Reports of the death of dental cavities are greatly exaggerated

Perfect is the enemy of the good.

A similar thing happened when the media learned about Ozempic (semaglutide) a while ago. Multiple progressive outlets, especially the Guardian, published articles stating the drug was overhyped, playing down its value, citing overweight women from "fat studies" academia (basically activists against the stigma of being overweight saying that being overweight itself is not the problem), emphasizing all its downsides etc. Of course they couldn't stop the hype, because the drug actually works.

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.

The claim of the headline is also not supported by the evidence shared in the article. As just one example, the article notes that many different strains of bacteria are responsible for caries. This fact doesn't necessarily say anything about the effectiveness of Lantern's treatments - although it might shed light on the mechanisms that make it effe tive (or not).

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.

> The tone of the article is for some reason very dismissive and derisive of alternatives to plain dental hygiene.

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.

> The tone of the article is for some reason very dismissive and derisive of alternatives to plain dental hygiene.

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.

You mean this quote?

https://news.ycombinator.com/item?id=41574918

The FDA, however, is not regulating the spread of the 800 other known species of oral bacteria as well as presumably numerous unknown ones, which do cause some known harm. The extreme suspicion of commercially introduced anthropogenic agents seems a bit ridiculous in both natural ecology and the human microbiome. Prove this compound conclusively safe, but not these other ten million compounds we're just going to allow to run wild. Or for competitors - rely on the 'proof' of safety established in the 1920's or the 1970's before we had any idea whatsoever what we were doing scientifically. Or just rely on doctors/dentists unsupported first-principles advice - we've never demonstrated scientifically that floss works, for example.

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.

Does the FDA have any actual mandate or expertise to do that, or are they just embracing mission creep?

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.

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.

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.

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?

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

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

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.

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

Fluoridated drinking water may explain the difference.

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.

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.

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

> From what I can tell, a strain of the bacteria was found in the wild that created less acid and seemed to lead to less carries

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.

> So people thought it needed to be safer

That was after they decided it needed to outcompete the existing bacterium and added a mutagen to kill it off.

When red tape makes drug development and testing impossible, as it did here, the system has ceased to benefit humanity and is causing nothing but stagnation and long-term suffering (by virtue of holding back potentially life-improving or life-saving treatments.)

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.

Some (most?) countries first wait for FDA’s decision before performing their own (lighter) reviews.

> Left out of this rant against the FDA is that the original product failed because it wasn't effective enough in rats to justify the expenses of a human trial.

Source? The article says something else.

It probably works, but it probably doesn’t work any better than using water or some other pH neutral liquid.

There’s a good chance all it’s doing is rinsing away or diluting existing acid.

Thousands of years of test of time stood with ayurveda. also validated with citations as experiments catch up

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654187/

Seems solid to me. They can predict reduction of caries before they add it to city supply water, which still happens in China I believe.

I also get the treatment because why risk your teeth and health at the cost of basically $50? But am still curious to know more about its efficacy.

I learned about Novamin a few years ago [0], and ordered BioMin Restore [1] to give it a try. I'm now a devoted customer. There are other Novamin/hydroxyapatite toothpastes, but I only have experience with this one brand.

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/

You can get high fluoride tooth paste (i.e. ~2% fluoride vs the 0.25% found in normal toothpaste) just by asking from most dentists. Costs about the same per bottle too.

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.

I socialize with a lot of international entrepreneurs who go to places like Prospera where Lumina was started. In those circles, it's not at all uncommon for people to see fluoride as an evil thing. I've even seen women in their dating profiles advertising that they won't date a man unless he's "unfluoridated".

Read the article. If you have not already, you might rethink consideration of this product.

I hope one day that the dudes eating sugar and the dudes using fluoride get into a room together, and discuss how long and often said substances are in contact with dental enamel, and at what concentrations, and then either they convert to homeopathy, or find something better to do with their HSAs.