Has anyone here closely investigated the research that led to recommendations to brush teeth after every meal or at least two times a day, as e.g. suggested on toothpaste containers, and to floss frequently, etc.? Any idea how well designed / how complete the relevant studies were? Have there been more recent improved studies? In the last few years I’ve heard second-hand some alternative recommendations to brush before meals rather than after, but I haven’t ever done my own research review.
I’ve long suspected that a good diet + brushing the teeth very carefully a few times per week would be more effective than drinking soda and sweet and starchy foods + brushing after every meal, just based anecdotally on how my own teeth feel to my tongue depending on my diet and toothbrushing frequency.
> Has anyone here closely investigated the research that led to recommendations to brush teeth after every meal or at least two times a day, as e.g. suggested on toothpaste containers, and to floss frequently, etc.?
Very interesting, because we teach dental hygienists that flossing + brushing is vital, while powered toothbrushes are for those with dexterity issues (children, elderly, or otherwise). Mind you, brushing and flossing studies have less moral hazard.
>There is some very low-quality evidence that using interdental brushes plus toothbrushing is more beneficial than toothbrushing alone for plaque and gingivitis at one month. There is also low-quality evidence that using interdental brushes reduces gingivitis (gum inflammation) by 52% when compared with flossing at one month. There was insufficient evidence to claim a benefit for either interdental brushing or flossing for plaque.
>There is some evidence from twelve studies that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone. There is weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months. No studies reported the effectiveness of flossing plus toothbrushing for preventing dental caries.
>The evidence produced shows benefits in using a powered toothbrush when compared with a manual toothbrush. There was an 11% reduction in plaque at one to three months of use, and a 21% reduction in plaque when assessed after three months of use. For gingivitis, there was a 6% reduction at one to three months of use and an 11% reduction when assessed after three months of use.
From my own experience Brush Picks are the ultimate interdental tool. I keep a small container full of them at my work and home desk and it's become a passive activity to fully clean all of my teeth, multiple times a day.
From adding Brush Picks to my already solid regimen of brushing 2-3 times a day depending on how much I've eaten I've achieved something I never had before in my ~30 years of living: Real compliments about my teeth from my dentist. No but's, no side note, no complaints. Just an unexpected compliment followed by questions of how I achieved such a feat.
> Very interesting, because we teach dental hygienists that flossing + brushing is vital, while powered toothbrushes are for those with dexterity issues (children, elderly, or otherwise).
For what it's worth, every dentist/hygienist I've ever had has told me that electric toothbrushes are better.
> I’ve long suspected that a good diet + brushing the teeth very carefully a few times per week would be more effective than drinking soda and sweet and starchy foods + brushing after every meal
That seems like a false dilemma. Those two things are never at odds with one another. People don't eat sugar because it is part of their brushing regimen, they eat sugar because they like/are addicted to the stuff.
So if you're eating sugar for reasons that have nothing to do with promoting teeth health, then brushing more often to combat that damage makes a lot of sense.
Could you eat less bad stuff and brush less? Potentially, but if people wished to drop sugar from their diet the list of benefits to doing so is so long that brushing less is just a minor footnote at best.
I feel the same way. A few years ago I became convinced that any well known brand name toothpaste was doing more damage to my teeth than help. I switched to using clay based tooth pastes as well as some other powders, and sometimes Ill take some tea spoons of cod liver oil. I grew up with cavities every visit and now it seems like going to the dentist is pointless. They tell me my teeth look great and I must be brushing and stuff, but really I just don't eat much sugar and brush my teeth with toothpaste that is edible, floss occasionally. I think dropping the listerine was the hardest part and also the most helpful. But ultimately it just makes sense in my own mind to brush with a paste that won't poison me if consumed.
It is interesting, my NHS dentist recommended I avoid alcohol-based mouthwash (which is the majority) since it dries out gums and also whitening toothpastes (because they're abrasive by design).
Both things are extremely common on supermarket aisles (even in the UK). But yet dentists suggest you avoid them. That's a rather interesting state of affairs.
Actually my dentist recommended Sensodyne (non-whitening) and a fluoride mouthwash without alcohol (the brand escapes me).
I stopped eating all sugar for 3 years (all carbs actually).
My dentist loved me. My dental visits consisted of me walking in, getting briefly looked at, the dental hygienist doing a quick go over my teeth, complementing me on how clean they are, and sending me on my way.
When I want back to eating sugar, my dental visits suddenly got a lot longer. The cleaning of plaque alone is now at least twice as long.
Dropping the low carb thing I can understand. I do low carb paleo on and off as my fiscal and lifestyle circumstances dictate... but I keep my sugar intake low regardless.
If you cut back on sugar a lot, that almost surely is the most major factor in the change. Sugar is amazingly bad for your teeth, and many sugary beverages (like soda) are also naturally acidic, which leads to erosion of enamel.
That said, you're right to have some skepticism about heavily marketed tooth pastes. For instance, I have four veneers and my dentist recommended against using any "whitening" toothpastes, because they're naturally abrasive against your teeth and can very slowly damage them over time. I just use Sensodyne and follow-up with a non-alcoholic flouride mouthwash, and I've had no dental issues since, even with a sugary diet. But I brush/rinse three times a day.
My dentist has advised me not to brush after a sugary meal or drink for at least an hour, otherwise you are effectively brushing the sugar into your teeth. Perhaps this also applies (but with a lesser timeframe) for meals that aren't so sugary.
It's more that your enamel is weakened temporarily by acids (which get produced by bacteria in your mouth as a side effect of their consuming the sugar). It is true that you shouldn't brush immediately after a meal -- waiting 30 minutes to an hour is a good practice.
Listening excessively to one lobby group is as hazardous as eating excessively exactly one staple - be it sugar or wheat. Moderation is important, both in politics and nutrition.
The industry shapes the culture, but worse, the law and the market.
Very typical example is the corn lobby group, whose result on the market is to cause junk food to be much cheaper than nutritious food, thanks to perverse subsidization. In turn this makes much more difficult for a relatively large part of the population to eat correctly - practically difficult.
This is one of the more bizarre artifacts of our system. And it took the concentrated efforts of almost everyone involved to make it this way.
But in a way , cheaper is always better. Nutritious food is also cheap, relatively, unless the "nutritiousness" of it is also a price differentiator. Frozen veggies are pretty easy to get, IMO - but it seems there usually has to be a largish supermarket to buy them in. And that implies a finance model, which implies a governance structure, which in the end means more dependence in suppliers being "standard". Junk food makers probably can spend more bandwidth on being "standard" and less on "quality".
If I had to describe Whole Foods model I would say that it intentionally "violates" this tendency.
I have never been to a Trader Joes, and I usually use a mix of WalMart and the dominant local chain - Publix when I lived in Florida. Whole Foods is kinda creepy to me to shop in. I can't say exactly why.
> But in a way , cheaper is always better. Nutritious food is also cheap, relatively, unless the "nutritiousness" of it is also a price differentiator.
Well, to get things into perspective, one needs to consider a few things.
We start from the fact that there is a disproportionate amount of people living on food stamps, which will be effectively forced to buy junk food.
Then we factor in that junk food is harmful (not just unhealthy or less nutritious).
Finally, we correlate with a huge amount of people having disease which are linked to unhealthy lifestyles, primarily food-related (60% obese people is the very general guideline given).
I see a very strong thread here.
Food is not just calories, it's a complex mix of things - the way the industry is working, in a way, it's giving cheaper food by stripping that mix of things; this doesn't match the idea of "making food cheaper" in a generic way.
(Note that I'm strongly identifying junk food with processed food in the logic).
For me, it's the paradoxical idea that not only do some dirty hippies have enough money to shop there, but also that there are enough of them to actually keep the company in business. Nationwide.
Very good elaboration. Most of the times, objective science has way fewer resources to spread the word than industry groups. One can only imagine how our society would look like if power and money was distributed more evenly and information was freely available to anyone.
Information is pretty much freely available to everyone already. The value of that information, however, has dropped to near-zero from the point of view of uninitiated - as various groups with agendas publish lies which then get regurgitated by clueless people, we have enough freely available information on any topic to confirm any biases you started with.
So for example, you love GMOs because they're cool and futuristic. So here, read that study on this new plant that is safe and abundant in vitamins and can save a million of children a year from blindness. Or maybe, you hate GMOs because they're unnatural and a product of humans messing up with what God has perfectly made - ok, here, have those 10 papers that have words "GMO", "rats" and "cancer" in them.
What we need is a system that doesn't incentivize people to lie and cheat as much as the current does.
> Very typical example is the corn lobby group, whose result on the market is to cause junk food to be much cheaper than nutritious food
Junk food is cheap because it is engineered to be cheap (particularly, to have a long shelf-life to avoid losses which drive up the price of what actually does get sold to the customer to subsidize the costs of what doesn't do to losses.) The effect of the corn lobby and the resulting subsidization isn't to make junk food cheaper than nutritious food so much as to encourage the use of corn products in junk food by making corn products cheap compared to other alternatives to corn products for making junk food.
The industry shapes the culture, but worse, the law and the market.
As you say, it's not so simple.
Industry is just a part of a cycle of perversion of the goal of effective government.
Industry isn't forcing politicians to create or execute bad legislation. Industry isn't forcing voters to ignore the voting records of politicians who demonstrate poor integrity.
Ultimately, the driver of everything in a democratic republic is the voter.
You seem to be reinventing "median voter theory", which got rebadged "public choice theory", which nearly nobody attests to in public.
In the US at least, government was designed to be ineffective and deadlock-prone. When there was a monoculture, individual legislators (say, Tip O'Neil) bucked the central tendency to ... do whatever it is we do now out of a sense of duty and pragmatism. And as the monoculture faded, so did that.
As the culture got noisier, you had to yell louder. Once you ( you public servant ) get used to living without dignity and a sense of gravitas, it just gets easier... eventually the system selects for the lack of those.
There's much more money in it now, and money makes people take less risk. So you get cookie cutter.
I didn't claim that voters got what the median wants. I claimed that the main driver in the complex cycle of perversion of the function of government is the bad choices of voters.
Without an informed citizenry that can make solid election choices, even the best government framework is doomed to fail because it will be populated with politicians who are unable or unwilling to do the jobs they were elected to do.
I've read perhaps too much Bryan Caplan :), who holds that Median Voter Theory/Public Choice theory is sufficient to explain the bad choices of voters. But of course you are as familiar with that as I am, right? No. You probably are not. My bad then. rends garment.
That's more like "assuming a linkage not in evidence", a much less crafted thing than a strawman. It's ordinary carelessness, not savage guile. I can see how they seem like the same, though.
Although in the sense of revealed preferences, I'm sort of loath to call it all "bad choices." We are inconsistent, hypocritical, vain and venal creatures. That's sort of who we are; I can ... function better if I accept that and celebrate the odd exception. That way the glass is half full. For every thing that doesn't work, there are thousands of cases where it does.
And let's not kid ourselves. It's all very difficult, what our public servants do.
And let's not kid ourselves. It's all very difficult, what our public servants do.
Yes, it's very difficult to raise that much money to destroy your political opponents while balancing all of the donor favors against what you promised to your constituents while also trying to figure out a way that you can become rich from your time in public office.
I have no pity for most politicians. They tend to be power hungry control freaks who have no problem lying to (get into/remain in) office. The lack of discrimination in voter ability to at least filter out the obvious liars is a never ending source of frustration for me.
This is true, but I think it glosses over a bunch of important structure in society that isn't obviously connected to the voter. An analogy might be to say that ultimately, all of your behaviors come down to the neuron. While technically true, it ignores brain structures, hormones, emotional state, etc that are almost always more important in actual treatment than any attempt to deal with individual neurons.
Society is an enormously complex thing with all kinds of hidden influences and imbalances, and I think that saying "it's all the voter" tends to shut down thinking about the real alternatives for fixing problems. I'm not saying that I know what those alternatives are, just that they are likely to exist because we live in a society with structure. Since they're likely to exist, I think we should be looking for them and trying to address them in order to treat this kind of problem.
I think that saying "it's all the voter" tends to shut down thinking about the real alternatives for fixing problems
There are plenty of real alternatives for fixing problems that involve the voter: Education, access to information, encouraging cultural changes, etc.
In part, I was countering the previous poster who was blaming the 'Industry' boogey man, for why sugar has done the damage it has - but not mentioning the culpability of a government so easily influenced by money and then voters so easily influenced by politicians who don't have their constituents' interests at heart.
As you say, it's complex. But, we could talk about fixes on HN all day, but until voters elect smart politicians with integrity who will implement fixes, it's all just academic.
Even more fundamental than the voter is information itself. Voters would be the ultimate drivers if they had perfect information. Since they do not, their choices are limited by their access to information (as well as their ability to process it).
Well, we don't have perfect information - but I think it's pretty obvious that we have abundant information that voters don't avail themselves of. The drive to use even the information available seems to be lacking.
At scale, I would agree with this, although I wouldn't say "prevents", I would say "discourages". You should definitely notice large effects at scale in any economy, in this case, people definitely do buy more junk food because it's cheaper
(I even do this, and I prefer healthy foods when possible! But at your typical gas station, junk:healthy::10:1, which is not quite the same problem)
vegatables, and fruit to a lesser extend, is much cheaper than junk food. Why isn't that encouraging healthy eating?
I believe junk food is like smoking. Everyone knows it's not a healthy choise, but they do it anyways. People are choosing to eat unhealthy food because they want to, it tastes good.
That's a nice belief, but evidence shows people choose junk food because of availability, price, associated preparation time and a lack of nutritional education.
The further down the income ladder you go the more those factors come into play rather than the simplistic "it tastes good" conclusion.
evidence shows people choose junk food because of availability, price, associated preparation time and a lack of nutritional education.
Oh I believe it. I would just phrase it as: people take the easy way out when it comes to eating. They prefer something that is front of them, cheap and they don't need to cook.
You can't ignore personal responsibility. Plenty of poor folks eat health meals.
You say 'they want to' but you ignore that junk food is designed to amplify the superficially appealing qualities of the food without regard to the nutritive value.
Nobody 'wants' that. What they want is good tasting food that is also nutritious. That costs more.
Sort of reminds me of Huxley's "Brave New World" when they traumatized the young children to recoil at nature so that when they grow up they never want to take trips out to the country, and so that they would spend all of their money on expensive sports equipment for recreation instead.
You are absolutely right. There was a lot of manipulation that went on with the food pyramid, but a lot of studies in the last 5 years have shown that the relationship that we once thought existed (red meat=bad) is false. There are also well validated studies showing that the nutrition science that has been taught for the last few decades about our relationship with sugar, fat, food in general, and how cholesterol affects our bodies is wrong.
Dr. Peter Attia's "The Eating Academy" (http://eatingacademy.com/) is a great place to learn more about what we are finding out about how certain foods actually affect out bodies.
If you read carefully, I didn't - I only pointed out that lobbies overrode the scientific body of evidence, as it does here.
Of course, if you don't find that peer reviewed evidence accepted by leading experts in appropriate fields is the most reliable source of policy, then I'm curious what differentiates you from human-generated climate change deniers.
Sure, it may be dangerous. Here's the thing- I've been around for a while and read a lot of stuff in the mainstream media about which combinations of foods will kill you and which will make you immortal. As these have changed over the years and as I have failed to see convincing evidence in the medical literature I have concluded that people have a strong urge to believe that doing something mildly unpleasant (not eating something delicious) now can somehow prevent much worse things in the future. Its the same mechanism and magical thinking that inspired our ancestors to sacrifice goats to appease the gods and assure a great harvest. Wrapping the explanation in scientific jargon is just the latest iteration of a priest in shiny robes.
I’ve long suspected that a good diet + brushing the teeth very carefully a few times per week would be more effective than drinking soda and sweet and starchy foods + brushing after every meal, just based anecdotally on how my own teeth feel to my tongue depending on my diet and toothbrushing frequency.