Comment by yogipatel | Hacker News Reader

Comment by yogipatel | Hacker News Reader

This headline is overly sensational — this treatment does not apply for what most people consider cavities (i.e. caries, bacterial decay). It only applies for the very early stage caries process where enamel is just beginning to become demineralized.

Tooth enamel is essentially a matrix that is hardened by mineralization. Caries initially demineralize the enamel, but as they progress they destroy the enamel as well. Once that enamel is gone, there is nothing left to mineralize. You can throw as much calcium, phosphate, electricity, etc at it and you won’t end up with any more enamel. The decay has to be removed and filled with something.

This proposed treatment only works for the very initial stages of demineralization, which are referred to as white spot lesions, since demineralization causes the enamel to become opaque. The current conservative treatment for white spot lesions is to be judicious with cleaning and possibly apply some additional fluoride, as the tooth simply needs to be remineralized. The researchers are claiming to be able to accelerate that remineralization, which is great, but is very, very far from saying that patients won't need fillings.

Source: I’m a 2nd year dental student.

Edit: formatting

> The current conservative treatment for white spot lesions is to be judicious with cleaning

And I'll point out that my current dentist is the only one I've ever had (or known of) who actually bothers to rigorously teach his patients how to clean their teeth well. Most apparently don't believe this is possible or worth their time. Obviously that's not going to take with every patient, but it's really quite amazing the difference between thinking you're doing what needs done (yet having the hygienist grumble all the same), and actually getting the plaque off every time. Put another way, diligence != skill when it comes to dental hygiene.

Care to elaborate what the techniques your current dentist taught you?

Off the top of my head:

* Modified Stillman's

* Floss properly; "scrape" gently with the floss.

* Water rinse after acidic drinks (like red wine). Brush a half hour after that.

One thing that has done a lot for me is I've been doing more brushing without toothpaste. I do use toothpaste, but when I do it I treat it more as a fluoride treatment than as a tool to get off plaque. When I'm trying to get off plaque I use a dry brush.

Toothpaste is more than fluoride, it contains surfactants and mild abrasives to aid in the cleaning process.

As my post above indicates, this effect is really important. The plaque biofilm is really sticky. I'm not sure what's going on in GP's case, but when using a plaque staining dye to see what's going on, it's clear that toothpaste makes a huge difference in the ability to mechanically disrupt plaque. It's amazingly hard to do without toothpaste.

Abrasives on enamel! Yay..

It's all about differences in hardness.

If everything goes as planned: The abrasive is more likely to scratch what's on the teeth; and the teeth are more likely to scratch the toothpaste if everything goes as planned.

I'm not sure I understand, are you basically brushing twice? Once w/o toothpaste and once with?

That's what I do. Once to get rid of food debris. Then start with toothpaste. Then floss, rinse, and a quick brush again with toothpaste. But sadly too little too late with my teeth. They are screwed.

I rarely ate sweets as a child and avoid sugar. I rarely eat processed foods. Drink is another matter. I most likely have harmed my teeth from drinking beer/wine/smoothies and from being too rough when cleaning. I really miss my younger healthy teeth.

My teeth have felt horrible ever since they failed and were drilled and filled. And now bring me a lot of misery. Look after your teeth! Healthy teeth are incredibly attractive. IMHO.

++ on the water rinse. It intuitively makes a lot of sense.

I've always wondered how much decay could be prevented if we just trained people to drink a glass of water after each meal.

One day I'll distribute a cola that includes a chewable calcium tablet to take after each consumption.

For anyone else confused, Modified Stillmans is a brushing technique. Demo video here: https://www.youtube.com/watch?v=5zEDhurn7zY

I usually do a "milk-rinse", because I have the feeling it brings the pH back to neutral a lot quicker than water. But milk contains sugar, so perhaps a water-rinse after that is a good idea.

milk is a slight acid, so no, water would still be a better job of balancing pH, and also better because water contains no sugars or other things that might stick to your teeth.

But milk is a buffer solution [1]

[1] http://milk.polybum.com/the_chemistry_of_milk/basic_physical...

Sorry, should have included that in my original post. The basic protocol is here: http://www.7dentalsteps.com/7steps.htm

The key premise is roughly: disrupt the plaque biofilm every 24 hours. The rest of the protocol is a method for doing that. The change in my gum health was profound after only about three days. Working with Dr. Nigrelle, you get a "process checkup" via plaque staining dye every time you go in. So you get feedback as to where you need to improve technique. I also got some extra dye swabs so I could do self-checks more frequently. The visual feedback is super-useful for dialing in technique, but not critical for that initial baseline boost in dental health.

A big tip for the stim-u-dents or similar cleaning aids. Don't think of them as "toothpicks". Think of them and use them like tiny tootbrushes that can work around the teeth near the gumline and in-between the teeth. It's the lateral faces of the picks that act as scrubbing tools. Also, the parts about lathering with toothpaste are important. The dye tells the story, and Dr. Nigrelle does this comparison with his patients: you learn that you can spend a long, long time scrubbing with a stim-u-dent or toothbrush without toothpaste and kinda sorta get the plaque, or you can lather up some toothpaste and obliterate it in short order.

The graphics on that page are adorably cheesy.

I haven't heard of stimudents before, the principle seems to be the same as the tepe interdental brushes which are more popular here in europe (http://www.tepe.com/products/interdental-brushes/how-to-use/)

With the regular 'brush compliance checks' mine does, an electrical toothbrush made significant difference. And it's not because I spend longer brushing, I even think I brush less in wall-clock time. The electrical one just seems to be more thorough ('seems' as in 'confirmed with dentist-administered plaque and gum health measurements', not 'I really want to believe so in my mind I make it so').

Electrical brush was night and day for me. Until I was 19 or so, I used to have a cavity nearly every check-up. Then, I got an electrical toothbrush, and it just stopped.

Now most of the work is maintenance on all those fillings, damage had been done, unfortunately.

I think the most important thing is teeth take a lot of time to properly clean.

An electric tooth brush is also extremely helpful.

Most apparently don't believe this is possible or worth their time.

Or perhaps they would rather their patients come back with cavities so he/she can charge more to fix them? Here's an experience of mine that's relevant: I once had a dentist who told me I had a cavity and showed me a little black spot on one of my teeth; for whatever reason I declined that day and said I'd come sometime in the future when it was convenient, to fix it. In the meantime I was introduced by a friend to another dentist who was recommended because he was much cheaper, and so I went to him to fix the cavity - to which his response was, "that ain't no cavity", and promptly scraped the spot away with a pick. He also did an x-ray and showed my teeth were in perfect condition with no signs of any decay. This was a few years ago and I've not had any problems with my teeth since.

I recently switched dentist and my new dentist requires that you also have a six monthly appointment with a full-time hygienist also at the same site. I was very skeptical about this but ultimately learnt a lot and my teeth are becoming a lot better for it.

I am not entirely sure if most dentists would be good at delivering hygiene advice to the level of the hygienist (it's a special skill, after all), but I'm also not sure most patients would voluntarily see a hygienist, so it's a tricky problem.

So, how are people a hundred years ago and back into distant past, or even nowadays people of remote villages in South Asia, unaware of the miracles of American dental industry, deat with demineralization issues?

Has it anything to do with a diet, particularly of consuming vegetable roots, such as ginger, or redis, of meat curries as a calcium source? Has it anything to do with gums health, to with consuming chilly pepers is related? How the third world people managed to survive up to this very day without that very costly help of American dental industry?

My guess would be no fizzy drinks and a lot less sugar.

Unfortunately for Americans & the industry, the answer is in fact not, consuming more of something.

Actually, it is not the parts of a plant that matters most, but the soil in which the plant grows. The very same tomatoes grown on fertile slopes of Himalaya or on North Indian Plain has very different compounds in it than hydroponic ones. This why Nepalese or Indian tomatoes are so tasty. Even such a crude instrument as tongue could tell the difference. It also will tell if a soup has been cooked with bones or not.

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