One of my earliest and happiest memories was being released from a hospital oxygen tent when I was a small child. I had developed pneumonia and was in pretty bad shape. They not only kept me under an oxygen tent for several days at St. Luke’s Hospital in Kansas City, but they also gave me massive amounts of tetracycline.
The good news is that I recovered. The bad news is that from then on, my teeth have had pretty severe tetracycline staining. This is not just surface discoloration — my enamel through and through is grayer than I’d like. I tell you this because I’ve always had an uncomfortable relationship with my teeth, and this feeling might bias my view of dentists. I don’t like going to my dentist’s office every six months and having my teeth cleaned. Recently, as I was sitting in the chair, a thought occurred to me.
I began to wonder if there was such a thing as “evidence-based dentistry.” In my book Super Crunchers (naked self-promotion), I wrote an entire chapter about evidence-based medicine — which is, in part, an effort to test whether medical treatments are statistically proven to be effective. I figured there had to be a parallel movement in dentistry, and maybe someone had analyzed whether hygienist teeth cleaning helps or not.
Thank God for Google. It turns out there is an entire journal called “Evidence Based Dentistry.” And in just a few minutes, I was looking at a formal Cochrane review titled “Insufficient evidence to understand effect of routine scaling and polishing.”
The review looked for evidence to answer two related questions:
The first is, do scale and polish procedures [having your teeth cleaned] lead to any difference in periodontal health compared with no scale and polish? Second, does the interval between these scale and polishing procedures make any difference?
The results were not heartening for those of us who have suffered through dozens upon dozens of cleanings. The meta analysis of qualifying studies suggested that the evidence was mixed, at best. For example, there is not strong evidence that hygienist cleaning reduces gingivitis:
[T]he authors of the only study that found differences in gingivitis scores (at 6, 12 and 22 months) deemed those differences clinically irrelevant….
One reasonable reaction to this is to simply reject the Cochrane review methodology. Evidence-based medicine ranks the quality of different types of evidence — and tends to give inordinate weight to randomized control trials. Indeed, Cochrane reviews often give no weight to the results of any non-randomized clinical study. As the review acknowledges:
[This Review] carries with it the limitation inherent in most of these reviews, of including only randomized clinical trials. For this particular question, the quantity of non-randomized trials identified in the exclusion list suggests that an independent review of this more ‘‘risky” literature might be profitable.
But another reaction is to question whether it is really necessary to put dental patients through so much financial and physical discomfort. Dentists, like other agents (real estate agents, car sales people), do not have the best economic incentives when advising how much to clean.
My dad always told me that dealership rust-proofing was a scam to give dealerships some extra cash without providing your car with any extra protection. Could getting your teeth cleaned be the economic equivalent to having a car dealership rust-proof your car?
Like I said before, this post is probably just working out some wounded inner child issue. (And let me be clear that I’m not calling into question the value of brushing and flossing your teeth, or visiting your dentist regularly to check for cavities, as well as other potential problems). But it’s food for thought. The next time your dentist asks you to make an appointment to have your teeth cleaned, you might reasonably ask, “Why?”
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we folks in “third-world” countries don’t visit the dentist routinely… we don’t visit dentists until and unless something’s terribly wrong. and we all do just fine.
i was in tenth grade when my molar broke in half. the dentist put a temporary filling on it and asked me to come back in two weeks to have it capped.
my exams came in the way, and then i moved away. when i did go back, it was three years later, when i was a freshman at college.. and he asked to come back two weeks later. i promptly forgot, and haven’t gone back… and my teeth are fine.
Sure, your teeth are fine…..that is why your molar broke in half!
Hot debate. What do you think?
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This is exactly the mentality that is the underlying issue. We all have different standards of what is fine. No one under 30 should ever have a molar break in half. And yes, you can in fact keep your teeth your entire life! And no, bad teeth are not genetic…but maybe the same bad learned behaviors and diet.
No big deal. 10-15 years later these guys are going to get partials, dentures or implant teeth. Good luck with that. By that time, maybe you will share your enlightment with your kids or grandkids.
I’ve wondered the same thing, but I’m not going to make any effort to find out. I enjoy having my teeth cleaned. I think it is like a massage in my mouth. If I had the cash to spend on luxuries, I’d go every month.
I think dentists are running a minor scam. They perform a very useful and necessary function, but not at the frequencies they recommend. It takes years to develop a cavity, even in the worst oral hygiene situations.
Anecdotally: I went eight years (from age 22 to age 30) without visiting a dentist. In that time I developed one cavity — below the gumline adjacent to a void where a wisdom tooth once resided.
I now visit a dentist every 12 to 18 months, depending on my insurance situation. Every time I visit they fret about the imminent demise of my teeth due to advanced scale, gingivitis, gum recession, and good old fashioned decay…none of which has obtained.
I do not have a good genetic history for teeth. My parents both have mouths full of fillings. Three of my grandparents wore dentures. I and my brother have had extensive orthodontia. My teeth are full of chips from bike accidents and opening beer bottles with my teeth. And yet, in 37 years of disinterested dentist visits: one cavity. Which took 8 years to develop. In a place I never brushed.
The outlying variables in my case might be: 1) my parents’ insistence on fluoride treatments AND fluoride pills when I was a child, in addition to growing up in places with fluoridated water; and 2) twice-daily brushing and once-weekly flossing, religiously, since I was a teenager. (In fact, several dentists have commented that I brush my teeth “too well,” causing gum recession.)
Of course, the plural of “anecdote” isn’t “data.”
Hot debate. What do you think?
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Issue #1, you allow your insurance to dictate the treatment you recieve….if anyone or anything in this equation is out for the Benjamins, insurance is it!
Issue #2, recession is a serious issue. It indicates that you have bone loss and therefore probably periodontal disease.
Issue #3, when did you become an expert in how long it takes for a cavity to develop? It does NOT take years for cavities to develop in the worst oral hygiene situations…you’ve heard of meth mouth or mountain dew mouth before, right?!
I go to a dental co-operative and they say that cleanings differ by person.
I am genetically predisposed to healthy teeth and take pretty good care of them; so I see my hygienist once a year, mostly just to make sure there are no problems developing.
In fact I rarely see my dentist,which is a shame as he is quite handsome.
Hot debate. What do you think?
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I thought that this was common knowledge. I always thought that frequent cleaning could potentially be harmful because it removes enamel (which is also why Consumer Reports’ report on toothpaste is useless at best and probably a public disservice).
by this reasoning, brushing my teeth at least twice a day almost everyday of my life and having regular 6 month cleanings, I should have virtually no enamel left on my teeth! We only have approximately .5mm to begin with…and less in some areas…but yet I have great teeth and have never had a cavity through the enamel…and I am not an anomaly.
This all just sounds like an excuse to be lazy to me….
When I was in high school, my buddy Rex blew my mind by revealing that neither he nor his brother had ever been to the dentist. He said they dutifully brushed their teeth twice a day, and had never had any problems. We lost touch after high school. I’m 29 now, and whenever I get my teeth cleaned I still wonder, “has Rex been to the dentist yet?”
Well-loved. Like or Dislike:
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Treat the routine cleaning as a value-added marketing strategy, if you will. Even if you have dental insurance, you may have to pay a co-pay for every visit. From the moment you sit in the chair to the moment a routine examination is finished, it may have taken 5 minutes. For the resources you have to spend (making an appointment, finding a parking space, waiting in the office, paying your co-pay, and other associated costs such as babysitting), the dentist’s time you receive in return is diminutively small. Thus it becomes a disincentive to visit the dentist in the first place.
On the other hand, if you sit there for 30 minutes having your teeth cleaned and an x-ray taken, and at the end having the dentist come in for a quick examination of your dental health, you the consumer feel like something important has been done and is more willing to pay (even paying more) for the services received.
Sadly, this doesn’t seem to apply to unmotivated students and their frustrated teachers.
Last time I had my teeth cleaned during my regular visit, I had a lot of nasty staining (apparently brought on by a change in caffeinated beverage type, no names because I need some evidence-based testing on that) that I was not able to clear up at home.
The dental tech was able to completely eradicate it with that super-polisher brush along with the gritty compound they use. Stains all gone.
I love that polishing compound. Even a couple days after the visit, a random chunk of whatever grit they use will shake loose and I’ll crunch down on it and go – aaaaaah.
So that was worth it.
On the other hand, why can’t I do the same thing at home?