[crimsoneer]

Slightly worrying that evidence-based dentistry wasn't the default position (though not surprising). I'm always kind of amazed that when I look up the robust evidence for even things as common as flossing, the evidence just...doesn't seem to be there. Let alone all the myriad of dental products from various mouth washes, tooth pastes, brushes and water picks.

How we've ended up regulating medicine to the nth degree, but when it's teeth we're like "oh well, lol", continues to mystify me.

[michaelt]

> Slightly worrying that evidence-based dentistry wasn't the default position

I see what you mean.

But I'm a computer programmer, and if someone asked me to find a top quality academic study proving, beyond a shadow of a doubt, that it's a good idea to indent your code - I couldn't point you to one.

[exitb]

If I decided to charge my customer specifically for indenting my code, I imagine they might be interesting in evidence that they're getting their money's worth.

[vardump]

They'd probably want to pay if you were coding in Python.

[appendix-rock]

No. They might trust your professional judgement, and not all professional judgement has roots in academic publications.

[Frost1x]

There’s a current trend of obsession with “data driven” or “evidence based” assessments. While measured data from reality is useful, it’s not without its own sets of flaws. Much data may not be representative or usefully representative of reality due to complexity of the situation (what we measure isn’t isolated or cant be easily linked, or our measurement process itself is flawed). The sort of pinnacle of relying on data assessments is the assumption of removing bias, which is often simply not true.

Not only is bias introduced from accidental collection flaws, it’s also often tampered with intentionally cherry picking data, choosing interesting data or in some cases flat out falsifying data. In addition, evidence based reasoning often suffers from there being a lack of evidence to make a decision from. Or in some cases some critical aspect surrounding the decision is very niche to the case so the data may not take that into account unless it’s highly tailored data (evidence based reasoning tends to focus on breadth of applicability because gathering evidence is a long and often expensive process).

There’s still a lot of place for using theory and reasoning in conjunction with or in absence of data. Things like experience, professional opinion, etc. Medicine should be no different in that regard to any profession. The key is of course to always strive for sound empirical evidence/data where possible, but to use sound documented reasoning and theory in its absence if you want the best objective results.

[exe34]

> Much data may not be representative or usefully representative of reality due to complexity of the situation

I've personally been on the receiving end of "the data we collected shows...x" (in a non-medical setting), but when I asked to have a look at it, it turned out that while this was true for a large part of the population sampled, there was a material difference between that population and a smaller population that can be clearly identified and for the latter, the data showed the exact opposite conclusion.

(think 100 men and 30 women, kind of scenario, except the difference wasn't gender, but job role).

[mekoka]

The data-driven human is a particularly annoying fallacy of our times. There seems to be a bias at play here. The ethos of the person that identifies as "rational" and whose trust in the data makes them seem smart. The result is this increased prevalence of people who think that ignoring the feedback of their subjective experience for the most mundane phenomenon, just because "where's the data", is somehow rational.

It's even more amazing to see this at play in domains that are directly tied with your well-being, where there's abundant anecdata, but people are holding out until very long and very expensive research have made a pronouncement. Like, thousands of people claim this particular herb is {$positive_claim}. I could try it for a week and see for myself, but I think I'll hold on to my 10$ and wait until research confirms this by the time I turn 90.

Another aspect of this fallacy is nicely highlighted by the aphorism Not everything that counts can be measured. Not everything measured counts.

[pizza234]

> the robust evidence for even things as common as flossing

I'm always baffled by all the discussions about flossing, as it's something that can be very easily verified empirically: one can just floss for a month, then stop doing it for another month, then resume and get a feeling for how the gums react. If they bleed or burn (lightly), then the efficacy is evident; if not... lucky person! No need for research either way.

In my case, I don't need to floss daily, but I still need to do it regularly. Two weeks without flossing, and I'll definitely feel the burn once I resume flossing.

[boomboomsubban]

How is "if you don't floss for a month it hurts when you floss" evidence flossing is good for you?

It's the same phenomenon as something like the calluses guitar players get. If they take a few weeks off, it'll hurt a bit when they play. That doesn't mean the activity improves their health. It means if you poke a part of the body enough it handles being poked better.

[mekoka]

It's not universal, but gingivitis (a minor gum disease) causes inflammation (thus pain). Some people are more prone to it due to their teeth arrangement. Some teeth tend to trap food, which then rots, promotes bacteria, and so forth. Flossing helps alleviate this. The initial floss tends to be strikingly different to the follow-ups (not unexpected). More bleeding and more pain (because of existing inflammation), also more gunk and funk (rotten food particles and bacteria).

One notable effect when regular flossing is sustained is that your whole mouth just feels generally less sensitive and healthy. Less pain when you chew, your breath feels fresher for longer. The reverse can also be noticed when you stop flossing.

As I said, this is not universal since not everyone has the same teeth arrangement. Which is one more argument in favor of not waiting for evidence. It's considerably cheaper to just get some 3$ dental floss, try it for a month, and see for yourself.

[psunavy03]

Because the bleeding is caused by inflammation of the gum tissue from the germs that get trapped up there when you don't floss. This then slowly breaks down your gums. This is why your dental hygienist uses that metal pick to measure under your gums; it should only go in 2-3mm and not bleed.

[conductr]

When I encounter these baffling things, I just remember how my grandparents and everyone around them were hacking their lungs out and everyone smoked tobacco everywhere all the time. You’d think the common sense approach would be to assume inhaling dense smoke directly into your lungs was not healthy, especially given the “look around you” factor of ailments (cancer, emphysema, etc). Yet still, there was a large group of people who refused to believe it could be unhealthy without hard evidence.

The tobacco industry was a contributing factor but common sense and independent thought was already gone or it wouldn’t have worked for as long as it did.

[wincy]

What evidence is that exactly? It’s evidence that your gums don’t like being traumatized by a small string of plastic?

[exe34]

it's the other way round for me - if there's nothing stuck in my gums, flossing feels no more painful than washing my hands. whenever it hurts, it's because there's something stuck in the gum causing an inflammation. once I manage to clean it, either with the floss stick or a small metal brush, the next time I floss it doesn't hurt in the slightest.

[mekoka]

It is baffling and sadly pervasive. There are multiple such little tests of minor consequences, that people could just try out for themselves for a month and observe how their body reacts. But they're waiting for "evidence". It seems that we live in times where it's been drilled into us that if how we feel isn't backed by statistics, then we're probably not feeling it.

[pprotas]

Not directly related to the topic at hand, but it amazes me how Dutch healthcare insurance does not cover dental care by default, and you have to get an extra package for that. As if dental health is not part of my regular health? Why are teeth treated differently from the rest of the body?

[andsens]

Here’s a good answer that tracks with what my parents, who are dentists, told me: https://www.reddit.com/r/explainlikeimfive/s/H4MsnWKatM

> For the longest time, surgeons, dentists and optometrists weren't part of the medical profession. You'd have a barber who could give you a shave or pull your teeth, or a butcher who could cut up a hog, or cut off your gangrenous leg. Optometrists were craftsmen who made the spectacles in their shop. Doctors were University educated in Latin and Greek to read ancient medical texts and despised the uncouth yokels.

> Surgeons muscled their way into the medical profession, originally with the help of the Royal Navy, who only had space for one or two people in charge of both cutting off legs and looking after crew health on their ships.

> Dentists and optometrists never did, so they started their own universities, certification boards, etc. By the time they became respectable enough for people to try to merge them with the medical establishment, in the 1920s, they had no desire to give up their independence.

> The first insurance policies were private contracts with groups of doctors and the system developed from there.

Details vary from country to country of course, but the gist of it generally holds true.

[bonoboTP]

Note that "optometrist" is distinct from "ophthalmologist", which is the actual eye doctor. The optometrist job is only about fitting glasses and contacts for near/farsightedness, while ophthalmologists can treat all manners of eye diseases.

And the final form of dentists, oral-maxillofacial surgeons are an all in one and have to study general medicine, surgery and dentistry.

[razakel]

An optician fits lenses, an optometrist measures your vision (and can refer you to an ophthalmologist if they spot something unusual).

[matwood]

A friend of mine is an orthopedic surgeon and says he's basically a carpenter.

[mauvehaus]

I once made the mistake of observing to my dentist that every tool he was using to fill my cavity looked like a smaller version of something I could buy at Home Depot, to which he cheerfully responded: "yup!" and carried on drilling.

[MVissers]

Doc here. They are basically carpenters. They us drills and saws and hammers and stuff.

[lesuorac]

Image removing somebody's leg without a saw. You just gunna twist it like thumbtack or clay until it separate?

[itishappy]

For a good time (citation needed) you can find clips online. Jaw surgery was particularly eye opening.

[psunavy03]

This is a perfect case to illustrate that while knowledge is power, ignorance is bliss.

[trashface]

In the US it is the same. The result is many people do not have dental insurance, and even if you do it often doesn't pay for much. Even our medicare (for old people) doesn't cover it. Thus some people cynically refer to teeth as "luxury bones".

[wrycoder]

In my experience (average teeth), dental insurance doesn't pay out enough to cover the premiums, and it's not worth the bother.

[cruffle_duffle]

For private dental insurance yes. It almost never makes sense to get private dental insurance and it’s almost always better to pay out of pocket.

I mean think about it from the insurer’s point of view. The only reason you’d ever get “the platinum” dental plan is if you were planning to use it. And it isn’t like you have that many “dental emergencies” if you have healthy teeth. If you don’t have healthy teeth you’d already know it when you pick out the insurance plan, so of course you’d get the upper tier.

The only scenario where it makes sense is if your employer picks up a healthy portion of the premium, in which case you are basically getting dental care subsidized by your employer. In that case you’ll likely come out ahead because you knew in advance pretty much how much dental care you’d need.

The same goes for vision care, really. You know in advance how many contacts, glasses and eye exams you’ll need. It isn’t really an insurable thing. If your employer pays for most of the premium, it’s employer subsidized eyewear & contacts for you!

…of course the math does change a bit when you have to pick the same type of plan for a family. In that case it’s time to bust out a spreadsheet and do the math to see the optimal course.

[ipqk]

It's also tax-payer subsidized (i.e. regressive, because it's mostly higher-income people that get dental insurance) because it's money from your employer that you or your employer don't have to pay taxes on.

[bonoboTP]

Not sure about Dutch, but in Germany and many other countries, basic dental care is included in the default public health insurance. But it's basic. So it won't be necessarily beautiful, the color may look less nice, they may pull out teeth that could be saved with more money etc. But indeed since it's part of the body, you can get it fixed to a basic level.

[Vinnl]

What's extra fun is that that insurance only covers treatments to a fairly low amount, just slightly higher than the price of your regular checkups.

(That said, I believe dental issues that are the result of e.g. accidents do get covered by the default care package.)

[ipqk]

I've been self-employed for years now (USA), and never buy dental insurance, because it's not really insurance, it's basically a non-taxable way for companies to give their employees extra money. Buying it as self-employed persons is basically just giving the "insurance" companies your own money.

[kbelder]

Isn't medical insurance the same? On average, the sum benefit you get from insurance is less than the total amount you pay.

[red-iron-pine]

Canada too. Some rumblings about it at the Federal level, but we'll see if that changes.

Apparently teeth are luxury bones

[amluto]

It’s an interesting case study in the US. Want to see a doctor for a minor issue? Good luck knowing the price in advance. Want to see a dentist? Ask for pricing on the phone, and you’ll get it.

[DowagerDave]

Not my experience in Canada. I went around to dentists and asked for their rates and none of them gave me the equivalent of a take-out menu for basic procedures. Why not?

[ipqk]

There just wasn't evidence-based studies for a lot of common dental practices. Not unlike when the FDA was created, a lot of old medicines were just given a pass, even though they aren't useful (like how Acetaminophen is barely better than placebo — it'd never be approved today).

Just because there's no actual studies for flossing, that doesn't mean that flossing is bad or not-needed per se, but there does need to be more basic-level studies for it. I had bad gum-disease in my 20s, but once I actually started flossing daily, it stopped progressing. So it clearly helped me, but a better study on whether everyone needs to floss and how often should be done.

[namdnay]

to be fair, evidence-based medecine in general is only just starting to take over

[cmgbhm]

There was a podcast on history of dental insurance that explained it from US perspective.

https://freakonomics.com/podcast/dental-insurance/

[mywacaday]

My dentist back in the 80s didn't even wear gloves, he was an older man but I can't imagine gloves were not required then or even when he would have trained in the 40s or 50s.

[bonoboTP]

Is your opinion based on evidence? Sorry for sounding harsh, the article is about evidence, but your comment seems to be more based on feels / ick / sheen / vibe of squeaky cleanliness. If it's imagine vs imagine: I imagine that a washed and disinfected hand without open wounds has no measurable risks, and the tactile feedback the dentist gets may improve the treatment.

[zoky]

> I imagine that a washed and disinfected hand without open wounds has no measurable risks

To the patient maybe. On the other hand (so to speak), if I were gonna spend my day sticking my fingers in people’s mouths, I’d want to wear gloves.

[red-iron-pine]

people with infected, nasty mouths too. ain't just gonna be the routine inspection and flouride treatment, something foul be brewing in some of their faceholes, and now its all over your hands.

[salad-tycoon]

Non sterile gloves are more for the wearer not the patient anyways. Assuming effective handwashing.

[konfusinomicon]

my 95yr old grandmother who still has her OG chompers always told me to only floss the teeth i want to keep, and given hers are still usable after 9 decades, i listened

[DowagerDave]

do you think your sample size of one could be attributed to any of the many other aspects, most outside the control of the owner?

[SirMaster]

Is flossing really that controversial?

It's so simple to do, might as well do it even even it only might provide a benefit.

I certainly can't imagine any downsides to it...

[trod123]

There's some evidence if you know where to look for some of these things (i.e. the programme Dr. Ellie recommends on youtube does actually have papers backing what she says), but overall the dental industry has a long sordid history.

You don't understand the power of the ADA/flouride lobby.

Even just 20 years ago it was routine to have mercury (toxic heavy metal) placed in your mouth for fillings, evidence said the compounds were stable and no one would fund anything that rocks the boat in the US. They did that for children, but they didn't call it mercury, they called it silver fillings (50% by weight mercury).

Normally flouride has very limited uses prior to government mandates, and was so common that it was largely considered a waste by-product not worth selling.

I've yet to find an evidence based study or information on why government require flouride ingestion in any population center above 30,000 when studies have shown its just as effective topically. A study out of african really put the nail in the coffin on this one.

Side effects include lethargy, neurological damage, cognitive decline, hypertension, acne, seizures, and gastrointestinal issues.

It also damages your kids brains more than an adult brain (seemingly lowering IQ permanently), can't be filtered out except by specialized filters that cost a lot (and rapidly become less effective over time).

If they get too much which is very simple indeed, this can happen since its in everything (even bottled water and sodas, GRAS and no label needed under a certain concentration that's well above the toxic limits of new studies).

Nursery Purified bottled Water for infants is a primary source of business.

https://www.readyrefresh.com/medias/sys_master/images/images...

Makes you wonder what's really going on, and why they have to drug broad swaths of the population under the guise that it helps fight dental decay (through ingestion), when most of those studies have been debunked outside the US.

When cities don't have the funding, they magically get the funding for it. When local municipalities don't keep the levels up, they go after them heavy handed, and they disappear from public view.

https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/...

[trod123]

For those people who can't even be bothered to find the papers.

Here's a site that gives you those references. Do the critical thinking and reasoning. If you actually do the reading, you'll find what I have said is quite correct (and your downvotes are you exercising your opinion to silence others irrationally, which is coercive and evil when its arbitrary and unbacked by rational evidence).

https://fluoridealert.org/content/50-reasons/ (the list is at the bottom)

Then there is also a good paper here for the history of Flouride.

For those that don't pick out the critical parts, conclusion isn't appropriate because it neglects common factors like funding (rather the lackthereof for anti-flouride research), the lack of ability to publish (subverted journals refusing publication), and a great many papers after the 1950s; and only briefly touches on methodological issues such as the fact that early studies used young men (not infants, kids, older populations, or women), and extrapolated out for the general population.

Women's health, birth, and allergies/thyroid changes were largely ignored, and rather than correct the bad science in a rational way; the expert voices involved were minimized and discredited, while simultaneously being barred from publishing in research pools (for a perceived stance rather than for actual science, ideologically against science). Its not hard to see why the thought that Communism was playing a role in this line of inquiry.

When seeing these tactics, they were commonly known by the public at the time, and were used primarily by Communists and Marxists who weren't follow western thought based in rationalism (science) to try to subvert the population, and if this were the case, its hard to argue that they didn't succeed in subverting the bureaucracy to force the changes despite the health consequences.

Read for yourself, also that objective 15% benefit (not 2/3) extrapolated didn't properly account for increasing tooth hygiene during that same time.

Even the CDC today recognizes the benefits are mainly from topical uses. Most western countries don't allow flouridated water supplies.

Much of the research over the years had to be independently funded, or were government funded by those countries, and the science has been overwhelming, but this isn't how public trust science is supposed to work (in the US). More specifically biasing funding on safety issues to push unsafe options for profit/benefit would fall under political corruption, and a violation of the public trust.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504307/