps either. I reserve the tools of sterility for the space in front of my laminar flow hood and the like when preparing live cultures for cheeses and brews. I lived where fluoridated water was a practice during my early years when my teeth had formed - as that's actually when the flouride has the most impact...once the teeth are built, there's little effect from consuming flouride on the enamel. Later in late grade-school I lived in a place where fluoridated water had not happened, and so the school was doing a routine annual flouride mouth rinse-and-spit routine in the class. Was a 'conscientious objector' causing some chagrin for the teachers, they would pass out the little cup of chemical brew and start the timer, while i just stared at the paper cup and got threatened with having to write "I will ...." sentences as punishment. Even that didn't really have any impact on my actions. Adding another hashmark by my name on the blackboard as a tally of pages of meaningless repetitive sentences which I would never actually do or turn in. That had zero leverage against my test scores or passing any subject. So what if I couldn't go out to recess to sweat on a bare dirt playground with zero swings or other appeal. Fine by me. But, by 3rd grade I already had my own two-stage steromicroscope and was acutely aware of the need for balanced microbiomes in all of life, learning about soil and aquatic microbiomes from my grandfather. So, very much not the normal kid. All that aside, my gums could use more care, so I'm trying to be more diligent and brush daily with salt, baking soda and the tiniest bit of fennel and mint oil. Its showing some improvement. | | |
| ▲ | fn-mote 2 hours ago | parent | next [-] | | I love this story, but science was invented so we didn’t have to stick to anecdotes. For myself, I’ll take my chances with the “recommended treatment”. | |
| ▲ | throwaway2037 2 hours ago | parent | prev [-] | | What is "deep cleaning" compared to regular, twice a year dental cleaning? |
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| ▲ | what 3 hours ago | parent | prev | next [-] | | Is this because people don’t floss properly? Or is it a study of people who floss properly? | |
| ▲ | ButlerianJihad 7 hours ago | parent | prev [-] | | Flossing is not merely essential to dislodging recalcitrant food particles, but also gives great stimulation to the gums themselves, and none of that effort is a waste, IMHO. It is not sugar that causes dental caries, but bacteria. Flossing that old food out from between teeth is guaranteed to cut down bacteria growth! Furthermore, my new and wonderful dentist and his hygienists wholeheartedly recommend and encourage the practice. So perhaps you can excuse me for ignoring a singular “research study”. | | |
| ▲ | csnover 7 hours ago | parent [-] | | It was a systematic review, not a “singular ‘research study’”. A newer 2019 Cochrane review[0] found about the same: > The evidence was limited in applicability and was incomplete. The included studies only presented data on gingivitis, plaque, and adverse events; most did not measure or report other important outcomes such as periodontitis or interproximal caries. … Additional use of floss or interdental brushes compared to toothbrushing alone may reduce gingivitis or plaque, or both, and interdental brushes may be more effective than floss. The evidence is low to very low‐certainty, and the effect sizes observed may not be clinically important. [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC6953268/ | | |
| ▲ | raddan 5 hours ago | parent [-] | | I am highly skeptical. In my younger years, I brushed regularly but did not floss at all. After dealing with a surprising number of cavities over a short period of time, I decided to just start flossing, morning and night. Not only does flossing remove quite a bit of, er... stuff... that toothbrushing does not seem to get, I have not had a single new cavity in 25 years. The only issues I've had were old fillings falling out, including one that cracked my tooth which required a crown. Not a lot of work considering the time span. Obviously one person is not "data" but seeing as I am that one person, I'm going to keep flossing. |
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