Tuesday, August 30, 2016
First, the surprising news that flossing--the prime guilt producer of dentists--is not really supported by studies saying it makes a big difference in dental health. It may help with bad breath and gum disease, but the evidence is not strong. Apparently, it does not do much to reduce plaque or cavities.
Second, there is little need and support evidence-wise for yearly x-rays. Still, dentists recommend them, often from childhood on. If something hurts, yes.
There is a whole journal urging more rigor in examining dental procedures--it's called Evidence-Based Dentistry.
On the plus side, brushing is good and effective--but it is brushing with fluoride toothpaste that does produces the anti-cavity results. This has been shown to reduce gingivitis, and plaque, too.
OK--what about powered toothbrushes? Randomized, controlled trials do support those. One review said the rotating kind is best.
Twice-a-day brushing is still supported.
What about twice-a-year cleaning? Evidence-Based Dentistry found eight randomized, controlled trials, but all were rated with a risk of bias--and the results were all over the map. Upshot: Who knows if twice-a-year scaling and cleaning is necessary.
When filling cavities, bonded amlgams--often recommended, are not supported by evidence--and they cost more than non-bonded amalgams.
How about the interdental brush to get a plaque between teeth? Almost no long-term benefits have been supported.
How about the preventive nature of periodic visits themselves? One study following 36,000 children did find these visits were assoicated with fewer restorative visits in the future--but one a year is probably enough.
But--it may also have been sealants applied to kids' teeth that had the protective effect. This may be able to be applied at lower cost, say by the hygienist. Fluoride varnish is also effective.
How about fluoride? They can't do randomized tests it because they are so sure it is a positive that they can't have controls who don't get it.
Bottom line? Brush twice a day with fluoride toothpaste, preferably with a power toothbrush. For kids--sealants or fluoride varnish.
As for the rest, you may be a product of your genetics and diet.
Hundreds of NYT readers responded. Many said if they didn't floss, their gums bled. So you can decide on that. Others said fluoride is a poison and to avoid it--again, a poison with good side efx--your call.