Is it just me, or does it feel like we've been hearing about advances in dental treatment for decades, without them actually having any effect on the practice? From my personal experience as someone living in the Netherlands, where standards of health care are pretty high, I would expect these advancements to make at least _some_ impact on the field. Instead my (admittedly anecdotal) experience as a patient has been basically the same over the years.
Having worked at a dental implant startup in Vienna (http://www.bioimplant.at/), I've experienced first-hand the obstacles that prevent new treatments and technology from reaching the patient.
In summary: here is an 'immediate' dental implant requiring no drilling or bone augmentation (ie. surgery-free), that can be placed in minutes, and - once healed in - has no risk of future infection (peri-implantitis). Clinically proven over 10 years. Revolutionary, right?
No top-end journal is willing to publish papers on this topic. (We surmise that the implant industry profits too much from existing treatments.) We've approached several popular science magazines with article proposals; declined. Reached out to journalists, no response.
The only real publicity so far has been through word-of-mouth and SEO. It's a baffling (and somewhat disgraceful) situation. There are hundreds, if not thousands, of patients suffering needlessly every year, and a solution exists - but where is the bridge that can connect them?
If I was in your boots I would talk to Health insurance companies.
They fight hard to reduce health costs (and increase their own revenues). They also know how to lobby, which is certainly mandatory in the health industry.
Some of them have their own clinics and can even fund research.
For what reasons were top-end journals unwilling to publish on even just the topic, and for what reasons were researchers completely ignoring communication attempts?
The articles - follow-ups on anatomic implant cases - were rejected mostly with the excuse that they didn't fall into the journal's area of interest. (I don't have access to the actual letters at the moment; I hope they're eventually published on the website.) We're talking here about top journals such as the International Journal of Oral & Maxillofacial Surgery. (Not their area of interest? Seriously?!)
More worrying yet were responses from implantologists and dentists on community sites such as Dentaltown. There was a shocking level of ignorance about osseointegration and zirconia, and a belittling attitude to such a 'newfangled' treatment. (Of course, it didn't help that the CEO on our side has a very low tolerance threshold, and expresses himself with typical Austrian directness - to put it mildly...)
I got a titanium implant a couple of years ago, and I've never heard of your company.
I had a look around your website and I really hope you're successful with it.
If I had heard of you when I was getting the implant, I would certainly have considered your service (assuming it's available where I am - there's no obvious way to find out?).
Zirconia (ceramic) has been used extensively in implants, and is clinically proven. To be sure, it hasn't been around as long as titanium, but that's just pedantry.
Titanium and zirconia both osseointegrate (bond to bone) extremely well. However, titanium is grey and this discoloration shows through gums. Zirconia is white - like a real tooth - so it's much better esthetically.
Some people turn out to be allergic to titanium. Zirconia is the best choice in such cases. (Zirconia is arguably the most biocompatible of all implant materials.)
There's a lot of medical literature about ceramic implants, but you can be assured that it's definitely at least on a par with titanium implants.
The best way of dealing with cavities is to do your darndest not to get them in the first place! (Although: read below...) Stay away from sugary and starchy foods that stick to teeth. Don't expose teeth to mixtures of sugar and acid (such as sodas).
Brush teeth carefully once a day: small, circular motions that cover every tooth surface; it's the mechanical action that removes food debris and plaque. A light touch is crucial, so you don't damage gums. Spend about 15-20 minutes on this in the evening, either while watching TV, reading, or just lying back in bed. Don't floss too often, because that can also damage gums.
Anecdote: I had a small cavity on a rear molar. I completely stopped chewing on that side for 2-3 months(!). During that time I dramatically increased my intake of calcium (yogurt, milk, green vegetables, supplements). When I later returned to normal chewing, the cavity was healed. From the medical literature I've read, this doesn't happen. But in my case, it most certainly did happen.
How big was the cavity? Did you actually have that checked by a dentist?
Also while I agree that the best is not to get the cavity in the first place, what do you do once you have it? What is the latest technology in filler material and treatment?
I don't know about the latest tech, unfortunately. The doctor I worked with is a maxillofacial surgeon; any case requiring fillings would probably get referred to a regular dentist!
Certainly! There's a 'Crowdfund' page on the website that urges people to make their dentists aware of this treatment: http://www.bioimplant.at/crowdfund/
The announcements of new treatments and new discoveries in various healthcare fields astronomically outstrips the real ones that you can actually make use of.
The easy money is in the hyping of potential cures, and it's easy to see why. Even in this HN thread where you'd expect the level of scientific understanding and healthy skepticism to be fairly high, you see a lot of "Wow, it's about time" type responses. Now imagine the response of the politician controlling grant money who has no background in science.
Generally speaking, politicians don't control grant money for research. They set the budgets for agencies who solicit proposals that are reviewed by domain experts. The exception is what is known as "pork", but that usually involves large projects.
That's pretty much untrue. In the US at least, the federal budget allocation passed by Congress specifies how funding is distributed across programs and to fund the implementation of initiatives specified in other acts. They not only set the budgets for agencies, but also they set the funding for specific programs in those agencies. For science funding agencies, those programs are partially grant soliciting programs, as well as other things. It's not just a big slush fund. Politicians regularly try to mess with these allocations to, for example, attempt to reduce funding for science programs they don't believe in. A famous example is with regard to embryonic stem cell research, although this was done by executive action.
All you say is true; I was trying to give a coarser-grained description. It applies to cases like this. Someone with a new idea for regrowing tooth enamel is going to apply to some program within NIH (I guess). He's not likely to get funded because a congressperson read a pop-sci article - his proposal will be reviewed by other researchers in dental health.
And that's true microscopically, but year-over-year the flow of money down the pipe is indeed controlled by political whims. In the Bush years, we had some grants granted by an agency that were ultimately only partially allocated by Congress for subsequent years, so that we ended up with only a fraction of what our overall budget was supposed to be by the end of a multiyear grant.
Novamin is a bioglass that is fortified in Sensodyne, which coats the enamel (a fluoride rival, but better), and was sold to GSK. After that, it suddenly disappeared from shelves in the US.
You can still buy it online (it ships mainly from Europe), but not in the stores.
I used to watch Shark Tank a lot, and they talk about this with patented products. That a big company will buy out a better solution just to shelf it because the current solution is more profitable. As a person that just spent $10k on oral care the past year this makes me incredibly sad and angry. Gov't is already so cheap that we (US) have fluoride in our water, that was planned to be cheap dental care =(.
I understand the need for IP to make the investment worthwhile. But when buying it out like this, it should be a use it or lose it situation with the patent. Depriving people of a better solution to make a profit ain't right.
> Gov't is already so cheap that we (US) have fluoride in our water, that was planned to be cheap dental care =(.
To understand you correctly, do you think the fluoride is a bad thing?
IIRC fluoridated water is amongst the best bang for the buck you can do for healthy teeth, with no downside that I'm aware of (?)
I was under the impression that no one has ever shown that drinking fluoride does much for your teeth: it doesn't have a systemic effect; if you soak your teeth in concentrated fluoride that helps (though we might be overdoing it now in the US for children: tons of cases of teeth with floirinosis; I have some friends who clearly have this problem... but for adults it is great), but the momentary contact of the extremely small concentration of flouride in drinking water can only do harm as it ends up in other parts of your body... and we also know it does harm, the only question is whether there is enough in your water for the harm to be noticeable.
(Living in continental Europe) That's funny. After reading your comment I went to the grocery store and found that brand and that 'model'. As I never know which kind of toothpaste I should buy I am eager to see if I am going to like this one.
The lasers also came out. Check out waterlase, it is widespread now.
But we are talking about regrowing dentin and enamel! And Kings College London seems to have been working on this for a while. Your article from 2014 is about it.
What I want to ask any dentists here is why is PHOTO ACTIVATED DISINFECTION not being used? Where can someone get it instead of drilling and filling???
These articles sadly derive from institutional press releases that invariably oversell the underlying work.
We have an unsustainable systemic problem arising from the need to convince governments filled with anti-science politicians to fund expensive science. The institutions therefore feel the need to oversell every tiny paper so voters and politicians believe we're getting somewhere fast and won't kill funding, but the pace of real science is always fits and starts. You see a lot of people who have somehow figured out how to search the literature and cherry pick a paper they don't like as evidence of wasteful spending, and the system believes (falsely in my view) that overselling and oversimplifying results in a language that voters and politicians can understand.
Edit: I should have also said that the other big motivating factor for institutional press offices is to market the institution to other potential donors.
Could you recommend a particular dentist there? Do they have the Solea 9.3 µm laser? From what I've been able to find, it's the only one that directly removes enamel and dentin. The other kind is erbium lasers which vaporize a water jet which then removes the material, but it's vastly less precise.
Seriously though, it really is just announcements that state something is available now that people outside of a particular profession should care about.
Maybe relevant to someone: Fluoroquinolone antibiotics like Cipro (ciprofloxacin), Levaquin (levofloxacin), *floxacin, etc, directly and maybe permanently increase the production of MMPs, the enzymes this article is talking about. That's (partly) why these antibiotics cause teeth to shatter at the gum line spontaneously.
There are something like 40 MMPs and we don't know what they all do, but they're generally responsible for destroying tissue in the body. Normally this is a good thing, like when a wound needs to clear out cells for wound healing. But fluoroquinolone antibiotics cause the "upregulation" of these enzymes, possibly permanently through epigenetic changes, so the body literally eats itself over time. This is why teeth shatter, hair falls out, collagen disappears (wrinkles, skin damage), connective tissue dissolves (like the optic nerve, leading to retinal detachment / blindness), and tendons literally snap without use, which can lead to disability. All of this damage can be irreversible even at low doses of fluoroquinolones.
Interesting to see this. In the hazy midst of a spell of bad food poisoning last month, I took the first dose in a course of levofloxacin that a pharmacist had given me. I had begun reading the Wikipedia entry on it before, but right after taking it I came to the section on spontaneous tendon rupture... since I'm an athlete, I freaked out and forced myself to vomit moments later. I'm glad I did. I personally try to avoid antibiotics as much as possible in general, but I had caved at the moment due to being in a lot of discomfort.
Just based on my own experience I never take fluoroquinolone antibiotics. I had one dose of Avelox and the next twelve hours were like a waking nightmare. They were twice a day pills, so I had to wait until that evening for the effect to pass. When I reported the reaction my physician told me to stop the drug immediately. She was quite vehement and sounded alarmed. The experience reminded me of the reaction I'd had to Cipro some years before, but worse. It was then that I looked them up and found they were in the same class.
Now I check. A few months ago I rejected a prescription of Levofloxacin from a new physician, and had him replace it with an antibiotic from a different class that I knew I tolerated well. My pharmacist agreed with my decision. She had taken Levofloxacin for a few days several years ago and it gave her permanent neuropathy in her hip and leg and balance problems. Actually, she said the neuropathy was permanent "so far." For all she knew it would go away, but after three years she wasn't expecting it.
Note that I'm reporting an n of 2 here. My brother says Cipro doesn't bother him at all. Do your research and make your own decisions.
If you do your research you will never use fluoroquinolones in your life. The antibiotics can ruin anyone's life, independent of supposed risk factors. Fluoroquinolones have killed many people but there are also many who suffer a permanent, irreversible fate that some consider worse than death. If you do your research you will see the thousands (over 2,000 in 2011 alone) of lawsuits because of these drugs. You will see how these are literally chemotherapy drugs (topoisomerase interrupters). You will see how they are designed to attack almost every cell in the human body, causing a potentially permanent chemical injury that can completely remove any joy of living.
It's important to understand that taking these drugs once without reaction does not mean you are safe taking them again. There are plenty of horror stories of people not experiencing side effects until their 2nd, 10th, etc dose. It's playing russian roulette with death and a living hell. This is not hyperbole, unfortunately.
There are literally thousands of studies on fluoroquinolones. Unfortunately none directly show tooth decay but the private support communities have. Simply Googling for "fluoroquinolone mmp" will return many studies to start from.
Tendon rupture and retinal detachment are well documented.
There are also many reasons why side effects from these drugs are under-reported and under-studied. For example, fluoroquinolones have been around since the 70s, but the first case report of tendon rupture did not appear until 1983. After all, who would believe an antibiotic would cause a tendon rupture up to years after taking it? Doctors to this day do not usually believe that patients' spontaneous ruptures are caused by fluoroquinolones, despite being well documented in the scientific literature now.
Not a source, but a corollary of the parent's claim that might be easier to look up: doxycycline, an MMP inhibitor, is used (under the trade name "Periostat") as a prophylactic after dental root planing to prevent damage to the enamel.
Your original question, "what happens if a drug downregulates MMPs" - is a great question and the tip of a largely unexplored iceberg.
MMPs are involved in many diseases, including fluoroquinolone insidious poisoning. They are implicated in heart disease and neurological disease like MS, for example. They are also implicated in general aging, because they destroy collagen which is considered to be irreplaceable in the body (hence why wrinkles are permanent).
Doxy is a known MMP inhibitor which may have benefits extending past its antibiotic range.
An important related question is why are MMPs upregulated by fluoroquinolones? One answer is that TIMPs are downregulated [1]. TIMPs are the antagonist to MMPs, they bind to MMPs and deactivate them. This is one way your body maintains MMP control.
Researching TIMP upregulators and MMP downregulators may help people suffering from permanent fluoroquinolone damage (like myself) deal with the constant pain and tissue destruction. These also have implications in aging and anti-aging technology. Notably, food from the ocean is well known to balance TIMP/MMP regulation [2]. Some natural antioxidants may also have the same effect [2]. This unexplored research is important both for tooth decay like the original article (since MMPs eat dentin, the hard tissue in teeth, and apparently enamel as well), and most tissue in the body, as fluoroquinolone sufferers experience in a hellish, constant reality.
Hmm. Took one course of cipro in early 2010. The year after that was the worst of my life health wise. After that, have steadily improved.
I can't say it's cipro related. The stuff that happened was: very bad digestion, chronic left arm pain due to typing in a poor ergonomic position, and a bike accident + broken tooth (this clearly wasn't due to an antibiotic). I did, however, likely acquire MRSA in a wound on my chin that I got during the bike accident (I found out I had MRSA five years later; it had moved to my nose and persisted there at an asymptomatic/occasional flare up level). MRSA seems linked to cipro usage. I also acquired tinnitus at some point, most likely after the bike accident. My liver enzymes also tend to be on the high end of the normal range or slightly above it.
May have started bruxism that year or the one after, but it's hard to date when teeth grinding started. That one could be something that developed after the bike accident.
Nothing necessarily specific to cipro. But, supposing it did contribute to any of that, is there a normal protocol to reverse effects? Beyond what you wrote above, which would be: eat seafood and certain antioxidants (which?)
I'm in a pretty good state right now, and also nowhere near certain Cipro had any impact on me. But, it was a very rough year, and I had always been in excellent health prior to that. So if there's some sort of low side effect thing I could adopt such as certain foods, it's worth trying.
FQs are some of the most powerful antibiotics in terms of destroying healthy gut bacteria, and likely cause permanent gut flora changes after use. Some of the bacteria it destroys are oxygen sensitive, so they aren't in probiotics because they can't survive long enough to be manufactured into a pill.
Muscle problems, especially muscle twitches, are very common among FQ toxicity sufferers. This is suspected nerve damage but there may be other factors.
FQs are well known to cause tinnitus, with the suspected biological mechanism being nerve damage to the ear.
Unfortunately, the medical community is severely lacking in treating these conditions, so there are no reliable tests for determining the underlying damage. It may be impossible to definitively know if any of these things were caused by the cipro.
Fair enough. So are there any further treatment indications, e.g. such as a way to get oxygen sensitive bacteria other than a pill? Likely would help my digestion whatever the cause.
A doctor who examined my tinnitus actually suspects it's nerve damage. However, it may well have been due to the bike accident, so it's hard to tell.
No muscle twitches that I'm aware of. More tension.
The root cause of most dental issues , including dental carries is a simple bacteria. We've been dealing with bacteria , extremely well, since the first vaccine. And for 30 years , there has been research for a vaccine. So where is it ?
Well, one company , oragenics was ready for clinical trials. But it seem[1] that, due to a very restrictive enrollment criteria they couldn't enrol people to their clinical trial.Due to that and to further uncertainity due to fda , they stopped the clinical trial waiting for "partnering opportunities".
Such a shame. I wonder how and what could restart that project ?
Dental caries aren't caused by a single species of bacteria, but by multiple species working together. They form an extracellular matrix called a 'biofilm' that makes them resistant to immune system attack [1].
The link you cite is not a vaccine, but a supposed 'replacement' bacteria that outcompetes the native bacteria [2]. This can definitely work, but I'm doubtful it will be universally effective, for the same reasons that probiotics don't always work: every person has different existing populations of bacteria, and not every invading species will be successful at colonizing or dominating that environment.
> Dental caries aren't caused by a single species of bacteria, but by multiple species working together.
Yeah, but not many. Next to the ~half-dozen-hundreds-or-so of species populating our oral cavity without issue (indeed contributing just fine), we know of just ~under-half-a-dozen-or-so potentially dangerous ones. The very ones who create the very few actually damaging acids (among the many kinds in the world that our initially-generally-robust dentition handles just-fine) when fermenting carbohydrate leftovers. Brushing regularly disrupts or may even destroy their biofilm, Xylitol accomplishes/contributes the same FWIW, or absent dietary carbohydrate (read, ancestral ice-age hunters / traditional inuit / Maasai warriors etc) the problematic sort doesn't even ever form.
You can regrow tooth enamel on your own right now. It's much, much slower than this and requires a criminally large amount of cod liver oil and butter oil (ie: vitamins A, D, K2 and calcium).
I'd suggest bone broth too. I don't know why my teeth are less sensitive when I have that regularly, but it's a clear effect, remineralization would be the obvious guess, and my dentist said to keep doing it.
Yup, you could also tackle your diet. Given the multifactorial aetiology of dental caries; Host, Plaque, and diet. I would highly recommend the least invasive approach; changing your diet. In addition to the noted vitamins, sucrose should not be included in your dietary program seeing as how it is a cariogenic constitute. There are other compounds that play a major role in the development of dental caries, but sucrose has that special something about it. Also, fluoride either in water (1.13ppm) or topical. Lasty, Xyiltol gum, it helps to rebalance oral pH. And of course brush and floss. This way, you prevent the development of dental caries--fingers crossed--and help in the reminiralisazion process.
1. The original comment was deleted. My comment would make more sense in context.
2. FUD is using false information to spread fear, uncertainty, and doubt. When someone claims nutritional supplements have some sort of miraculous medical benefit, that is FUD. It is FUD because it is almost certainly false information and it helps to create doubt and uncertainty of mainstream medical science.
3. If OP provides empirical evidence that using nutritional supplements regrows enamel, I will admit I was wrong. The wider medical community would also be very interested.
Dental technology comes out of stone age :) Most of 'innovation' was around x-ray machines and nice chairs for last several years ( at least for most of patients )
when i came back, i had issues. but the imaging was really quite a bit better. the adhesives were better. the crown construction process was a lot better. cleaning processes much better. filling materials substantially advanced. mold making considerably advanced.
everything was substantially less painful, cheaper, and more well understood. maybe you can fault it for not being better faster
> "The nano-hydroxyapatite is a revolutionary material with a wide use in dentistry. With regard to restorative and preventive fields, nano-hydroxyapatite has remarkable remineralizing effects on initial lesions of enamel, certainly higher than traditional fluorides used until now for this purpose."
I wonder how much existing practices, who are invested in repair and especially cleaning of teeth feel about possibilities to permanently repair teeth. There are other advances such as the one with laser stimulation.
I know about that. It will be years before it becomes available. The only way this will come to market faster is if the emerging market as China or some other country, Japan for example, adopt it and start using it. Japan comes to mind as I heard that they actually try to treat root canals overthere.
There's Silver Nitrate / Silver Diamine Fluoride [1] which appear to be as effective as drilling + filling cavities. Of course, they are also much, much cheaper, so they will cut into that average $160K/yr salary for dentists in the US...
> Of course, they are also much, much cheaper, so they will cut into that average $160K/yr salary for dentists in the US...
I doubt that this makes much of an impact. Cavities aren't really a money maker for dentists and inadequacies inherent to the repair process mean that you'll almost certainly need more expensive work later on. The only way to really "beat" the dentists is to avoid enamel loss and calculus formation through proper cleaning technique and regular dental cleanings.
Most dentists in the US are private practice which makes for a competitive market that prides itself on the quality of its customer care. If you really want to be worried about someone coming to take your hard earned money I'd be concerned about the growing incorporation of dentistry offices in the US.
2014 - "No more fillings as dentists reveal new tooth decay treatment" https://www.theguardian.com/society/2014/jun/16/fillings-den...
2011 - "An end to the dentist's drill: New painless cavity filler could be on the market in two years" http://www.dailymail.co.uk/health/article-2077816/Scared-den...
2004 - "No drilling, no filling in painless dentistry" http://www.telegraph.co.uk/news/uknews/1477044/No-drilling-n...
1998 - "Dental lasers – are they the safest way to fill your cavity?" http://judyforeman.com/columns/dental-lasers-are-they-safest...