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> They offered my wife and I free samples (based on her work, not as compensation for writing this post); she accepted, and I’m still debating.

Amusing but still somewhat serious question: if their product, which they offered samples of, is a colony of bacteria that live in the mouth in perpetuity, and your wife takes it, then wouldn't any debating you do with yourself on the subject be rendered moot the next time you kiss your wife?

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See 2.1

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My teenage daughter is allergic to fluoride (horrible mouth rash) and subsequently gets a lot of cavities. We have tried all of the holistic hippie approaches to dentistry , including some nonspecific probiotics and no dice. We don’t have 20k (but have spent at least that on her teeth so far) so will bookmark and keep an eye out. She’s been convinced that the people who never get cavities just have a different mouth biome than her. Hopefully, she’s right and soon these bacteria will be safely living in her mouth.

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> She’s been convinced that the people who never get cavities just have a different mouth biome than her.

A friend of mine says that he was recently told something similar to this, by his dentist. I don't remember the exact details, but basically there are two basic "mouth types." There's the type that gets cavities easily, and the type that doesn't, but that second type is far more likely to get gum disease instead.

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Dec 7, 2023·edited Dec 7, 2023

Huh. As someone who has never had a cavity (despite plenty of sugar and less-than-stellar dental hygiene), and who has had constant low-level gingivitis for as long as I can remember, this is very interesting to hear.

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Sounds like me too.

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Huh. My brother is the same way. I however get cavities easily even when I brush and floss every day; a water pick seems to be necessary.

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I am similar but did ultimately get a cavity.

Long before there was any threat of me getting a cavity, I started experiencing pain in some of my teeth (the bicuspids) while chewing things that might be termed "soft candy", such as gummy bears and chocolate chips. I complained about this to my dentist several times, he investigated the teeth that hurt, and he informed me that as far as he could determine there was absolutely nothing wrong with them.

I still have no idea what this phenomenon is about (it's still happening).

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I have the same thing. My dentist said it's the enamel wearing away on my teeth where there's a misalignment where the teeth are rubbing. Apparently it's a non-issue beyond the pain, and sensodyne toothpaste is a good enough solution. I've been using for the past few weeks and have been enjoying chewing with the left side of my mouth. Maybe you've got something similar.

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Agree. I have terrible dental hygiene (I floss every now and then, and rarely brush) but I haven't gotten a cavity since in twenty years. But my gums bleed easily and every dentist I've ever met has told me I need to do something about my gums before they get worse.

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Been wondering about this for a long time. I've never gotten a cavity despite literal zero dental hygiene and eating whatever I want for decades, which kept surprising my dentists..."you must brush and floss a lot!" Like, they refused to believe it was possible not to and not get cavities. But they did always warn about gingivitis, which has admittedly been less successful. At least my teeth will be hearty and hale when they fall out!

Anyway, it's an exciting product and I hope it's successful. Pretty sure I have one of those S. mutans variants myself, but could never figure out how to get into studies for this kind of thing. If only I'd gone to grad school, I guess?

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There is a strong genetic effect on whether you get cavities. Most dentists are aware of this. I am in a similar position to you, though I did get a cavity at the age of 36.

My dentist's comment was just "you have your mother's teeth".

It's possible that the genetic effect is intermediated by a difference in oral microbiome, but that's certainly not the only possibility, and even if it is the case, it does not follow that transferring the oral microbiome will successfully transfer the cavity resistance.

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I thought this mechanism was well understood and has to do with the ph of your saliva. Us no-cavitiers get gum disease because less acid and more plaque.

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That's the rub though: I'm the *only* one in my family who doesn't get cavities. For everyone else it's been a lifelong struggle, not just with cavities but with the more serious dental stuff as well. There are some dietary differences - I've got the typical autist oversensitivity to certain gustatories, so lots of common foods are Right Out - but it's not like I never consume any simple carbs or acid. (Childhood dentist *hated* that I eat raw lemons.) So, if indeed more genetic than environmental, it's a weird nat20 roll.

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founding

I mean, if you go to a dentist you're likely to have either cavities or gum disease. The potentially much larger category "healthy" just doesn't see a dentist.

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My dentist told me the same thing in a more folksy way. I dismissed it as i thought he was just trying to condition me for usual reprimands about flossing more (I was the sort with good teeth bad gums). Maybe i should update. (Any bacteria strains that prevent gum disease?)

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shit. I am virtually immune to cavities, and have gum disease

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Allergy to fluoride sounds hard. Is she unable to drink any water that hasn't been through a special filter?

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We haven’t tested extensively but she drinks filtered water almost all the time and our house has a filter. We have heard of people who can’t shower or swim in water that has fluoride and that sounds miserable. She gets mouth sores a couple of times a year that I and her doctor had written off as viral, but I’m wondering now if they coincide with fluoride exposure somewhere.

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Does your house have a filtration system that removes fluoride? They're a pretty involved setup I believe. My house has 2 cartridge filters but those won't touch fluoride

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I'm told that letting fluoridated water sit out on the counter in an unsealed container for a day allows the fluoride to evaporate.

I do that for plants, but would not want to experiment on someone allergic to it.

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I thought that was chlorine. A quick google suggests that fluoride doesn't evaporate out of water.

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Dec 9, 2023·edited Dec 9, 2023

She shouldn't rely on water which has had all minerals filtered out though, as would be the case if she drank distilled water for example. That is because in the body it will dissolve out vital minerals, to equalize concentrations, and lead to malnutrition.

For the same reason, people stranded in remote locations should not drink "pure" water, such as rain water or melted snow, for long without adding a pinch of clay to it.

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Not sure if you've looked into it, but check her preferred toothpaste and see if it contains Sodium Lauryl Sulfate; it is notorious for causing mouth sores, and could be contributing to the problem. Once I switched to a toothpaste free of SLS, common mouth sore frequency notably decreased.

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Thanks! That was our first guess when she was a toddler, but nope! It’s definitely fluoride.

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Dec 8, 2023·edited Dec 8, 2023

Have you all tried xylitol? It seems to work for me. I don't have a fluoride allergy and I'm not a dentist, so take with a bunch of grains of salt, assuming you haven't tried xylitol already.

ETA: I realize my question might be condescending, especially if you've already tried it. But I had horrible teeth and xylitol seemed to help and wanted to let you know about it on the off chance you hadn't heard of it. That said, I have no idea if it's safe, and I've found precious little info on it, though I haven't looked as hard as I should.

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How do you use xylitol?

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Dec 8, 2023·edited Dec 8, 2023

I use xylitol mints, a couple after I eat something, or about 10 grams per day.

ETA: I'll add that it can get kind of expensive, about $100 for a two- to three-month supply. I'm also a bit nervous that maybe it's not really all that good more me. I should also say that when I started taking xylitol, I also changed my dental hygiene regimen pretty significantly, so it's always possible that if my teeth are doing better, it's because of that regimen and not (or not only) because of the xylitol.

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This makes me laugh. Finland has endless supply of xylitol gum

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Have you tried toothpaste with hydroxyapatite? Has a similar remineralization effect as Fluoride, according to early studies

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There’s a brand called Apagard Premio that you can get on Amazon for a reasonable price. People seem to think it’s better than flouride for tooth health, especially for teeth sensitivity. I’ve been using it for around a year and it’s been good enough — I didn’t get cavities before, but I still don’t.

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This was my first thought. I use a brand called Boka, and it's wonderful. I have ***hated*** brushing my entire life, and I neve really knew why, specifically. Apparently I (subconsciously) disliked flouride, because I have no issue with the Boka stuff and now, finally, brush regularly.

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She might benefit from using these: https://betterbiom.com/products/nobs-toothpaste-tablets?variant=44347081982262. They were created by a dentist and use calcium hydroxyapatite as an alternative to fluoride.

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Thanks everyone! She has tried xylitol and hydroxylatite. Still getting 4-8 cavities per year. The goal is to get to cavity zero but it seems like every time she gets teeth filled, there are more in the next round of x-rays. And yes, we’ve had multiple dentists and have a hygienist in the family- not just getting scammed with fake treatment. Based on some other comments she’s going to try some of the other oral probiotics and she has already emailed this company offering to volunteer if they end up doing research at Texas A&M (a possibility listed in investor docs).

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Sounds like she is short of minerals of some kind - See my post above.

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Have you looked into nano-hydroxyapatite? It's a toothpaste additive that's been in use in Japan since the 1990's that remineralizes tooth enamel. Anecdotally, I've been using it for about six months, and on last checkup, my dentist noted that my teeth were in the best state he's ever seen them.

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In India, Villager’s use stick of neem tree(Azadirachta indica) to brush teeth. Read more about it here. Maybe it will help

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Heh. Guess that's what I get for asking the obvious question before reading the whole article.

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I was disappointed for moment to see Scott would write "They offered my wife and I free samples", but it's just misquoted. The original sentence is grammatically correct: "They offered my wife and me free samples". At least now it is.

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It was not misquoted when I quoted it; that was a direct copy-paste. Scott must have edited it at some later point. Good catch, though.

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Clearly this has been thought through carefully by some very bright people.

Even so, putting genetically modified bacteria into your body is high on my list of things likely to have unintended consequences.

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This is a good intuition to have, EXCEPT that there being large amounts of bacteria in your mouth doing nasty things to your teeth, the "natural" status quo, sounds like a problem to solve.

I'm actually not as sure as you about the "thought through carefully" part as you: this seems like the kind of cool idea that biohackers (or people who like the idea of being biohackers but have a much lower risk tolerance) would enthusiastically embrace without overthinking it because it FEELS reasonably safe (and probably IS): it doesn't promise too much, it's not messing about with complex bits like the eyes or the brain or whatever, and it's relatively easily reversible if you really wanted to.

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The easiest way to disrupt this “status quo” is by brushing twice a day and flossing once a day. If the Lantern product seems safe, regular dental hygiene risk is functionally zero. However, I agree that if this process is safe it’s a no-brainer.

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This seems to be the equivalent of advising "eat healthy and exercise" to someone trying to cure aging.

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Except aging is not a disease, nor is brushing and flossing an attempt to “cure” anything. It’s preventative care, same as this treatment would be.

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Then replace "aging" with "obesity", and you end up in the same place. We know eating healthy and exercising prevents obesity, and yet we end up with a very overweight population.

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Aging isn't a disease much like alcohol isn't a drug: it totally is, but we're too used to it to notice, most of it the time.

It's functionally indistinguishable from a disease, certainly — I don't care if the thing making me become weaker, slower, dumber, uglier, and deader is a genetic disorder, a pathogen, or Nature's Natural Way of Wisdom™: I want that shit to stop regardless.

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Dec 8, 2023·edited Dec 8, 2023

If you really do want it to stop, you will need to be aware that it isn't a disease. When two processes occur for radically different reasons, the approaches to stopping them are going to be different.

Note that for as long as the historical record permits us to see, people have railed against aging and wished that it could be stopped, prevented, and reversed. Nobody has ever described it as anything other than awful. We are used to it, and we know that it's not a disease, but there are no illusions about whether it is good or bad. It just isn't a disease. There can be more than one kind of bad thing in the world.

Tangential: https://www.smbc-comics.com/comic/2010-01-06

If I were responsible for that second panel, it would manage to include as large of a human diplomatic delegation as could be crammed into the frame, and all of them would be giving the aliens the stoniest glare that it's possible for a human to draw.

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Brushing twice a day and flossing once isn't optimal for oral hygiene - it's just the optimal balance between oral hygiene and "not so onerous that people just won't bother" (see also eg. "five portions of fresh fruit & veg per day" &c.)

I've been told that if we were really optimising for hygiene, instead we'd brush after every meal, plus in the morning and evening even if we hadn't eaten then, plus rinse our mouths out thoroughly immediately after snacking or drinking something with sugars, acids, or tannins (so pretty much anything..)

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I was under the impression that more than twice per day starts to get counterproductive due to enamel wear.

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Honestly wouldn't know! I was told that by a navy dentist who mayyyy have been tailoring his advice for navigational watchkeepers who essentially live biphasically rather than having a 'morning' and 'evening'. Could maybe also be one of those things (eg. rescue breaths in CPR, removing somebody's helmet after a motorcycle crash, etc.) where the best available advice sees to flip 180° every decade or so, perhaps?

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(Disclaimer: not a dentist.)

This is why dentists recommend soft-bristle brushes, and why modern toothbrushes are much crappier at making your teeth feel clean than they used to be.

My cat's veterinarian recommends brushing their teeth with a kleenex. I can't imagine soft tissue paper would pose any risk to your enamel but apparently it's better than nothing. Wipe your teeth with a clean napkin after eating and you'll probably come out ahead.

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My own anecdote on this:

I get cavities really easily and to prevent them I have to brush after every meal or snack plus brush and floss before bed.

If I use whitening toothpaste then like you say it causes its own issues, but as long as I use non-whitening toothpaste and don't scrub too hard it's fine.

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Probably want some efficacy evidence too

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Technically the natural status quo is that you have a large number of bacteria in your mouth not really doing much. Ancient skulls still have fine teeth today.

Premodern skulls don't; what changed was the introduction of dietary sugar.

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Yeah, yeah, the Agricultural Revolution and its consequences have been a disaster for the human race.

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The agricultural revolution predates dietary sugar by tens of thousands of years.

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The prehistorical dental record shows that agriculture was the worst catastrophe in the history of teeth. Sugar is not the mechanism.

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Dec 8, 2023·edited Dec 8, 2023

But that's completely false. The pre-agricultural dental record shows some cavities.

Compare this from Slate ( https://slate.com/human-interest/2015/04/dental-hygiene-did-people-in-the-middle-ages-have-bad-teeth.html ):

> Not surprisingly, tooth decay was actually much less prevalent in the Middle Ages than it became in later centuries, when mass imports of sugar from the tropics made it a staple rather than a rarity. Surveys of archaeological data from the medieval period show that an average of only 20 percent of teeth show any sign of decay, as opposed to up to 90 percent in some early 20th-century populations.

Assuming that prehistoric people had perfect teeth, which we know they didn't, do you really think that going from 0% experiencing tooth decay to 20% is worse than going from 20% to 90%?

(The stated figures are not like measurements. But the difference is so large that it doesn't really matter.)

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Dec 8, 2023·edited Dec 8, 2023

A lot of dental problems in former times were caused not so much by the agricultural product eaten but the sandstones they used to grind it. It was the microscopic grit particles worn off these while grinding wheat and similar which eroded the enamel.

As for brushing teeth, they would wee into a pot the previous evening and leave it overnight to settle. Then in the morning they could dip the end of a slightly frayed willow twig into it and scrub their teeth with that. Worked a treat! :-)

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^^ I say this constantly

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Could this not be because those people died young, before their teeth decayed, and they stopped eating when they died, essentially starving the bacteria that cause this kind of decay? Could population-level tooth decay essentially just be tracking life expectancy?

(I've no special knowledge here; just wild hypothesising!)

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Dec 8, 2023·edited Dec 8, 2023

I can tell you that during the Han dynasty (roughly 200 BC - 200 AD), the cultural assumption existed that by 70 years old you would have lost your teeth.

It is not clear to me how different the situation today is. I have seen someone tell the story of an older female relative (so, the relatively recent history of the United States) who received, as a wedding gift, the prophylactic extraction of all of her teeth, so that as she aged she wouldn't have to worry about them.†

Similarly, the last time I saw a dentist, I had to fill out a questionnaire that included the question "do you want to keep your original teeth?".

But it is clear that the premodern period was much worse than today.

† This was based on a mistaken assumption; the health of your jawbones is maintained by the roots of your teeth, which dentures don't have. In general, I think prophylactic dentistry is unwise.

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The pre-modern norm for life expectancy is horrendous mortality rates in early childhood and a higher attrition rate in adulthood, but a substantial portion of people who survive to adolescent make it to or beyond what's now considered middle age.

As for teeth vs diet, the pattern I'm familiar with is that hunter-gatherer societies tend to have excellent teeth, early agricultural societies (especially ones that use wheat, rye, or barley as their main staple crops) tend to get really nasty wear because grit from the grindstones gets into their flour, and societies with access to refined sugar tend to get a ton of cavities.

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Hunter gatherer societies that eat a lot of fruit, or especially a lot of honey (like the Hadza) do tend to get cavities. It's not purely a disease of civilization.

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> it's relatively easily reversible if you really wanted to.

Um, from reading section 2.3, it sounds quite difficult to reverse.

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Couldn't you just do the exact same process, but introduce normal bacteria instead of the GMO variety?

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The GMO variety has the advantage of secreting an antibiotic (which it's resistant to), so to introduce it you just need some cleaned surfaces on your teeth where it can get started. Then its advantage let's it eventually take over.

To reverse it, you have to completely wipe out the GMO variety before putting the normal ones back (apparently this requires "harsh antibiotics"). You might not be able to get back to the same ecological balance you started with (maybe Migratory's spit freezing idea could help with that, I don't know).

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I plan to do this once it's cheap enough, but I will also freeze vials of my spit first in case I find a need to go back to my old biome.

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Yeah I was torn between wanting to reply with the "leaving humanity behind" meme or the "me am play god!" meme.

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I think the worst possible consequences is the FDA blocking this avenue after this gets past them, and if we can only get ONE probiotic miracle past the enemies of all humanity, it would be a shame for that to be tooth decay precluding, say, Alzheimer's or something.

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Yeah.

When I read, ' The FDA demanded a study of 100 subjects, all of whom had to be “age 18-30, with removable dentures, living alone and far from school zones,” ' I wondered if risk vs reward entered their thinking, if that position was just a bureaucratic reflex, or if they were under the thumb of "big dentistry." (just kidding, sorta).

BTW, I'm over 50 and have never had a cavity. I usually brush 1-2 times a day, use a dental pick to remove the calculus behind my lower incisors, and floss when I'm really bored. Quit seeing dentists years ago. I'm grateful and if there's a way for everybody to have this good fortune, I'd love to see it.

Gut microbiomes can change when people get older, so I would think that might happen with the oral microbiome.

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I think the regulations were different back then.

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About the time I turned 80, I started to get cavities again (I had them as a child/teenager) and my dentist said that people's mouths change with age. I wonder if it the biome?

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When I read, ' The FDA demanded a study of 100 subjects, all of whom had to be “age 18-30, with removable dentures, living alone and far from school zones,” ' I got real skeptical. Show me the receipts. This sounds like someone framing a ruling they didn't like in the most infuriating way possible to try to get sympathy.

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Are you skeptical enough to demand receipts from Lantern Bioworks founder Aaron Silverbook?

Or just skeptical enough to demand them here in the comments from people who don't have access to them?

Let me know what you find out.

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Seems like the receipts would be in the possession of the original inventor, Professor Hillman, and that he would probably be eager to share them to someone motivated enough to ask, so it's not a particularly dickish thing to wonder about.

Of perhaps greater interest is the *entire* FDA evaluation that resulted in them declining to give Hillman an easier path to approval. Someone who is curious about the efficacy and safety of this novel product - a pretty reasonable, middle-of-the-road kind of position - would probably be greatly interested in the evaluation of an organization that is architected to be somewhat adversarial here. Nobody else has a motivation to uncover problems, even if Lantern seems pretty open and accepting of input.

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Why haven't you accepted their offer of a free trial yet? What are your reservations?

Also, you addressed the alcohol issue but is there any downside to the lack of lactic acid? Does lactic acid really not provide any benefits to your mouth?

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I would be astonished if it did, but this is an interesting idea.

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I was waiting to write this post and see if any commenters noticed a danger I'd missed!

We probably have way more lactic acid in our mouths than the design specs given the rate at which people get cavities.

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> We probably have way more lactic acid in our mouths than the design specs given the rate at which people get cavities.

That is clearly true, but going below spec can still be a problem.

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Reading this back later those questions sound weirdly confrontation. Definitely didn't mean it that way. I'd heard about this before and am pretty excited about it. Not "$20,000 plus flight to Honduras" excited but definitely a couple hundred bucks excited.

Your answer to question 1 makes a ton of sense. If I had thousands of people to bounce ideas off of I would definitely take advantage. I do think there isn't really a reason a priori to expect the lactic acid levels in our mouths to be optimal. Our diets are much higher in sugar than in the evolutionary environment, which is why cavities and dentists are a thing at all.

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If people who get cavities less get gum disease more, it’s possible that it’s lactic acid that suppresses gum disease

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Good point, also isn't alcohol a rather potent topical antiseptic? Probably it's fine or positive even, but possibly it might disrupt the biome or clear a niche for microbes that otherwise couldn't get a foothold to cause other problems like gum disease.

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So this brings up a question I've had before in the past...

Ethyl alcohol is metabolized to Acetaldehyde, which is carcinogenic. But there's not consensus on whether there's a safe level of acetaldehyde. I mean, there are beneficial levels of radiation, so it seems reasonable that there might be a beneficial level of acetaldehyde. But this hasn't been proven. The long term effects of low dose alcohol may be beneficial. (Reduced cardiac events. Better hormonal profile.) They may be neutral. Or they may be negative. ( increased deaths from tuberculosis was one item that was supposedly associated with drink-a-day levels of alcohol consumption due to immune suppression, IIRC) I'm curious if anyone has a take on the topic.

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"there are beneficial levels of radiation" My impression is that this has been claimed, but still under dispute.

(and the level from this treatment would be considerably below drink-a-day levels - so I'd expect any effect (except in people who are hypersensitive to ethanol for some reason) to be lost in the noise)

<mild snark>Is the tiny amount of ethanol enough the Moslem and Mormons would have an issue?</mild snark>

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The optimum dose of alcohol is significantly less than drink-a-day levels. I'm not sure it's been proved that a drink a day reduces lifespan relative to zero drinks. A large Meta study saying that a drink a day decreases lifespan include things like increased deaths from tuberculosis and increased drunk driving deaths. The increased drunk driving deaths make me suspicious about how well they actually tracked dosages. The increased deaths from tuberculosis make me question how well the results would generalize to first world countries where the incidence of fatal transmissible disease is lower.

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I'm suspicious of any study that relies on self-reported alcohol consumption, since we're pretty sure self-reported alcohol consumption is hideously inaccurate at the population level. Specifically, the level of total consumption implied by self-reports is about half the level implied by retail alcoholic beverage sales. Some of the gap is probably due to waste, alcohol used in cooking, and stuff that sits on shelves for years before being consumed. Buy a lot of it has to be underreporting.

There doesn't seem to be a good indication of where the underreporting is concentrated, though, and it makes a big difference whether it's mostly people who say they seldom or never drink actually having several drinks a month, people who say they average one drink a day actually averaging two, or raging alcoholics who say they're averaging five drinks a day when they're actually averaging ten. Or even raging alcoholics who claim to be moderate drinkers or teetotalers.

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With spirits there's also wild ambiguity in measures. For example, the standard measure of a sixth of a gill is barely a drop and could easily be quadrupled or more by a generous pouring of spirits without using a measuring cup.

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Unfortunately that's nearly all of them. But this in turn makes me wonder about the actual level of alcohol consumption by that cohort that shows up with the lowest all cause mortality, in those studies that give you graphs of acm-by-alcohol-consumption. It's well known that the lowest acm is not at zero, but I've seen variations that show the low at anywhere from 0.8 to 2.5 drinks per day, depending on what kind of corrections they tried to apply and what population they were looking at.

But if underreporting is uniform then the real level would presumably be higher.

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Dec 8, 2023·edited Dec 9, 2023

"The increased drunk driving deaths make me suspicious about how well they actually tracked dosages." Yup, that would make me suspicious too.

Do you have a url for the study?

One other thing that seems odd: In the usa there are about 4x10^4 driving deaths per year (and presumably fewer drunk driving deaths) out of a population of 3x10^8, so one driving death per 0.75x10^4 person-years. To see even a 2X difference at even a 1 sigma level, the study would need to see roughly 1 death in one arm and 2 in the other, around 2.2x10^4 person-years. To see a 2X difference at a 3 sigma level they would need around 2x10^5 person-years. Did they have this large-lengthy a study?

edit: just typos

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There was a Mendelian randomization study in UK Biobank looking at that, and their conclusion was that any amount is worse than 0, at least for CBD https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790520

I'm inclined to believe them, and the observation studies showing otherwise have probably not fully controlled for confounders, which is a known issue with observation studies. Don't think it extrapolates to the bacteria though, just because, as Scott points out, it's 10-100 times lower alcohol levels than what you get from even one drink.

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Correction - it's CVD, not CBD. The study looked at the effects of alcohol on cardio-vascular disease, and has nothing to do with cannabidiol, it's just a typo on my part.

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I'd vaguely remembered that there had been some sort of connection found between CVD and dental health, and was hoping that the primary effect of this treatment on dental health and then a follow-on benefit to CVD would be larger than an effect of a 0.01 - 0.1 drink-per-day effective ethanol intake from the engineered oral bacteria. But a preliminary google turned up https://www.health.harvard.edu/diseases-and-conditions/gum-disease-and-the-connection-to-heart-disease and their (at least tentative) conclusion was:

"When smoking status was considered, the connection between tooth loss and cardiovascular disease largely disappeared"

Oh well.

( I think I spent too long in the electronics industry. My default expansion of CVD was "chemical vapor deposition"... :-) )

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Oh really? I haven't heard that it was mostly explained by smoking and other confounders, but of course it makes much sense. The explanation I've heard was through oral inflammation -> systemic inflammation -> atherosclerosis, although in that case BCS3-L1 would still not be very helpful, since (according to people elsewhere in the comments) gum disease is driven by different bacteria.

[Also I feel compelled to nit-pick that, going by the numbers from the post, the alcohol intake is rather on the order of 0.001 - 0.0001 drink-per-day]

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Many Thanks! The inflammation pathway was one that the authors of that web page explicitly considered, but their tentative conclusion was that the smoking confounder fit better. Thanks for the correction on the drinks-per-day equivalent!

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I don't like the idea of selling drugs to people when they haven't undergone extensive safety testing. We have no real evidence of the long-term safety of this drug besides the say-so of the inventor, and we have zero information about the manufacturing controls of Lantern. I wouldn't ingest a genetically modified bacteria from a factory that has not been inspected [edited for pedants in the comments].

On a side note, I really doubt that this will become commercially available after Lantern has thumbed their nose at the FDA by selling it in Prospera. There's no chance they'll find that amusing.

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Why would the FDA be upset about people selling a treatment outside of the FDA's jurisdiction? Is that a thing the FDA has gotten upset about before?

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Not to my knowledge.

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I think people around here think of the FDA as a bunch of vindictive storybook villains, because a bunch of bloggers are always emphasizing bad/dumb FDA decisions and their harmful effects. I can't specifically contradict that view since I don't know anyone at the FDA (I used to know one, but he was on the food side). But I know plenty of government bureaucrats and they are overwhelmingly somewhere on the spectrum from well-meaning to apathetic. Many have a strong habit of doing things by the book without too much regard for the effect of delays or unnecessary requirements on their "customers" (the public). They do not, in general, try to take revenge on anyone, feel personally offended when someone uses a "loophole" in the rules, or take into account what anyone has done in other countries.

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I've met one years ago, whom I asked about 23andme before it was fda-approved at all. And they were so vitriolic about the company's nerve tho market something without their approval! I was taken aback. It was just the one person, with one company, but it colored my view towards the more negative.

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> I wouldn't ingest food that was made in a facility that hasn't been inspected by health inspectors

... You don't eat food prepared in your friends' kitchens?

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You wouldn't buy a bowl of chili from a cook-off, brownie from a bake-sale fundraiser, or any of the foods from a farmer's market? That's fine I suppose, although it seems like a fairly extreme position as far as caution goes. I do hope that you wouldn't try to compel others into the same narrow range of choice, as your first sentence seems to imply.

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Exactly. This is also why I require people to prove that the bacteria inhabiting their relevant biomes are judged safe by the FDA. If I have to ingest food or fluids for which the vendor can make no such assurances, I play it safe and either cook it for 30 minutes in a pressure cooker first or subject it to 50kGray of ionizing radiation. </sarcasm>

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>I wouldn't ingest a genetically modified bacteria from a factory that has not been inspected [edited for pedants in the comments].

The singular is "bacterium".

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But the singular can refer to the species. Consider "The lion is found all over Africa." doesn't imply that one particular lion is delocalized.

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Yes, but that is not pertinent; Trevor used the plural ("bacteria") with a singular article ("a").

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Dec 8, 2023·edited Dec 8, 2023

Based on the article and this sounding pretty cool I at least will be buying and taking it when more widely available. Not for 20 grand though

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>On a side note, I really doubt that this will become commercially available after Lantern has thumbed their nose at the FDA by selling it in Prospera. There's no chance they'll find that amusing.

So in addition to being inefficient, slow and lacking in common sense, they're also self-important and touchy?

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I'm sure that there are self-important and touchy people working for the FDA. If you've got bad luck, one of them may be deciding. More likely, though, the requirement is based on an anti-GMO feeling, or more precisely, not wanting to be the target of an anti-GMO based attack.

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Just two questions:

1. What's your prediction (%) on whether this - or a similar product - will be proven to be highly effective and in common use by 2029? (BTW, curious about the implications to the dentists)

2. Why shouldn't individuals interested in the product consider Aella's involvement as a red flag? Not sharing a personal opinion here, but a rationalist colleague has just reminded me about her guide on squeezing the most money from (vulnerable?) men watching webcams, and her engagement in the failed dating service that cost many people a lot of money.

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For (2), presumably the kind of libertarian biohackers this post is targeted at aren't interested in shaming consenting adults for what they choose to spend money on, and the rest is just marketing.

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I think that even libertarian biohackers may want to exercise extra caution when considering this type of promising (may it work!) but highly speculative and potentially risky novel treatment option. Also, without taking a strong personal stance on (2), isn’t the criticism of consensual consumer choices a generally valid activity, frequently practiced even by libertarian types who e.g. recognize the presence of various forms of „market failures”? We do it all the time for meat, diamonds, smoking, fortune telling, and countless other things.

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Meat, conflict diamonds and smoking all have obvious negative externalities.

I think a case can be made that fortune telling should be protected as a religious activity, and I don't think libertarians generally want to ban it.

My assumption is that Aella is involved in marketing Lantern because she is well connected in the ratsphere and mostly well-regarded. Your counter-hypothesis would be that Lantern hired her because they want to squeeze as much money as possible out of a target population, and thought "well, Aella is really good at marketing on OnlyFans (or whatever), obviously her skills can be transferred to market our medical treatment." I do not find that plausible.

A real red flag would be if Elizabeth Holmes was involved with the company (which she is not).

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Dec 22, 2023·edited Dec 22, 2023

I don't think anyone mentioned banning anything. As a consumer, I would view it as a red flag if a business chose to associate with someone involved with fortune telling or other fraudulent or semifraudulent activities.

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> presumably the kind of libertarian biohackers this post is targeted at aren't interested in shaming consenting adults for what they choose to spend money on

I disagree with this. Being a libertarian is about not wanting to use government violence to enforce certain behaviors. Shaming people is very different than using government violence (almost all laws are ultimately enforced with violence if you resist long enough) Personally I believe that the majority of men who spend large amounts of money on the services of cam girls are exhibiting dissonant emotions and a lack of self respect and that social shame would be an acceptable response towards such men. However as a libertarian I would strongly object to a law against cam sites.

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1) 20% it actually gets rid of cavities, 30% it’s widespread by 2029 conditional on it working. So around 6%.

2) I don’t care either way is my answer.

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Re 1), (how) would you update from 30% if I added „effective, safe, at least moderately accessible (no major regulatory huddles), and less expensive than the conventional treatment of cavities”?

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"less expensive than the conventional treatment"

Arguably less invasive as well. Drilling and filling is routine, but still counts as invasive and adding a foreign material.

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If you're worried about adding foreign material, gold fillings should solve that problem. Gold's not going to do anything.

Modern fillings are a white ceramic. I assume they are about as inert as the gold would be, but I don't know that.

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A lot of fillings are still done with mercury-alloy amalgam. It's not particularly dangerous but I can see why it would freak people out.

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Dec 8, 2023·edited Dec 8, 2023

I agree with dogiv - the gold is essentially inert but it is usually put in place as a mercury-alloy amalgam. I also agree with you that none of these materials is a significant worry.

( Albeit for just about _anything_ there is going to be an open question about the effects over a span of multiple decades. Even the best double-blinded RCT can only run so long... )

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Dec 8, 2023·edited Dec 8, 2023

Plenty of successful entrepreneurs had many failures before finding success, so I don't see why Aella's failed dating service matters. I also suspect that many successful entrepreneurs are personally repugnant people (see: Steve Jobs) so I don't think that provides much predictive power.

I agree she mostly sucks. But she's also internet-famous despite mostly sucking so that seems to qualify her as _some_ sort of expert on online marketing. As long as she sticks to that limited advisory role then I don't see what problems her involvement could reasonably cause.

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For me, it just helps it to pattern-match to something like FTX. There were no super-obvious red flags around FTX, just a general stench of weird internet people carelessly doing something that they should have done in the boring, normal, conventional, legally-compliant way.

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>There were no super-obvious red flags around FTX.

Well, the whole crypto industry was a giant red flag for as long as it existed, underscored by the constant onslaught of scams and hacks. FTX didn't look worse than other things, but that's about as faint a praise as you could muster. That the whole "rationalist"/EA sphere downplayed the obvious risks always felt weird to me, but it was entirely understandable that the glut of crypto money in their ecosystem colored judgements.

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1. No clue. Suspect that any dentist who supports eg. regular brushing, fluorinated toothpaste, etc. would also support this (if it works)

2. Because it doesn't really have anything to do with the product itself. Given that marketing is such a universally ethically objectionable field (for pretty solid Moloch-related reasons..) learning that a marketing officer for a particular product was an ethically objectionable person shouldn't really shift your beliefs regarding the product itself much. To put it another way: if you're going to exclusively buy products whose marketing officers are paragons of virtue and would never manipulate or mislead anybody, you're going to end up leading a remarkably ascetic life...

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80 or 90% of businesses don't take, so being involved in an unsuccessful business is extremely strong evidence that Aella is a totally average Joe like you or me

My interpretation of her attitude towards sex work things is that she tends to think if people pay for something it really did have high value for them

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> her guide on squeezing the most money from (vulnerable?) men watching webcams

What's wrong with this? It's sex work, people do it to make money, and unless there's some sort of fraud or coercion involved, there's nothing wrong with making money from webcams. Is the "vulnerable?" intended to imply that the men who pay sex workers don't know what they're doing or can't be trusted to make their own decisions?

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I think it's generally considered to be a complicated and controversial issue, so I wouldn't want to take a strong position or steer away from the core topic too much. It might be also about different expectations when it comes to marketing and communications used e.g. in arts/entertainment vs. medicine.

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I'd only be concerned if the tactics she trained people in left their customers feeling worse, or made them exhibit addictive behaviors.

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> her guide on squeezing the most money from (vulnerable?) men watching webcams

Is this the video guide that she put online so that anyone, including vulnerable men, can see it and learn?

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As an adult with a water-pic and decent self control, this is of limited utility, but as a young adult with neither of those who hated flossing, it might have saved me a mouth full of cavities

Anywho, i imagine there’s a % of the population due to genetics or micro biome that have a really high propensity to caries and might be very interested in the product. I can see the Instagram ad now: DENTISTS HATE THIS ONE WEIRD TRUCK

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Slight off-topic, but what kind of water-pic do you use? It’s great, but the duct tends to get moldy or affected by scale deposits, and you usually cannot clean it from the inside, so curious if it’s hygienic enough after a longer use.

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founding

I swear by the kind that directly attach to your sink or shower for under $50 on Amazon

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Will be interesting to see how this compares to BLIS M18 which has been readily available online for years now and of which I originally learned of as a bacteria strain that was advertised to do exactly the same thing - populate the mouth with something that dominates the decay-inducong bacteria.

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This seems relevant, wonder if Scott or anyone can comment on it. I did a quick google on BLIS M18 and found at least one paper featuring a small randomized trial that suggested significant results from using BLIS M18 lozenges (also apparently there's something similar, BLIS K12?)

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Wow, this is very interesting.

was this the paper you found? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9012604/

As far as I can tell, S. salivarius M18, while it possibly inhibits S. mutans and other more pathogenic mouth bacteria (https://www.nature.com/articles/s41598-020-70024-y), still produces its own lactic acid, so I don’t really understand how it works. Maybe it produces less lactic acid? Maybe the mechanisms for it benefiting oral health are different from just decreasing lactic acid?

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Dec 7, 2023·edited Dec 7, 2023

Does anyone know how this compares to the already available Probiora? My weak understanding is that it is very similar but with two differences:

1) Probiora produces hydrogen peroxide instead of alcohol (is that better or worse?)

2) Probiora doesn’t permanently outcompete existing bacterial, so you have to chew the pills everyday. So in theory you could stop if you wanted.

Cost is about $20/month

https://probiorahealth.com/patented-formula/

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Interesting. I guess he was able to get that one through the FDA?

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I think they took the same sidestep by labeling it as a probiotic rather than a drug:

> In the United States, we market ProBiora3® as a food ingredient under self-affirmed Generally Recognized as Safe, or GRAS, status. GRAS is available for food ingredients that are generally recognized as being safe for human use and do not claim to treat, prevent, or cure a disease.

https://probiorahealth.com/regulatory-status/

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Are there any independent studies demonstrating effectiveness?

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Only one I've found so far: https://pubmed.ncbi.nlm.nih.gov/26427036/

> Results: The primary and secondary outcome measures were significantly (p < 0.05) improved at the 12- and the 24-week evaluation in both groups. However, no significant inter-group differences could be detected at any time point, except from the % of sites with plaque that were significantly lower in the probiotic group than in the control group at the 24-week evaluation. In addition, at the 12-week time point, the salivary Prevotella intermedia counts were significantly lower in the probiotic group.

They really only investigated primary and secondary markers of gum disease rather than tooth decay, and the treatment didn't seem to show much promise in terms of preventing gum disease. However, given that the treatment significantly reduced plaque formation and successfully displaced Prevotella intermedia populations, I think the results show promise with regard to preventing the formation of cavities. I wouldn't be surprised if the treatment strains also displaced pathological populations of bacteria more directly responsible for tooth decay like Streptococcus mutans.

Also, n = 48.

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Interesting. They claim that it does compete favorably with other mouth organisms. I wonder if you could get long-term effects by using it after a tooth cleaning?

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Dec 7, 2023·edited Dec 7, 2023

We should start a crowdfunding campaign to pay for one person to go to Próspera and become infected. Then they could transfer it to everyone who contributed to the campaign. Would anyone be open to this?

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You'd need ~100 people for this to be worthwhile, and that's not counting the hassle (and expense EDIT: okay, I just read more, and that should be negligible) of figuring out how to do the transfer correctly. I'm not going to pay $20,000, but I would actually pay a few hundred bucks for this; I think that's cheap enough that your proposed circumvention is unnecessary.

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Assuming the transfer can be shown to be effective then yeah, I'd be willing to pay a few hundred bucks for this.

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Dec 7, 2023·edited Dec 7, 2023

Oh man, I remember reading about this bacteria that produces alcohol (probably in either Popular Science magazine, or maybe reddit) well over a decade ago. I immediately thought about it when I saw the subtitle, and was pleasantly surprised to realize it was one and the same (1.1).

It's cool to get some closure (1.2) about the neat thing I read about so long ago and have wondered on and off whatever became of it... and slightly less cool to have yet another thing in the pile towards convincing me the FDA is awful.

...This was the straw that motivated Tuesday's article, isn't it?

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_S. mutans_ is possibly associated with cardiovascular disease[1]. Does alcohol instead of lactic acid impact that role? That's the unknown that's stopping me from jumping on this now.

1 - https://www.sciencedirect.com/science/article/pii/S1882761608000045

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But you already have mutans in your mouth right now! This is just switching out one kind of mutans for another.

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IIUC, the paper says that effects on CVD are driven not by what it secretes, but by different strains having different surface proteins, some of which protect it from phagocytosis and allow survive longer in the bloodstream. So the question is, which strain of this bacterium they used as the basis, if it's the normal strain, you actually want it to replace all others since it would reduce CVD effects. But also, those effects are tiny either way.

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Two related manifold markets:

Will Aella get any new cavities by 2026: (22%) https://manifold.markets/Aella/will-i-get-any-new-cavities-after-a?r=Tmlrb3M

Will 10k+ people receive this treatment by 2030: (42%) https://manifold.markets/jcb/if-lantern-bioworks-successfully-re?r=Tmlrb3M

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"The FDA demanded a study of 100 subjects, all of whom had to be “age 18-30, with removable dentures, living alone and far from school zones”. Hillman wasn’t sure there even were 100 young people with dentures, but the FDA wouldn’t budge from requiring this impossible trial."

You might be able to round up that many hockey players or something; even moreso in the 80s. Then pay them to live alone during the offseason or something?

I notice I'm confused though -- does the FDA want to check whether the product prevents cavities *in dentures*?

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The first trial would be for safety, not efficacy. I'd guess the point of the dentures would be so that if anything looked even slightly wrong health-wise, they could all be confiscated and put into an autoclave and incinerated to a fare-thee-well. Hard to do that with regular teeth.

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People kiss their children on the mouth?

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I'm *hoping* that people kiss their children on the forehead/cheek/whatever, the children touch their faces and later put their fingers into their mouths; the alternative is just too utterly bloody weird to contemplate.

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Dec 8, 2023·edited Dec 8, 2023

It's gone out of fashion in the West but yes, it used to be normal, at least in my neck of the woods a few generations back (rural France, last instance I heard of would have been pre-WWII).

It might still be normal in some cultures.

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“Do you have a kiss for daddy?”

(From Ferris Bueller's Day Off)

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David Beckham kisses his kids on the mouth (why on earth do I know this? I had a kid with a huge fan of Victoria Beckham).

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Kissed kid here! But not by my parents, so disqualified from your precise question.

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Follow-up question: In cultures where people don't kiss their children on the mouth, how do oral bacteria spread?

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Sharing food, I guess? I don't think breast milk has oral bacteria in it...

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I suspect that lots of parents get their kids to eat stuff by putting it in their own mouth and having a nibble in front of the kid, and then directly putting the food in the kid's mouth.

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This really bugs me actually. My family used to always kiss each other on the (closed) mouth. I was kissed as a child. I kissed my children. I was NOT molested. I was NOT a molester. I had a lovely childhood. Just bc television has shamenormed all the inherited culture/language out of huge swaths of previously richly unique geographic areas of the US in a single generation doesn’t mean it’s right. There’s NOTHING wrong with showing familial affection by chaste kissing on the mouth and it pisses me off so hard that you’ve made whole fams feel weird about it! Cut that s*** out!

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I had no idea anyone was suppose to feel ashamed of that. Kissing your kids on the mouth is perfectly normal.

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Scott, gah, it's "They offered my wife and me", not "They offered my wife and I". Try it both ways without "my wife and".

I loved "(as you do)". I love your marvellous understated wit.

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Sorry, fixed, thanks.

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The spread of this hyper-nominative case is both annoying and amusing.

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I know perfectly well that it’s wrong too, but I hear it so often that it doesn’t jangle in my ear the way it used to. One of these days I’ll probably start saying it without noticing the transition. We’re language sponges, you know? But I will never never start saying “sounds good” instead of

“OK.”

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I agree, it's very common, and doesn't grate like it once did - I usually have to think it through.

One instance that has stuck was the theme song from The Land Before Time, which ended with "... for you and I".

As a parent of then-preschoolers, I heard this one quite a few times.

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I agree, but I just found out even Shakespeare did it: https://en.wikipedia.org/wiki/Between_you_and_I

And here I thought it was all Hollywood's fault.

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Wait, people just know about real hangover cures and have not been saying anything? Does this zbiotics thing really work? This could give me many hours of my life back.

Has anyone tried it? I'd order it myself but they only offer shipping inside the US.

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Regarding Zbiotics: lots of people used them at my lab retreat in 2022. They still ended up with hangovers, but given the amount of drinking that happened I'm not sure how much the probiotics realistically could have done. I wish we had organized a randomized trial.

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Sounds like a fun lab retreat. I'll give them a shot

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Dec 8, 2023·edited Dec 8, 2023

I mean, if the zbiotics only work if you don't drink too much, they...don't work. I suppose they could still be useful if they reduce hangover severity, but so many factors go into that it's hard to judge outside an actual controlled trial

Edit: my priors are low considering that all other hangover cures seem to not work, with the exception of uh not drinking.

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I haven't checked recently but years ago I read a marginally convincing study that showed a 50% reduction in hangover symptoms from taking large amounts of vitamin b6 before and during the drinking.

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Well, I've always been low on hangovers, so don't take this too seriously, but my preferred hangover avoidance is to drink a bit over a pint of water before going to sleep.

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I just ordered some for NYE and will report back.

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Please do!

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With the caveat that N =1, it seemed to be ~80% effective. No headaches, nausea or sensitivity to noise. I was tired and rather lethargic all day, but could just as easily due to general lack of sleep.

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From reading reviews online, I think it'll be hard to come to any conclusions without a proper trial. Mild hangovers are subtle, so subject to the placebo effect. But if you drink enough for a heavy hangover, it's likely that it'll overwhelm any effect the zbiotics has. So it'll be very hard to get a clear signal.

Plus, it doesn't help with the other main cause of hangovers, dehydration. So you have to eliminate that as a factor in both your control and test cases.

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Zbiotics peaked my interest after reading this, but after reviewing their site and their links, I think there are reasons to be skeptical. Zbiotics claims to reduce hangovers by ingesting their probiotic, which contains a recombinant gene and resides in the gut and breaks down one of the toxic byproducts of alcohol metabolism, acetaldehyde, into a less toxic acetate (okay so far). In normal circumstances though, alcohol metabolism and therefore production of acetaldehyde, occurs largely in the liver, after gut absoprtion of the alcohol has already occurred. They have good seeming data showing that their bacteria does indeed break down acetaldehyde, but I am skeptical it would do much of anything in humans, and I don't see any links to any kind of human studies, aside from personal reviews - placebo?

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*piqued

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thank you

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Wait till you find out about ro15-4513. Fast ethanol antidote, banned by busybodies on "ethical grounds". ( See e.g. https://archive.is/jW1pv )

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Dec 9, 2023·edited Dec 9, 2023

I use zbiotics and like it. I can't rule out a strong placebo effect, but it works well enough for me that I buy it in bulk.

Notes:

• it just addresses one factor in hangovers; you still need to stay hydrated

• you're still going to feel like shit if you drink enough to black out

• I don't notice an effect if I'm only having one drink

• some friends who have tried it like it, others don't notice any effect

If you're curious, find a referral code. Order a 12-pack subscription. Immediately push the next shipment out as far as it will let you, and set a calendar reminder to cancel it. Last I looked, this brought the price to something like $66 for 12.

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A friend of mine started a business to produce hangover prevention gummies: https://alwaystoast.com/

- It's prevention, not cure. You take 'em ideally before you start drinking, though during or even a little after can still be fine, just as long as it's before you go to sleep that night.

- The principal active ingredient (n-acetylcysteine, or NAC) has long been known to have this effect, and pills with it are available over the counter. However, distributing pills in bars has the annoying side effect of getting you thrown out for distributing drugs, hence his focus on the gummies form-factor.

- He was deep into the very-tiny scientific research community that was focused on the problem, I think they had occasional meetings called the Hangover Research Group or something, but in any case there were studies and journals and such things. I skimmed a few.

- As a result of that research, he included ~3 other active ingredients besides NAC, I think I remember two of them being prickly pear extract and milk thistle.

- I remember him telling me there are a bunch of other hangover-prevention products on the market but they generally do absolutely nothing and have not taken advantage of the research on it at all. Enough of them are much better at marketing than he is that it's become a cottage industry of snake-oil, though.

- The principal downside of the gummies is that his initial versions smelled really bad and tasted worse, though they indeed had the consistency of normal gummy bears and I didn't find it hard to get them down (my wife and her friends absolutely refused after the first try though). Subsequent versions have much improved that characteristic, but by my wife's evaluation, not by nearly enough.

- Efficacy: I swear by them, and have some in my pantry for all occasions where I expect to be drinking. I'm not super prone to hangovers, but certainly have gotten them when sufficiently earned, and I've never had anything more than a mild dehydration headache after taking these gummies.

Anyway, if that's an area of interest for you, give it a try. I'm not compensated / incentivized for this in any way, I just know Sean and advised him a little bit and think the product's pretty good.

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I’d be down to chip in $500 for someone to fly to Honduras, get these bacteria, then transfer them to me back in the US. If you’d be down too, please reply to this comment. I’m sure we could find a trustworthy rationality community member to actually fly to Honduras if there’s enough interest.

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I'm down.

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Why not just collect it from Scott's wife, culture it, etc?

The only problem with doing it in the US is the FDA won't let you do it for money.

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If I were trying to earn back the $400k, I would probably try to sell it to 200 people for $2,000 each, instead of to 20 people for $20,000? Though admittedly I have no expertise in setting prices for anything.

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author

I think there are two counterbalancing factors:

- If you've got to fly to Prospera anyway, that's a several day trip, so you're already limiting it to people who are willing to make large sacrifices, so you might as well collect some of that.

- One-time windfall of a conference of rich entrepreneurs in Prospera, might as well get as much as you can from that.

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Selling it to 20 people for $20k each and then to 180 people for $2k each seems even better, tho.

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(Epistemic status: Know nothing about dentistry and this is entirely based off of things I vaguely half-remember people who may have been dentists mentioning in casual conversation long ago..)

I believe the point of brushing your teeth has little to do with "scrubbing" them clean, like you'd scrub dirty dishes or wash a car or whatever; rather, you're actually trying to distribute fluoride throughly into every nook and cranny, to create an unfavourable environment for bacteria. (That's why we're told not to rinse with water after washing; it removes most of the fluoride we've just gone to the trouble of laying down..)

The bacteria aren't just a threat to your teeth; they also cause gum disease. If gum disease is caused by lactic acid (doubt it, but of course what do I know..) then we're all right - but if some other bacterium in some other niche is causing gum disease by some other mechanism (and assuming BCS3-L1 can't outcompete *all* other bacteria, as the chart in section 4.2 seems to suggest) it would still be necessary to brush regularly with fluoride for the sake of one's gums even if one's teeth weren't at-risk of decay.

If this is wrong I'd be awfully glad to be corrected, of course!

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Fluoride doesn’t work on bacteria; it hardens tooth enamel. Brushing also remove the food detritus that the bacteria feed on.

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Yeah, was leaving out the food detritus part for simplicity (thinking of eg. the necessity to brush one's teeth in the morning even if one isn't having breakfast) but I didn't understand the enamel hardening thing at all and was totally mixed-up about what fluoride did - thanks for the correction!

When they market toothpaste as (eg.) "fights plaque", is that literally just marketing bulshytt, then, or are there other chemicals in the toothpaste that do this?

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I believe that’s mostly due to the cleaning away of food debris. The toothpaste helps with that; I’m not sure if the fluoride makes much of a difference.

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It's (slightly) worse than that. Too much fluoride makes your teeth brittle. This, however, mainly matters while they are growing. Toothpaste is just a surface treatment, and a thin hard+brittle external surface isn't bad.

Caution: I'm not any sort of dentist or medical professional, but:

As for "fights plaque", well, yesssss. Perhaps some actively fight it, but mainly the process of applying it fights the plaque. None of them get rid of plaque that's hardened in place. Before it hardens, plaque is a bacterial film. It's *relatively* impermeable to externally applied chemicals. But it's not very resistant to mechanical stresses. So toothbrush disrupts the film. Then the toothpaste can get at the tooth below the film, and prevent the film from reattaching.

The preceding paragraph was based on info that's around a decade old, but it's probably still true.

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Brushing removes plaque, otherwise all you needed would be a mouthwash with fluoride

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Since they also advise you not to use a fluoride mouthwash directly after brushing your teeth because it washes away the fluoride (https://www.nhs.uk/live-well/healthy-teeth-and-gums/how-to-keep-your-teeth-clean) I would guess that maybe the fluoride concentration achievable with a mouthwash is either lower or else less well-distributed than with a paste applied with a brush?

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Different brands have different concentrations, but theyre generally lower than toothpaste (normal toothpaste has about ~1450 ppm, I think Listerine is at 300ppm). I would also guess that the residue of toothpaste "sticks better" to the teeth than a mouthwash.

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Brushing is absolutely designed to disrupt and remove the biofilm on the teeth.

But that is as much to remove the precursors of calculus (the hard matter your dentist removes when they are cleaning your teeth) as it is to prevent cavities.

Both are bad for your tooth/gum health.

Fluoride enhances tooth enamel, it does nothing to bacteria.

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