Author Topic: Healthy teeth vs everything else  (Read 11395 times)

TheCatWhisperer

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Healthy teeth vs everything else
« on: May 17, 2014, 07:05:31 PM »
I am a dentist, hence the name Tooth Carpenter. Some of the people I encounter never fail to amaze me as fair as priorities are concerned. Last week I saw a young woman who was on the schedule for multiple fillings. When she got there, she told us that she only wanted to do one because money was tight. So we proceeded to start on the worst tooth, which likely would've needed a root canal had she waited longer. I understand that some people unfortunately have worst teeth than others, and we try our best to accommodate our patients who are truly financially strapped. However, her reason for not wanting to do the other 2 fillings was because she was going on vacation...An overseas cruise for 10 days. She was also carrying a new handbag and had acrylic fingernails. Total facepalm.

People like this will come back in about a year with a toothache, and something that would've cost them $200 now costs $2000 or more to fix. And somehow it's my fault. So frustrating.
« Last Edit: May 17, 2014, 07:32:55 PM by ToothCarpenter »

CarDude

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Re: Healthy teeth vs everything else
« Reply #1 on: May 17, 2014, 07:14:20 PM »
Ah, the old 'ounce of prevention' vs. 'pound of cure' dilemma. Don't worry, though...she'll be back, with credit!

ArbitraryGuy

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Re: Healthy teeth vs everything else
« Reply #2 on: May 17, 2014, 08:28:35 PM »
Ah, the old 'ounce of prevention' vs. 'pound of cure' dilemma. Don't worry, though...she'll be back, with credit!

My dentist told me that flossing was the best dental insurance.

HoneyBadger

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Re: Healthy teeth vs everything else
« Reply #3 on: May 18, 2014, 08:28:09 AM »
I was cursed with a plethora of hereditary dental issues and have spent a small fortune saving my teeth.  It just kills me when people who were lucky enough to be born with good teeth neglect theirs!

I agree with the dental floss thing.  I've found it's more cost-effective to take excellent care of my teeth (such as they are) and find a dentist that gives discounts for cash payment.

CarDude

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Re: Healthy teeth vs everything else
« Reply #4 on: May 18, 2014, 09:09:12 AM »
Yeah, it took me a while, but I realized that if I wanted a long, healthy life, I needed to look after my teeth. Besides an electric toothbrush, my best investment has been a water pik. Flossing with water is a lot more fun than with string, and it's finally gotten me in the habit of flossing multiple times a week.
« Last Edit: June 04, 2014, 11:11:25 AM by CarSafetyGuy »

Moonwaves

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Re: Healthy teeth vs everything else
« Reply #5 on: May 18, 2014, 09:47:30 AM »
Best thing I ever invested in was supplementary dental insurance. Of course, I hadn't filled out the forms before the first time I needed serious dental help and that ended up costing me several thousands. I've cried at the dentists on hearing I needed yet more work (although he was so nasty to me then it gave me the push to get a second opinion and it turns out a filling was more than sufficient and I've ended up with a far more reasonable, nicer dentist).  Anyway, I can fully understand someone not wanting to get something done because funds are tight. But, yep, total facepalm if that person can then 'afford' to go on holidays etc., etc.

centwise

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Re: Healthy teeth vs everything else
« Reply #6 on: May 18, 2014, 04:07:04 PM »
I couldn't agree more! I think many people don't realize how important healthy teeth are to their overall well-being until it's too late (i.e., until they have been neglecting their teeth for decades). I wish I had flossed more when I was younger. At least now I (1) am a dedicated daily flosser and (2) have an awesome dental benefits plan from my employer.

Your story reminds me of a (sadly former) friend who was low-income and un-mustachian. I try not to judge, but some of her financial decisions did erode our friendship. One of the worst: She said her young kids' teeth were in terrible shape, but she couldn't afford to take them to the dentist. I reminded her that our province provides some dental benefits for children of low-income parents, and she said she knew about it but -- "Well, you know meeee!" she said cheerily -- she hadn't gotten around to applying for the benefit!

Well, that conversation prompted her to finally fill out the paperwork and later I was very happy to hear that the benefit had been approved. Meanwhile, she and her husband had run up their credit card debt to the limit with consumer purchases. She had told me that their credit card limit had just been increased so they bought expensive cameras for the kids. They were frugal in some ways, but their daily nickel-and-dime spending was terrible: they both smoked, ate lots of candy and chips from a vending machine, drank many cola drinks every day, etc.

Imagine my shock to find out many months later that she still "hadn't gotten around to" taking the kids to the dentist. Shortly thereafter her older daughter required dental surgery (under general anesthesia) to take care of her neglected dental problems. :(  Sometimes there's just nothing you can say.

TheCatWhisperer

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Re: Healthy teeth vs everything else
« Reply #7 on: May 18, 2014, 05:13:38 PM »
I couldn't agree more! I think many people don't realize how important healthy teeth are to their overall well-being until it's too late (i.e., until they have been neglecting their teeth for decades). I wish I had flossed more when I was younger. At least now I (1) am a dedicated daily flosser and (2) have an awesome dental benefits plan from my employer.

Your story reminds me of a (sadly former) friend who was low-income and un-mustachian. I try not to judge, but some of her financial decisions did erode our friendship. One of the worst: She said her young kids' teeth were in terrible shape, but she couldn't afford to take them to the dentist. I reminded her that our province provides some dental benefits for children of low-income parents, and she said she knew about it but -- "Well, you know meeee!" she said cheerily -- she hadn't gotten around to applying for the benefit!

Well, that conversation prompted her to finally fill out the paperwork and later I was very happy to hear that the benefit had been approved. Meanwhile, she and her husband had run up their credit card debt to the limit with consumer purchases. She had told me that their credit card limit had just been increased so they bought expensive cameras for the kids. They were frugal in some ways, but their daily nickel-and-dime spending was terrible: they both smoked, ate lots of candy and chips from a vending machine, drank many cola drinks every day, etc.

Imagine my shock to find out many months later that she still "hadn't gotten around to" taking the kids to the dentist. Shortly thereafter her older daughter required dental surgery (under general anesthesia) to take care of her neglected dental problems. :(  Sometimes there's just nothing you can say.

I see this all the time. The majority of people with dental insurance don't even use it for the free preventative stuff.

MrsPete

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Re: Healthy teeth vs everything else
« Reply #8 on: May 19, 2014, 08:00:17 AM »
A couple old sayings come to mind:

Experience is a hard teacher, but fools will have no other.
Experience is a hard teacher because it gives the test first and then the lesson. 

TheCatWhisperer

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Re: Healthy teeth vs everything else
« Reply #9 on: May 19, 2014, 05:30:23 PM »
A couple old sayings come to mind:

Experience is a hard teacher, but fools will have no other.
Experience is a hard teacher because it gives the test first and then the lesson.

No problem. I would suggest using a fluoride toothpaste twice a day for 2 minutes. Sonicare is the best brush available, and you won't be able to use a traditional brush once you make the switch. This is BY FAR the best thing you can do for yourself. Flossing has been shown to be better than a Waterpik, and there is a product out there called Air Floss that is supposed to be better than flossing. Personally, I feel that a Sonicare toothbrush and daily flossing is all you really need. As for foods, pay attention to what you put in your body in between 3 meals a day. That's usually where the problems start. You would do better to sit down and have a pound of candy with a meal than to nibble on a few pieces throughout the day. Also watch out for the "good" things that still cause tooth decay such as dried fruit and juices. Super high sugar content here that can lead to tooth decay. Also, steer clear of energy drinks or diet drinks as they contain acids which is harmful to teeth, with or without sugar.

And as noted earlier, see your dentist at least yearly to check for problems. Caught early, most problems are only a couple hundred of dollars to fix.

Dee18

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Re: Healthy teeth vs everything else
« Reply #10 on: May 19, 2014, 09:49:21 PM »
Sonicare really made my teeth hurt. Do you have a second favorite toothbrush?

Basenji

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Re: Healthy teeth vs everything else
« Reply #11 on: May 20, 2014, 05:56:43 AM »
Thanks Tooth!

golden1

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Re: Healthy teeth vs everything else
« Reply #12 on: May 20, 2014, 06:54:42 AM »
Loooooove my sonicare toothbrush! 

I really need to get into better flossing habits however.  It just keeps slipping my mind.

randymarsh

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Re: Healthy teeth vs everything else
« Reply #13 on: May 20, 2014, 09:49:39 AM »
Sonicare really made my teeth hurt. Do you have a second favorite toothbrush?

This might be a dumb question so forgive me, but were you using it right? AFAIK, you're not really supposed to "brush" with it. You just very lightly move it over your teeth. Not much pressure. Out of the box, the intensity builds. I remember it sort of hurt/felt odd for the first week or 2 but then you get used to it.

Ambition89

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Re: Healthy teeth vs everything else
« Reply #14 on: May 20, 2014, 03:48:27 PM »
Went to the dentist today...no cavities!

ShortInSeattle

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Re: Healthy teeth vs everything else
« Reply #15 on: May 20, 2014, 04:42:46 PM »
I hate my Sonicare. I bow to the science but it feels like sticking a jackhammer in my mouth.


Cassie

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Re: Healthy teeth vs everything else
« Reply #16 on: May 20, 2014, 05:09:46 PM »
Emmi-dent is the best one. It brushes & flosses at the same time.  30 years ago the company Rotadent made such a good toothbrush but it was only available with a RX. Now this same company makes the Emmi-dent & the Reader's Digest refers to it as the James Bond of electric toothbrushes and no RX required to get it.   I have genetically bad teeth my entire life & this really helps.  I have always taken good care of my teeth but my dentist can tell a difference with this toothbrush.

tanhanivar

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Re: Healthy teeth vs everything else
« Reply #17 on: May 20, 2014, 05:21:33 PM »
Mustachianism has been the best aid to my dental health so far. I'd been reading the blog and then was standing over the sink brushing my teeth and thought, "If I also floss, that will save money in the future!".

SpeedReader

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Re: Healthy teeth vs everything else
« Reply #18 on: May 20, 2014, 09:00:39 PM »
My dental hygienist could immediately tell when I finally got a Sonicare -- the inexpensive Wal-Mart battery version.  It took me a couple weeks to learn to like it, and like Tooth Carpenter said, now I can never switch back -- my teeth don't feel clean with manual brushing.  The irony is that I actually work for the manufacturer!

TheCatWhisperer

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Re: Healthy teeth vs everything else
« Reply #19 on: May 20, 2014, 09:01:20 PM »
Sonicares have come a long way in the past few years. I tried one in dental school 7 years ago...total mouth jackhammer and only used it for a week. I was hell-bent that I hated them until using the more current model. They seem to have worked out some of the glitches and it feels good now. The best deal on new ones I've found for the general public is at Costco. We stopped stocking them in my office because we couldn't beat their prices. You don't need the fancy ones with the bells and whistles. Just a basic model.

There are some similar models out there that are probably just as good. The "sonic" action is what you need because it really gets into those nooks and crannies.
Cheers!

Cassie

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Re: Healthy teeth vs everything else
« Reply #20 on: May 20, 2014, 10:15:41 PM »
All dentists recommend soniccare although specialists & the research says otherwise-Can I say kickbacks?

CarDude

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Re: Healthy teeth vs everything else
« Reply #21 on: May 21, 2014, 04:39:34 AM »
Flossing has been shown to be better than a Waterpik, and there is a product out there called Air Floss that is supposed to be better than flossing.

Odd...my dentist said the opposite, and they don't sell waterpiks, as far as I know. Can you link to some research showing that flossing is better than a waterpik?
« Last Edit: May 21, 2014, 10:10:30 AM by CarSafetyGuy »

ShortInSeattle

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Re: Healthy teeth vs everything else
« Reply #22 on: May 21, 2014, 09:14:08 AM »
Sonicares have come a long way in the past few years. I tried one in dental school 7 years ago...total mouth jackhammer and only used it for a week. I was hell-bent that I hated them until using the more current model. They seem to have worked out some of the glitches and it feels good now. The best deal on new ones I've found for the general public is at Costco. We stopped stocking them in my office because we couldn't beat their prices. You don't need the fancy ones with the bells and whistles. Just a basic model.

There are some similar models out there that are probably just as good. The "sonic" action is what you need because it really gets into those nooks and crannies.
Cheers!

This is super useful. My Sonicare is 10 years old.

Gin1984

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Re: Healthy teeth vs everything else
« Reply #23 on: May 21, 2014, 10:05:59 AM »
All dentists recommend soniccare although specialists & the research says otherwise-Can I say kickbacks?
Could you post some links/articles?

Cassie

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Re: Healthy teeth vs everything else
« Reply #24 on: May 21, 2014, 12:51:36 PM »
The REader's Digest had an article last year calling the Emmi-dent the James Bond of toothbrushes and quoting studies. I am sure you can google and find it.

Daleth

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Re: Healthy teeth vs everything else
« Reply #25 on: May 24, 2014, 02:53:10 PM »
Sonicare really made my teeth hurt. Do you have a second favorite toothbrush?

I love my Braun Oral-B. And a few months after I got it, my dental hygienist commented that I had way less plaque than the last time she'd seen me.

Cpa Cat

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Re: Healthy teeth vs everything else
« Reply #26 on: May 24, 2014, 07:26:46 PM »
My Sonicare made the difference between having multiple cavities a year to having only one every 2-3 years. It's about 10 years old now and it's getting harder to find replacement heads for my version. I should probably replace it soon.

I honestly think that the thing that made the biggest difference was that the electric toothbrush has an automatic 2 minute timer. I really had no idea that I wasn't brushing my teeth for that long when I used a manual toothbrush.

nancyjnelson

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Re: Healthy teeth vs everything else
« Reply #27 on: May 25, 2014, 09:45:35 AM »
Another Q-

We don't have fluoridated water, and we haven't for four years. We use floridated toothpaste, so is that a big deal in your opinion? Our hygienist wants us to buy fluoridated water for kids, but it seems unnecessary to drink it, right?

Although fluoride is great at cleaning teeth, it was never meant to be swallowed - which is why the toothpaste manufacturers direct you to call a poison control center should a small child accidentally swallow any (really - look at the label).  I actually have a filter on my sink that takes fluoride out.  Save money; don't buy the fluoridated water.

prefrontalfinance

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Re: Healthy teeth vs everything else
« Reply #28 on: May 25, 2014, 01:24:11 PM »
Another Q-

We don't have fluoridated water, and we haven't for four years. We use floridated toothpaste, so is that a big deal in your opinion? Our hygienist wants us to buy fluoridated water for kids, but it seems unnecessary to drink it, right?

Although fluoride is great at cleaning teeth, it was never meant to be swallowed - which is why the toothpaste manufacturers direct you to call a poison control center should a small child accidentally swallow any (really - look at the label).  I actually have a filter on my sink that takes fluoride out.  Save money; don't buy the fluoridated water.

Fluoride doesn't really clean teeth. It is absorbed by the enamel, which strengthens it and protects it against decay.

Fluoride is dangerous to consume *in large amounts in a single dose*, or *in large amounts continuously*. There are many ions or molecules that are dangerous this way. If a small child somehow ate a cup of salt, that would also be dangerous, but a small consumption of salt every day is important for maintaining blood osmolarity, the function of the nervous system, etc.
The main danger of massive fluoride consumption is that fluoride is up-taken by bone, causing skeletal fluorosis. This is extremely rare in developed countries because the concentrations in drinking water are carefully monitored and truly massive doses of fluoride are necessary to begin to show symptoms.
http://en.wikipedia.org/wiki/Skeletal_fluorosis

Municipal fluoridated drinking water is completely safe for regular consumption. In fact, fluoridated drinking water has been shown in almost every study over the last 60+ years to be an incredibly cheap, safe, and effective public health intervention, joining the likes of iodized salt and enriched flour.
http://www.cdc.gov/fluoridation/safety/systematic.htm
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm

The reason your hygienist wants you to supplement the kids' fluoride intake is that fluoride intake during childhood has been shown to have life-long protective effect for the health of teeth.

Some relevant quotes (bolding mine)
"Because frequent exposure to small amounts of fluoride each day will best reduce the risk for dental caries in all age groups, the work group recommends that all persons drink water with an optimal fluoride concentration and brush their teeth twice daily with fluoride toothpaste. For persons at high risk for dental caries, additional fluoride measures might be needed. Measured use of fluoride modalities is particularly appropriate during the time of anterior tooth enamel development (i.e., age <6 years). "

"Fluoride works to control early dental caries in several ways. Fluoride concentrated in plaque and saliva inhibits the demineralization of sound enamel and enhances the remineralization (i.e., recovery) of demineralized enamel (12,13). As cariogenic bacteria metabolize carbohydrates and produce acid, fluoride is released from dental plaque in response to lowered pH at the tooth-plaque interface (14). The released fluoride and the fluoride present in saliva are then taken up, along with calcium and phosphate, by de-mineralized enamel to establish an improved enamel crystal structure. This improved structure is more acid resistant and contains more fluoride and less carbonate (12,15--19) (Figure 1). Fluoride is more readily taken up by demineralized enamel than by sound enamel (20). Cycles of demineralization and remineralization continue throughout the lifetime of the tooth. [eg, lifelong]

Fluoride also inhibits dental caries by affecting the activity of cariogenic bacteria. As fluoride concentrates in dental plaque, it inhibits the process by which cariogenic bacteria metabolize carbohydrates to produce acid and affects bacterial production of adhesive polysaccharides (21). In laboratory studies, when a low concentration of fluoride is constantly present, one type of cariogenic bacteria, Streptococcus mutans, produces less acid (22--25). Whether this reduced acid production reduces the cariogenicity of these bacteria in humans is unclear (26).

Saliva is a major carrier of topical fluoride. The concentration of fluoride in ductal saliva, as it is secreted from salivary glands, is low --- approximately 0.016 parts per million (ppm) in areas where drinking water is fluoridated and 0.006 ppm in nonfluoridated areas (27). This concentration of fluoride is not likely to affect cariogenic activity. However, drinking fluoridated water, brushing with fluoride toothpaste, or using other fluoride dental products can raise the concentration of fluoride in saliva present in the mouth 100- to 1,000-fold. The concentration returns to previous levels within 1--2 hours but, during this time, saliva serves as an important source of fluoride for concentration in plaque and for tooth remineralization (28). "

"Initial studies of community water fluoridation demonstrated that reductions in childhood dental caries attributable to fluoridation were approximately 50%--60% (94--97). More recent estimates are lower --- 18%--40% (98,99). This decrease in attributable benefit is likely caused by the increasing use of fluoride from other sources, with the widespread use of fluoride toothpaste probably the most important. The diffusion or "halo" effect of beverages and food processed in fluoridated areas but consumed in nonfluoridated areas also indirectly spreads some benefit of fluoridated water to nonfluoridated communities. This effect lessens the differences in caries experience among communities (100).

Quantifying the benefits of water fluoridation among adults is more complicated because adults are rarely surveyed, their fluoride histories are potentially more varied, and their tooth loss or restorations might be caused by dental problems other than caries (e.g., trauma or periodontal diseases). Nevertheless, adults are reported to receive caries-preventive benefits from community water fluoridation (99,101--103). These benefits might be particularly advantageous for adults aged >50 years, many of whom are at increased risk for dental caries. Besides coronal caries, older adults typically experience gingival recession, which results in teeth with exposed root surfaces. Unlike the crowns of teeth, these root surfaces are not covered by enamel and are more susceptible to caries. Because tooth retention among older age groups has increased in recent decades in the United States (39), these groups' risk for caries will increase as the country's population ages. Older adults also frequently require multiple medications for chronic conditions, and many of these medications can reduce salivary output (104). Drinking water containing an optimal concentration of fluoride can mitigate the risk factors for caries among older adults. Studies have reported that the prevalence of root caries among adults is inversely related to fluoride concentration in the community drinking water (105--107)."

avongil

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Re: Healthy teeth vs everything else
« Reply #29 on: May 25, 2014, 06:58:38 PM »
+1 on Sonicare. Worth every penny. I have to purchase the soft brushes though, the regular ones remove my gums.  Sonicare is one of those rare expenses that saves me tons of money. I have terrible teeth, I have yearly cavities. Don't eat candy, or sugar and floss nightly. :(

SpeedReader

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Re: Healthy teeth vs everything else
« Reply #30 on: May 25, 2014, 08:08:54 PM »
+1 to "Sonicare is one of those rare expenses that saves me tons of money." 

We've spent a lot of money getting DH's mouth rebuilt this year and last (multiple teeth pulled, root planing, seven fillings...).  I wish we'd had Sonicare -- or better still, good dental insurance -- years ago.

RetiredAt63

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Re: Healthy teeth vs everything else
« Reply #31 on: May 28, 2014, 02:11:26 PM »
I know someone who says he is cash-strapped and has not been to the dentist in over 4 years.  He knows of a dental hygiene school where he could have had his teeth cleaned and checked for very low cost.  Nope, doesn't go.
Kicker - this is a serious golfer, he could have had amazing dental care for what he spends on golf in one year.

Priorities.   sigh . . . .

I am a dentist, hence the name Tooth Carpenter. Some of the people I encounter never fail to amaze me as fair as priorities are concerned. Last week I saw a young woman who was on the schedule for multiple fillings. When she got there, she told us that she only wanted to do one because money was tight. So we proceeded to start on the worst tooth, which likely would've needed a root canal had she waited longer. I understand that some people unfortunately have worst teeth than others, and we try our best to accommodate our patients who are truly financially strapped. However, her reason for not wanting to do the other 2 fillings was because she was going on vacation...An overseas cruise for 10 days. She was also carrying a new handbag and had acrylic fingernails. Total facepalm.

People like this will come back in about a year with a toothache, and something that would've cost them $200 now costs $2000 or more to fix. And somehow it's my fault. So frustrating.

Leisured

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Re: Healthy teeth vs everything else
« Reply #32 on: June 05, 2014, 12:03:04 AM »

Thank you ToothCarpenter for your tips.

A comment on fluoridated drinking water, in addition to the comments from prefrontalalliance. Some places in the world have naturally occurring fluoride in water. I understand that when dentists migrated to the west coast of the USA late nineteenth century, they found business was slow because people had better teeth. Eventually it was traced to 1 part per million of fluoride running off granite in the Rocky Mountains. Other parts of the world also have naturally occurring fluoride.

There is a condition known I think as Colorado Stain, where Colorado drinking water is 1.5 ppm fluoride, naturally occurring. Teeth become very hard, and mottled. The mottling does no harm, it a cosmetic matter. Nature showed us that the desired level of fluoride in drinking water is 1 ppm, and all health authorities are doing in adding fluoride to drinking water is to make everybody's drinking water as good as the water in on the west coast of the USA.

Do not filter fluoride from drinking water; welcome it.

bikebum

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Re: Healthy teeth vs everything else
« Reply #33 on: June 05, 2014, 01:14:55 AM »
Hey Tooth Carpenter!

What's your opinion on why us modern folks have to care for our teeth the way we do? I remember "learning" in school that in the bad old days people would die early because their teeth rotted out since they didn't have toothpaste, floss, and such.

Later, I read that we have to do all this dental care mostly because the modern diet has tons of sugar, which feed the bad bacteria in your mouth. I once ate nothing but meat, eggs, and veggies for a couple weeks as an experiment, and I noticed that my mouth felt clean all the time and I didn't feel the need to brush. I decided it was worth it to eat a more "regular" diet anyway.

BlueHouse

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Re: Healthy teeth vs everything else
« Reply #34 on: June 05, 2014, 09:27:29 AM »
I hate the gunk that builds up under the Sonicare head.  It's so gross I'm starting to dry-heave right now just thinking about it. 

I use an electric toothbrush at night and a manual toothbrush in the morning. 
For the electric, I switch between Sonicare and Oral-b electric every time I run out of heads. 
I floss BEFORE I brush at night.  Should I floss before or after brushing?
I also use the tongue squeegee (available on dentist.net).  Every other tongue cleaner makes me gag, but this thing is magic. Once you see what comes off your tongue with the squeegee, you will never want to use your toothbrush on your tongue again until AFTER you've squeegee'd it. 


BlueMR2

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Re: Healthy teeth vs everything else
« Reply #35 on: June 05, 2014, 10:10:03 AM »
something that would've cost them $200 now costs $2000 or more to fix. And somehow it's my fault. So frustrating.

Dental insurance is such a scam too.  They claim to pay 50% or 80% depending on the treatment, but manage to manipulate the numbers so they don't actually pay it.  Recent example.  Dentist submits bill for around $4000 for some major work.  Insurance company decides, nope, that's really only an $1800 job and it falls mostly into the 50% category.  They claim the part they refuse to pay as most of their "payment", and we get to pay around $2000 (since the dentist accepts their judgement, probably a condition of being a preferred provider?)...  Refusing to pay a portion is NOT the same as actually paying in my book.  I find that behavior quite unethical.  Society would be better off if we cut out the waste and eliminated the middle man/insurance by having the dentist just charge us the $2000 to begin with.

Or, I should start my own insurance company.  Apparently all you need to do is get people to pay you money every month and then say that your coverage portion is really an overcharge by the doctor.  Perfect scam, collect money and then avoid the pay out...