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Comment by drspock11 | Hacker News Reader

What the article author doesn't seem to realize is much of dentistry (and medicine in general) is not based on evidence. There is zero clinical evidence that flossing actually does anything beneficial. I wouldn't be surprised if there was a lack of evidence for 6-month cleanings actually being beneficial. Similarly, doctors make decisions based mostly on hunches and gut feelings unless you're actively bleeding from a gunshot wound.

I look forward to the day when AI is sophisticated enough to take medical decisions out of the hands of fallible and emotional human beings. (We're not anywhere close to that day)

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Limited evidence doesn't mean it doesn't work.

The reasoning behind flossing makes a lot of sense:

1. You remove food sources for streptococcus mutans

2. You avoid inflammation from teeth shifting

3. You disrupt biofilm (plaque) formation in the joints of your teeth

I imagine the evidence is limited because genetics, diet and other oral hygiene routines significantly impact the outcome. There is a whole microflora system in your mouth, and the advice is to throw everything (floss, scrape tongue, mouthwash, brush) at it for everyone because personalising it is not worth the effort.

Yeah, but these same arguments apply in favor to the diode laser treatment the original article talks about. There is biological and chemical reasoning behind it. There are favorable vitro studies. And a couple of the systematic reviews linked in the original article conclude there is weak evidence that it is weakly effective (same with flossing).

I appreciate what you’re saying, but it’s worth keeping in mind that the cost of a single diode laser treatment can supply you with enough floss for an entire lifetime.

If the service was being provided for by the dentist for $1 I don’t think the author would have cared so much about the evidence behind it. Floss is just so incredibly cheap that even with weak evidence behind it it’s worth doing —- having just a 0.1% benefit, even if it’s just placebo, still has it being worthwhile.

Something is working, even if it may not be clear specifically what that is. My grandfather had a full set of false teeth by the time he was the age my parents are now. The other big change in that time would be diet, but I don't think more refined sugar improves tooth quality.

I mean, some things that dentists believe in do have strong evidence, like water fluoridation and fluoride in toothpaste. And some things dentists believe in don't, like flossing.

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