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With modern X ray imaging devices I feel like the dangers of irradiation from dental imaging are probably quite low. If nuclear hormesis holds up, you may actually be better off getting the imaging done.

The problem is the same as the CT scan: as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing, while leaving other things that can't show up on imaging unnoticed, potentially diverting attention and giving you a false sense of security.

YouTuber and doctor Dr. Bernard "Chubbyemu" Hsu recently covered an upsetting example to demonstrate how doing additional routine scans wouldn't have helped and may have harmed in a specific sort of scenario that I'm sure many of us fear from time to time. It doesn't prove or even assert that such scans would be useless, only that they are far from a panacea and that it isn't settled science that we'd be better off with it.

https://youtu.be/YDYMMgyN4k0

And to me, I think that ties into how we're doing dentistry wrong: I think taking routine X rays for patients with healthy mouths, no history of issues and no symptoms is reckless. Maybe it is sometimes beneficial, but every single year as a requirement seems insane. Why not every 3? Are we really catching things early or are we drilling into teeth that are fine? I question it.

Of course, I'm just some chuckle fuck on the Internet with zero dentistry experience, but my knee-jerk is that something seems off here.

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> as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing

I personally have a preference for having the maximum amount of information available to make a decision.

“Don’t get that “unnecessary” test, it might give you a result that might lead to treatment you don’t need” — hearing this blows my mind every time.

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The treatment you don't need might be zero risk, but it might also have quite a bit of it. And some tests carry risks too: See how different countries have very different protocols. The US system, which is colonoscopy first, and where polypectomies will be done at the same time, can end up with bowel perforations when the polyp was not even cancer. So the diferente treatment protocol is not just about costs, but about balancing different risks.

The unnecessary test, leading to an unnecessary intervention, which gets you unnecessary long term issues is a real risk in many cases. It's not just a matter of doing a bonus blood test here or there.

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To take it to the extreme:

If there were a risk free button that you could click to see a full breakdown of all illnesses no more how early stage, would you click the button?

It would include a report of cells that may eventually turn into cancer (or may not).

It would include things like polyps, and every other diagnosable condition.

Do you avoid pressing the button? Why?

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Unnecessary medical treatments can have serious consequences. Even if you are absolutely certain you have a given condition, some treatments are very not worth it. More importantly, any given scan misses tons of important potential health issues. Not just the fact that CT scans don't show signs of MS vs MRIs, but neither of them will tell you about many cardiovascular conditions. So time spent treating made up issues from CT scans you don't need may be better spent doing other regular exams instead. Meanwhile, many aggressive cancers will be far too fast for any reasonable scan interval to catch in time. (And CT scans, to my understanding, can miss tumors early on, since it can't see as fine of detail as MRIs.)
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The ADA no longer recommends routine x-rays - they should only be taken when there is something specific that needs to be investigated.
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TIL. That's good to know, makes me feel a bit better. I'm sure my dentist will want an Xray anyway next time I come in.
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> If nuclear hormesis holds up

TIL of that theory: https://en.wikipedia.org/wiki/Radiation_hormesis

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It's fiercely debated but as time goes on it seems like it is at least partially true. I'm guessing that some effects of radiation really do map better to LNT whereas others map better to radiation hormesis; why and when is a mystery, I think. Maybe some folks more vested in this topic have an idea.

The most fascinating example of hormesis I can think of is that after the atomic bombing of Hiroshima, some people who would've received a relatively small dose of radiation seemed to have a slightly lower cancer risk than people who wouldn't have received any additional radiation.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6937943/

I'm sure there is plenty of debate about these studies and their methodology, but I have some suspicions. There seems to have been a lot of handwaving and intentional omission to explain away or ignore why LNT didn't seem to match reality. Radiation hormesis may be an illusion itself, but as it stands it appears LNT is unable to explain experimental evidence sufficiently. We're clearly missing something, and there is a lot of potential conflict of interest, especially given the obvious incentives for the energy sector...

But also, I just read Wikipedia and watch YouTube causally, so hell if I know.

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Hmm, googling it, it seems like a cross country flight is equal to 40 dental xrays. had no idea it was that low.
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There is a reason why Los Algodones has 1000 dentists for a city with population of 5000. It is called Molar City.
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Off topic: The idea of a City of Dentists seems like a Grim Fandango [0] kinda thing. Bonus points if somehow "cotton" (algodon) can be worked into the afterlife themes.

[0] https://en.wikipedia.org/wiki/Grim_Fandango

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Last I checked, actual evidence that flossing is helpful seems pretty limited.

" In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence."

https://pubmed.ncbi.nlm.nih.gov/19138178/

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I regularly get food particles out of my molars using floss that brushing wouldn't have been able to, so for me it works.
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I have always been an infrequent flosser, but deep down I've hoped for something like this to reach mainstream scientific consensus for a while so I no longer beat myself over it. Fingers crossed this is not a skewed study
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At my dentist’s recommendation I’ve been using Proxabrush every day. It is very important not to force it, and my teeth are very tight so I had to get the smaller ones (I even have trouble flossing between some) but I had some early decay between some teeth and these seem really good with trapped material before regular electric brushing.
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Water flosser.
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I told my dentist how much I liked my water flosser, and he immediately said "that's fine but it's not very effective, you still need to use regular floss too".
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Came to post this. These things are frigging amazing and like $20. Absolutely everyone should have one. Really you can floss and brush and it still gets stuff. I wish they existed when I was younger! Buy one! Thank me later!

On the 'dentists don't really know what they're doing' front, my kid's orthodontist ($$$$) describes himself as a "fencing contractor". Conversely, I got the water flosser tip from an Indonesian dentist who I hired opportunistically on holiday for a clean; he turned up in flip-flops but decanted to bare feet during operating and gave the most sage advice I've ever had in 40+ years of dentists: BUY A WATER FLOSSER. Terimakasih, Doktor!

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> actual evidence that flossing is helpful seems pretty limited

If I don't floss my breath smells terrible because of bacteria and bacteria causes tooth decay. I'm pretty certain I'm not special.

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It depends on the bacteria living in your mouth.

Some people get lucky, and even with low brushing, won't get cavities.

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Flossing is not merely essential to dislodging recalcitrant food particles, but also gives great stimulation to the gums themselves, and none of that effort is a waste, IMHO.

It is not sugar that causes dental caries, but bacteria. Flossing that old food out from between teeth is guaranteed to cut down bacteria growth!

Furthermore, my new and wonderful dentist and his hygienists wholeheartedly recommend and encourage the practice.

So perhaps you can excuse me for ignoring a singular “research study”.

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It was a systematic review, not a “singular ‘research study’”. A newer 2019 Cochrane review[0] found about the same:

> The evidence was limited in applicability and was incomplete. The included studies only presented data on gingivitis, plaque, and adverse events; most did not measure or report other important outcomes such as periodontitis or interproximal caries. … Additional use of floss or interdental brushes compared to toothbrushing alone may reduce gingivitis or plaque, or both, and interdental brushes may be more effective than floss. The evidence is low to very low‐certainty, and the effect sizes observed may not be clinically important.

[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC6953268/

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