Wednesday, August 7, 2013

Dentistry Gets No Respect

The share of news coverage devoted to the healthcare industry and health science seems to grow every year. This makes sense: as people grow richer and longer-lived, personal health should be more highly valued compared to other life concerns. Additionally, healthcare is increasingly a driver of local and national growth and employment. But as we hear more and more about dazzling new medical devices and cutting-edge healthcare business innovations (minute-clinics! urgent-care facilities are so hot right now! checklists!), one important sub-field seems curiously overlooked: dental health.

The medical industry has changed a lot, and it's been pretty easy to track this via big national news providers. In my personal experience, dentistry has also changed a lot, yet I've heard next-to-nothing about the landscape of the industry or the current big innovations and ideas.

The procedures involved in regular dental check-ups today have changed considerably compared to just ten years ago. There's clearly been some paradigm-shift regarding the efficacy of fluoride treatments. The primacy of flossing is a fairly recent development (current 20-30 year olds were intensely socialized to brush every day, but flossing wasn't stressed), and optimal brushing standards are shifting to be more floss-like (emphasis on gums over teeth). Mouthwash used to be supplementary but it seems to be edging its way into everyone's nightly routine. In short, things are happening in dentistry that we're not hearing about, which is unfortunate, because it's a fascinating sub-field of healthcare.

Unlike traditional holistic conceptions of "health", which are ambiguous regarding what constitutes "healthy", teeth and gums are fairly straightforward. Healthy mouths should be able to mildly stress themselves by eating food and flossing/brushing without pain or discomfort. Aesthetically, social standards are simple and universal: white, straight teeth without bad breath. The existence of a simple and clearly-defined upper-limit on dental health differentiates it from "healthcare" broadly and begs the ultimate question: when will we eliminate gum disease and tooth decay altogether?

Considering this question requires a deep understanding of the complex social, economic, and psychological web of factors that cradle outcomes in dental health. The role of diet seems to be important, but gets downplayed compared to fancy toothpaste marketing materials. There are likely some good statistical studies out there looking at good and bad outcomes in dental health and identifying specific causal factors, but I've never seen one reported on in a newspaper. Likewise with randomized controlled trials investigating specific technologies or lifestyle interventions. Historians, anthropologists, and paleobiologists probably have much to say about dental health, given that humans have been eating food with their teeth for quite a while. Looking at dental health in animals (who don't brush or floss) would also seem to be a fruitful line of inquiry.

Ultimately the end-goal of preventative dentistry should be to develop a pill to destroy or control the bacteria that cause gum disease and tooth decay. Whether this is scientifically possible, or even advisable, I'm not entirely sure. The ethical issues involved would mirror those of obesity drugs currently in development: should we really use a pill to hack some biological mechanism to fix a problem while potentially leaving in place the deep causative factors (like not brushing/flossing or eating unhealthy foods)? These are all fascinating and important questions, but don't expect to read about any in your local newspaper or website.

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