Nobody seems to do proper studies on dentistry, so we don’t have any gold standard evidence that I’ve ever seen. But, discounting institutional knowledge out of hand is foolhardy. I’d call the story the dentists tell about this “moderately strong” evidence for a causal connection, but (all together now!) more research is (obviously) needed.
I know a guy who had thyroid cancer. They took the gland out and he has to take a daily pill to replicate the function, but from about two weeks after the surgery I haven’t heard him complain in the years since. So, seems manageable from a quality of life angle.
But, discounting institutional knowledge out of hand is foolhardy.
Is it? I feel like dentistry seems similar to sports science and physiotherapy in addressing super complex evolving gibs of soft and hard tissue. My general impression is that sports and physio research is marginally better than dentistry, which leaves the state of research clear enough to declare it… kind of abysmal. But also to show that a lot of practitioners swear by isn’t well supported by evidence. Much of Ingraham’s painscience.com is devoted to scrutinizing physio standards of care w/r/t the state of research..
I honestly don’t know how to square this with practitioners who always seem confident in their assessments and make rote noises about being evidence based, and then even have reasonable sounding noises when I ask probing questions.
Absent the preferred evidence, we have to work with what we’ve got. Dentists keep detailed records on their clients, including notes related to their medical situation so that they know e.g. “Alice has [condition] and should get this kind of care but not that.”. Look at the state of evidence regarding flossing and gum health: I remember reading that the statement “flossing is good for your gums” is supported by exactly one study that’s over 50 years old and followed a dozen people for two weeks, then had them self-report their flossing habits over that time. That’s terrible, but my hygienist can accurately divine if I’ve been flossing or not just by looking at my gums for about 2 seconds, and I have less pain and taste less blood during cleanings if I have been.
Some of dentistry certainly might have developed how it did because somebody thought it seemed like a good idea at the time and nobody’s had the good sense to check the facts. But, absent studies, I don’t have another way that’s quite as robust of discerning that stuff from the dentistry that represents over a century of increasingly trained medical specialists noticing that their patients get better when they do X. And neither category represents a guarantee that a practice is good or bad for my health and wellbeing, nor does it identify short-term-gain-long-term-loss situations. So I have to treat everything my dentist says as at least slightly sus; but for a slightly sus claim about (e.g.) how taking care of my teeth and gums (which are connected to the blood supply) for a couple minutes every day can reduce my risk of heart problems later in life, the risk is large enough and the cost is small enough that I’m willing to brush, floss, and use that gum stimulator thinggie to get at the back surfaces where my wisdom teeth used to be every night just in case the claim is correct.
“Unsupported by science” doesn’t necessarily mean a practice is bad or a claim is wrong. It can also mean simply that nobody has bothered to publish a paper in the subject. I can think of a few simple reasons why that might be the case, and there are probably more.
Nobody who might publish new research has really been interested in the topic before now
Scientific journals aren’t publishing that sort of thing for whatever internal reasons they have
The claim seems so obviously true/false that nobody feels it’s worth their time to actually do the study
There’s a small pool of existent literature that tends to cause people to extrapolate a larger scientific presence whose lack of actual existence has gone largely unnoticed, at least by those who might do something about it
You’re absolutely correct to ask the questions and investigate the answers. And there comes a point where you’ve collected all the available evidence and you have to decide if a procedure is right for you at this time. In the case of dentistry, the current best source of evidence in many cases is dentists. That’s suboptimal for a bunch of reasons, but it’s what we’ve got to work with. In the end, you choose whether to follow or ignore their advice, and you own the outcomes.
Nobody who might publish new research has really been interested in the topic before now
Or to express it another way, all the people who actually have the expertise in the topic are not interested in publishing anything but rather want to do hands-on-work.
In the case of dentistry, the current best source of evidence in many cases is dentists.
That’s true. Dentists all over the world are advocating flossing, so flossing seems to be worthwhile.
When it comes to interventions such as very regular dental exams that are done much more in the US then in other countries the case is less good.
Dentists have large financial incentives to overtreat their patients. Getting the x-ray increases your chances that your dentist will drill into a teeth that doesn’t really need drilling.
As far as dental interventions oral probiotics is one that a lot of dentists don’t recommend but that actually has a few studies on it’s side.
To address your clarifications:
Nobody seems to do proper studies on dentistry, so we don’t have any gold standard evidence that I’ve ever seen. But, discounting institutional knowledge out of hand is foolhardy. I’d call the story the dentists tell about this “moderately strong” evidence for a causal connection, but (all together now!) more research is (obviously) needed.
I know a guy who had thyroid cancer. They took the gland out and he has to take a daily pill to replicate the function, but from about two weeks after the surgery I haven’t heard him complain in the years since. So, seems manageable from a quality of life angle.
Is it? I feel like dentistry seems similar to sports science and physiotherapy in addressing super complex evolving gibs of soft and hard tissue. My general impression is that sports and physio research is marginally better than dentistry, which leaves the state of research clear enough to declare it… kind of abysmal. But also to show that a lot of practitioners swear by isn’t well supported by evidence. Much of Ingraham’s painscience.com is devoted to scrutinizing physio standards of care w/r/t the state of research..
I honestly don’t know how to square this with practitioners who always seem confident in their assessments and make rote noises about being evidence based, and then even have reasonable sounding noises when I ask probing questions.
Absent the preferred evidence, we have to work with what we’ve got. Dentists keep detailed records on their clients, including notes related to their medical situation so that they know e.g. “Alice has [condition] and should get this kind of care but not that.”. Look at the state of evidence regarding flossing and gum health: I remember reading that the statement “flossing is good for your gums” is supported by exactly one study that’s over 50 years old and followed a dozen people for two weeks, then had them self-report their flossing habits over that time. That’s terrible, but my hygienist can accurately divine if I’ve been flossing or not just by looking at my gums for about 2 seconds, and I have less pain and taste less blood during cleanings if I have been.
Some of dentistry certainly might have developed how it did because somebody thought it seemed like a good idea at the time and nobody’s had the good sense to check the facts. But, absent studies, I don’t have another way that’s quite as robust of discerning that stuff from the dentistry that represents over a century of increasingly trained medical specialists noticing that their patients get better when they do X. And neither category represents a guarantee that a practice is good or bad for my health and wellbeing, nor does it identify short-term-gain-long-term-loss situations. So I have to treat everything my dentist says as at least slightly sus; but for a slightly sus claim about (e.g.) how taking care of my teeth and gums (which are connected to the blood supply) for a couple minutes every day can reduce my risk of heart problems later in life, the risk is large enough and the cost is small enough that I’m willing to brush, floss, and use that gum stimulator thinggie to get at the back surfaces where my wisdom teeth used to be every night just in case the claim is correct.
“Unsupported by science” doesn’t necessarily mean a practice is bad or a claim is wrong. It can also mean simply that nobody has bothered to publish a paper in the subject. I can think of a few simple reasons why that might be the case, and there are probably more.
Nobody who might publish new research has really been interested in the topic before now
Scientific journals aren’t publishing that sort of thing for whatever internal reasons they have
The claim seems so obviously true/false that nobody feels it’s worth their time to actually do the study
There’s a small pool of existent literature that tends to cause people to extrapolate a larger scientific presence whose lack of actual existence has gone largely unnoticed, at least by those who might do something about it
You’re absolutely correct to ask the questions and investigate the answers. And there comes a point where you’ve collected all the available evidence and you have to decide if a procedure is right for you at this time. In the case of dentistry, the current best source of evidence in many cases is dentists. That’s suboptimal for a bunch of reasons, but it’s what we’ve got to work with. In the end, you choose whether to follow or ignore their advice, and you own the outcomes.
Or to express it another way, all the people who actually have the expertise in the topic are not interested in publishing anything but rather want to do hands-on-work.
That’s true. Dentists all over the world are advocating flossing, so flossing seems to be worthwhile.
When it comes to interventions such as very regular dental exams that are done much more in the US then in other countries the case is less good.
Dentists have large financial incentives to overtreat their patients. Getting the x-ray increases your chances that your dentist will drill into a teeth that doesn’t really need drilling.
As far as dental interventions oral probiotics is one that a lot of dentists don’t recommend but that actually has a few studies on it’s side.