4 March 2008

Mouthwash hysteria and protocol mythology

Our society of the 21st century is rather alarmist. I was reading an interesting link on Boing Boing about a single-blind study in which a bunch of audiophiles could hear no difference in sound quality between music conducted through expensive stereo cables and music conducted through coat hanger wire. This led me to the original article at The Consumerist and finally on to this. Briefly, it seems that people are concerned that using Crest Pro-Health Oral Rinse leaves their teeth stained brown. So far, the article has generated more than 150 online comments, most from concerned mouthwash users upset at Procter & Gamble for putting the stuff on the market in the first place. Brown stains in return for practicing good oral hygiene? No thanks!

The comments were really interesting to read. They remind me of a lab phenomenon I call 'protocol mythology'. It starts like this: you're busy in the lab, homogenizing your samples, centrifuging your tubes, cloning your DNA fragments, running your gels, when suddenly... things go pretty much the shape of a pomaceous fruit (hint: it's not an apple). The arduous task of troubleshooting begins. You retrace your steps back to that part of the procedure when things were still working. What came next? Did you precipitate at room temperature, or on ice? What was the pH of the buffer again? Perhaps the restriction enzymes are not compatible with your extraction method. What voltage did you run the gel at? The protocol therefore gets altered, often changing many variables at once in order to save time. Big mistake. And yet, changing it up seems to have worked - the DNA fragments on your gel are of the right size. Hurrah for troubleshooting! This is how the grad lab protocol myth gets born: one student will suggest the set of in-house modifications (which they spent simply months optimizing) to the next student, who then passes it along. Newbies are often intimidated into compliance with tales woe and crying under lab benches. I know I was. Who wouldn't follow the sound advice to rather use that laminar flow cabinet instead of this one, unless you want guaranteed yet unexplained contamination of your agar plates? We can't explain why, all we know is that it works. Don't argue with us - we know what we're talking about. Or do we?

Back to the mouthwash. It seems so much like a snowballing mass hysteria thing to me. Almost everyone has at least some kind of discoloration to their teeth. This is usually in the hard-to-reach areas, like between the bottom teeth, right at the gum line. It's a spot that goes without close scrutiny for the most part - but you're bound to find it if you go looking for it specifically. And what better time to investigate your gumline than after reading a scary report that everyone who has used your new brand of mouthwash was left with stains making them look like champion tobacco chewers? As disinformation gets spread around, the whole thing takes on a mythology of its own. The staining gets rapidly attributed to various things, including the blue dye in the rinse (so why are the stains brown?) and the presence of stannous fluoride (although the Pro-Health toothpaste does contain fluoride, the mouthwash does not and besides, dental fluorosis only occurs during tooth development). Some people spit out blue gunk after using it: how strange and unexpected! Who could have guessed that the active ingredient designed to rupture microbial membranes and act as a detergent to collect cellular debris might actually do its job? We can't be having that! People have poured the contents of their bottles down the drain, or returned them and demanded refunds. The stuff of urban legend. And then there are those who have completely lost their sense of taste after using it. Now that's scary, isn't it? Truth be told, I've never used a brand of mouthwash that didn't extinguish my sense of taste for a couple of hours. Actually, I've never had a gin & tonic that didn't do pretty much the same thing.

We all react differently to different products. Some people are allergic to peanuts, others to tomatoes, some to antibiotics, some to anything that isn't cashmere, Dahlinks! That doesn't mean we should take peanuts, tomatoes or acrylic sweaters off our shelves. Well, maybe the acrylic sweaters at least... The point is that everything we consume, whether it be food or medicine (or both, in the case of nutraceuticals and dietary supplements) has side effects or is toxic to some degree. Yes, even water. The next generation of mouthwash is no exception to this. The brand in question uses cetylpyridinium chloride instead of alcohol to battle bacteria, making it an attractive, non-dehydrating alternative for children, diabetics, the aged... and recovering alcoholics, naturally. The bacterial remnants and salivary proteins disrupted this way can attract tannins from food, and form brown residues in the crevices between teeth. This is will be especially noticeable in only about 7% of people who use the product. And one person out of a million having a bad reaction to one of its ingredients doesn't imply that the product is no longer of any use to the population at large. If that were the case, we wouldn't have any antibiotics left to treat disease with. Or, indeed, food. So there you go. Since stains are not harmful, the rinse has not been slapped with a warning label. Neither are pineapples, which contain enzymes that can cause bleeding, by the way... Is the Crest Pro-Health Oral Rinse responsible for stained teeth? In some cases, probably. Does this warrant all the disinformation-based consumer hysteria? Probably not, although P&G are partly to blame for not explaining the possible side effects and their origins clearly enough. And so fear and ignorance creates a whole 21st century mythology around what is actually a marvelous advancement in human health. From chunky blue saliva to evil fluoride to burned tastebuds... to oral cancer, presumably.

All I know is that once the lab protocol fails again (as it inevitably does) reverting back to the original procedures, presented in Molecular Cloning: A Laboratory Manual by Joseph Sambrook and David W. Russell more than twenty years ago, always gives you the desired results. All that tweaking was just weaving a myth.


arcadia said...

yay, jy's terug!

jy't 'n beautifully lucid manier van skryf, weet jy?

(moet nou gaan, wil graag gou my tande van naderby bekyk)

twanji said...

Thanks for posting - I love this post. I take a bow before you.
I was beginning to think about stopping my routine of stopping by to see if you had posted anything new.
Hope you are well my friend.

Unknown said...

arcadia: thanks!

twanji: haven't you heard of RSS yet? It's the handiest invention since Blogger itself.

Chris Eldin said...

I haven't heard of RSS either. But I like the personal touch.

Glad to see you back. Was hoping for a photo of your teeth (before and after and with all appropriate protocols in place). Now that was liven up this already enjoyable post.


Chris Eldin said...

I'd like to put you on an email list that I have, if you'd be interested. It's called "Dubai Chronicles" and they're short snippets of life here. I don't put these on my blog because there are certain things I don't want people to google and get to me.
Please drop me an email if you'd like to be included! If not, no worries!


Lisa said...

So glad to see a new post! You've pointed out an interesting thing to me about mass marketed, over the counter products. We seem to have an expectation of zero defects with them, where on the other hand, we're completely comfortable with prescription drugs that fully disclose warnings and side effects that are potentially far more harmful. I'd hazard a guess that most Americans rarely read the prescription inserts that describe the potential side effects or pay attention to the warnings about how some drugs are dangerous or ineffective when used in combination with others.

HopSkipJump said...

Hmmm... interesting to think about. I've got to say that I haven't had to think about what works and what doesn't when it comes to oral hygiene in a very long time. My partner is a dentist.

I just sit in the chair and say 'whiter, brighter, straighter' and make sure that the blanket they bring me is cashmere. After all, I'm allergic to the others :)

Glad you're back!

Unknown said...

christineeldin: haha! No pics of my teeth, I'm afraid. The leering eye will have to do for now.

lisa: the danger with reading about possible side-effects is that you then start to imagine that you're experiencing them! Catch-22, if you ask me. "Oh, the horrors of overdosing on carrots! They should slap warnings on those things. I had no idea..."

IF: hahaha! Teeth are the first thing I look at when meeting new people. Personally, good dental health is top of the list of dating criteria... along with being able to afford cashmere.

david mcmahon said...

G'day Mate,

Yep, I do like the term ``protocol mythology''.

A dose of healthy scepticism never goes astray - as long as it's leavened with humour!!

Good on ya ...

Andrew said...

That demented kid with his lazy eye and satanic smile scares the bejesus out of me.

He does give me pause for thought though. Have we become so obsessed with our technology and desire to succeed that we have forgotten how to experience the simple joys of not having rotten teeth?

No. Before technology everybody had rotten teeth, probably with brown stains too.

Anonymous said...

Great post, EOH! Especially great to see you back.

This post made me think of the grave danger that pseudo-science shows on television can cause. You know, the people "studying" some religious event, or UFO's, or bigfoot, who sound scientific, but whose scientific method is laughable. To many people, their "findings" take on great weight.

All of those things are fine to study, but not by people who are simply out to prove one conclusion over another.

Anonymous said...

Dis maar basies dieselfde storie met toetse op allerhande produkte. Vandag is botter skadelik vir jou en margarien meer gesond. More besluit die wetenskaplikes weer andersom.

Ek steur my min en gebruik wat ek goeddunk en besluit self of ek van die reaksies of newe effekte hou of nie.

Dankie vir jou inloer daar by my. Het jou kommentaar gemis!

Aine said...

You have such a talent for writing entertaining and informative posts!

Ha! Mass hysteria about mouthwash! I can only imagine what "third world" folks would say to this nonsense.

I do wonder what the evolutionary explanation is for this type of group behavior. Hmmm... I've never heard of a hominid herding instinct.

Anonymous said...

interesting post, but i would offer another opinion. i've personally seen the stains from this product, and removing them is no easy or small affair. For many people it will take 2 or more dental cleanings, and even then there still may be some residual stain in hard-to-reach places. also, if there is staining on bonding, then that cannot be removed, the only remedy is to replace the bonding.

the main ingredient in the crest rinse (CPC) has long been known to cause brown stains, and it is present in this product at a much higher concentration than any other rinse on the market. as such, i wouldn't necessarily be so quick to blame this problem on mass hysteria: it could, in fact, be that a large percentage of users really ARE experiencing significant stains as a side effect.

as for me, i don't necessarily recommend ANY mouth rinse or mouthwash for patients (unless the pt has a history or early indications of periodontal disease). 99% of oral health is to due brussing and flossing, the RIGHT way. and if you do feel like you need an OTC mouth rinse (for "fresh" breath or whatever other reason) i would recommend an all natural product.

we really don't know all of the ramifications of long-term exposure to chemicals like CPC or even alcohol, so why chance it, if you don't need it. and most people don't need it.

Unknown said...

david mcmahon: thanks for stopping by.

andrew: I quite like the kid: he's by Rockwell, I believe.

jason evans: don't get me started on those. Although, I have actually touched a little on cryptozoology before.

sonkind: dis totaal waar.

aine: sheeple?

anonymous: yes, it is indeed the cetylperidinium chloride that causes the brown stains, and it's true that the rinse in question has it at a very high concentration. A good concept, but probably not a good idea, of sorts. In my opinion, the company did not state the side-effects prominently enough (and they didn't need to from a pseudo-legal perspective). I'm not blaming the stains on mass hysteria per se, of course, but rather wanted to point out that people seemed to be alarmist. In a state of consumer anxiety, people were quick to blame all sorts of non-existent ingredients (like the stannous fluoride), inactive ingredients and the mouthwash as a whole for all stains they could find. Some people rather resort to conspiracy theory than getting their facts straight. But good point - I think it ties in rather well with what Andrew said. Personally, my Oral-B is enough technology for me. And my awesome dentist. I assume you are in the profession?

Anonymous said...

I'm sorry, but having brown stains on your teeth that it takes the dental hygienist 3 times as long and twice the force to remove isn't "protocol mythology", it's disgusting. What's worse is that I suspect many people don't even figure out what is causing the staining, because who would think to suspect your mouthwash is causing it. It took me months to figure it out, and I've heard the same story over and over again from many people.

You claim these stains will noticeably occur in 7% of people using it, yet P&G publicly claims "99.9%" of people have no such problems. You tell me who is engaging in "disinformation"?