A Look Back at…Keeping Your Teeth Naturally Healthy

Originally posted June 4, 2015

The Caries Crisis

tooth models showing cariesAccording to the latest CDC statistics, almost all adults have experienced dental caries – 91% to be exact.

“It is not what people are doing wrong,” Dr. Bruce Dye, who led the survey, told Today. “It is maybe what we can do better.”

Well, that’s a way of putting it – and a positive one at that. Yet tooth decay doesn’t happen just because it happens. Some “wrong” things are playing a role – or, at the very least, are doing little to help.

Consider fluoride, which the Today write-up mentions as one intervention that “greatly reduces rates of tooth decay.” Consider that nearly 70% of Americans receive fluoridated water. Consider that in some stores, it is near impossible to find non-fluoridated toothpastes. Fluoride is everywhere.

Then consider again: 91% of American adults have experienced tooth decay. More than a quarter have untreated tooth decay.

The upside to that startling statistic is that it may be partly explained by the fact that more of us are keeping more of our natural teeth for a longer time. In fact, the rate of edentulism – having no teeth – has dropped almost 40% over the past 50 years.

But the ideal, of course, is not just to keep all your teeth but to keep them in their naturally healthy condition.

A major help is ditching soft drinks and fruit juices – the two biggest culprits when it comes to enamel erosion, which leaves the teeth more vulnerable to decay. Even better is when that’s part of a move to a simpler, more wholesome diet.

It’s interesting to note that our distant ancestors typically had far less oral disease than we do. For instance, people living during the Middle Ages did have problems like worn down or broken teeth, but as recently discussed in a column on Slate:

Contrary to the depiction of medieval peasants with blackened and rotting teeth, the average person in the Middle Ages had teeth that were in very good condition. This is substantially due to one factor—the rarity of sugar in the diet. Most medieval people simply could not afford sugar, and those who could used it sparingly, usually as a seasoning or minor ingredient and almost never as a condiment or the basis of a dish. This means that most people used natural sugars, such as those in fruits and honey; even then, they ate this kind of sugar sparingly. Taken with a diet high in calcium via dairy, high in vegetables and cereals, and low in foods that cause decay, the average medieval person ate the way most modern dentists would recommend for good teeth.

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.

This is totally in line with what Dr. Weston Price found through his observations of indigenous populations. He found that who ate traditional diets consumed at least four times the minerals and water-soluble vitamins than those who ate industrial diets, and had good orofacial development and good oral health. Once they transitioned to a Western, industrial diet with its white flour and refined sugar, crowded, crooked teeth, caries and other problems soon appeared.

Better food: A better way than fluoride to support good oral health.

Image by Xauxa

Is Erythritol Really All That?

erythritolYou hear a lot about xylitol and how it may help keep your teeth healthy, but lately, another sugar alcohol has been put forth as dentistry’s “new best friend”: erythritol.

It has nearly zero calories (0.2 calories per gram); does not raise plasma glucose, or insulin levels; is non-cariogenic; and is easy to digest. More than 90% of erythritol is absorbed in the small intestine, so minimal amounts reach the colon where some sugar alcohols can cause bloating, gas, or diarrhea. Erythritol is heat stable, so it can be used in food preparation.

And that’s not all. According to research published in Molecular Oral Microbiology, it seems to prevent the build-up of oral biofilm – the bacterial colonies that cause decay, more popularly known as plaque.

Another study looked at the effects of both xylitol and erythritol on caries prevention in children. For three years, nearly 500 children ate four xylitol, erythritol or sorbitol candies three times a day. Erythritol clearly outperformed the other two sweeteners in this double-blind, randomized study. Not only did the children consuming erythritol have significantly less decay, but the decay that did develop took considerably longer to form.

This confirmed the findings of a similar 2013 study in the Journal of Dentistry:

Three-year consumption of erythritol-containing candies by initially 7- to 8-year old children was associated with reduced plaque growth, lower levels of plaque acetic acid and propionic acid, and reduced oral counts of mutans streptococci compared with the consumption of xylitol or sorbitol candies.

However, a 2012 study found no effect on caries prevention, leading the authors to conclude that the lozenges would have no additional benefit “when compared with comprehensive prevention.”

Although erythritol does occur naturally in some plants and fermented foods, much more is added to food products. Industry produces 16,000 to 18,000 tons each year for use in chewing gum, pudding, condiments, cookies, and – especially – sodas (59% of all erythritol manufactured). It is also blended with stevia leaf extract and flavorings to make the consumer sugar substitute Truvia.

And, of course, when you consume such hyper-processed products, you’re usually getting a whole lot more than just erythritol. It’s unreal food, and beyond brushing and flossing, eating real food is the number one thing you can do to maintain a naturally healthy smile.

For 8 more things you can do, read on…

Previously

The Dental Benefits of Breastfeeding

baby with first toothWhen it comes to infant health and development, breast, as they say, is best. And you may already know that breastfeeding lowers a baby’s risk of things like SIDS, allergies, asthma, ear infections, severe lower respiratory infections, obesity, pneumonia and more.

But did you also know it also supports good orofacial and dental development?

According to a 2013 study in the Journal of the American Dental Association, children who breastfeed “may develop a more favorable occlusion [bite – the way the teeth come together] in the primary dentition.” A more recent study, published earlier this summer in Pediatrics, found that there may be even greater improvement for infants who breastfeed exclusively for longer periods. As WebMD reported,

The risk of overbite was one-third lower for those who exclusively breast-fed for three to six months compared to those who didn’t, the findings showed. If they breast-fed at least six months or more, the risk of overbite dropped by 44 percent.

Similarly, children who exclusively breast-fed for three months to six months were 41 percent less likely to have moderate to severe misalignment of the teeth. Breast-feeding six months or longer reduced their risk by 72 percent.

But they also found that pacifier use interfered with this healthy development – as can other habits such as thumb-sucking or physical impediments such as a tongue-tie. The former, of course, can be broken, while tongue-tie can be alleviated through a surgical procedure known as frenectomy.

How can something so simple as breastfeeding have such an effect on how the teeth come in? As myofunctional therapist and dental hygienist Carol Vander Stoep describes it in her book Mouth Matters,

The coordination required for an infant to swallow and breathe at the same time while breastfeeding is also a critical step in learning correct swallow patterns. In a proper swallow, the lips touch together lightly. The lower jaw moves slightly upward to touch the upper teeth. The tongue lightly moves up and reinforces the good arch form. There is minimal TM/jaw joint compression. Good breathing and swallowing habits maintain the balance of forces.

Babies who breastfeed and develop proper swallowing patterns and facial structure generally have more prominent cheekbones, less constricted sinuses, and a larger eye orbit that allows the eyeball to develop a proper shape. This improves chances of good eyesight. They also develop far fewer ear infections. Children with deep dental overbites are 2.8 times more likely to have ear tubes placed.

On the other hand, the tongue of a bottle-feeding baby creates a strong vacuum against the roof of the mouth and at the back of the throat. This can form a very high palatal vault, reduce the width of the arch, and constrict the sinuses and airway.

There’s also evidence that breastfeeding may protect your child against caries. A new review of the science in Acta Paediatrica found that children who were breastfed more through their first year had a lower risk of developing caries. However, they also found that those who breastfed beyond that time had a higher risk, particularly if they fed at night or more frequently. What they couldn’t say is what role other habits – diet, hygiene and such – might be at work in elevating risk. There just wasn’t enough evidence to say.

Regardless, we do know that the benefits of breastfeeding far outweigh any negatives. As the American Academy of Pediatrics notes, it’s not just a lifestyle choice. It’s a matter of public health.

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.

Image by Daniel

The Caries Crisis

tooth models showing cariesAccording to the latest CDC statistics, almost all adults have experienced dental caries – 91% to be exact.

“It is not what people are doing wrong,” Dr. Bruce Dye, who led the survey, told Today. “It is maybe what we can do better.”

Well, that’s a way of putting it – and a positive one at that. Yet tooth decay doesn’t happen just because it happens. Some “wrong” things are playing a role – or, at the very least, are doing little to help.

Consider fluoride, which the Today write-up mentions as one intervention that “greatly reduces rates of tooth decay.” Consider that nearly 70% of Americans receive fluoridated water. Consider that in some stores, it is near impossible to find non-fluoridated toothpastes. Fluoride is everywhere.

Then consider again: 91% of American adults have experienced tooth decay. More than a quarter have untreated tooth decay.

The upside to that startling statistic is that it may be partly explained by the fact that more of us are keeping more of our natural teeth for a longer time. In fact, the rate of edentulism – having no teeth – has dropped almost 40% over the past 50 years.

But the ideal, of course, is not just to keep all your teeth but to keep them in their naturally healthy condition.

A major help is ditching soft drinks and fruit juices – the two biggest culprits when it comes to enamel erosion, which leaves the teeth more vulnerable to decay. Even better is when that’s part of a move to a simpler, more wholesome diet.

It’s interesting to note that our distant ancestors typically had far less oral disease than we do. For instance, people living during the Middle Ages did have problems like worn down or broken teeth, but as recently discussed in a column on Slate:

Contrary to the depiction of medieval peasants with blackened and rotting teeth, the average person in the Middle Ages had teeth that were in very good condition. This is substantially due to one factor—the rarity of sugar in the diet. Most medieval people simply could not afford sugar, and those who could used it sparingly, usually as a seasoning or minor ingredient and almost never as a condiment or the basis of a dish. This means that most people used natural sugars, such as those in fruits and honey; even then, they ate this kind of sugar sparingly. Taken with a diet high in calcium via dairy, high in vegetables and cereals, and low in foods that cause decay, the average medieval person ate the way most modern dentists would recommend for good teeth.

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.

This is totally in line with what Dr. Weston Price found through his observations of indigenous populations. He found that who ate traditional diets consumed at least four times the minerals and water-soluble vitamins than those who ate industrial diets, and had good orofacial development and good oral health. Once they transitioned to a Western, industrial diet with its white flour and refined sugar, crowded, crooked teeth, caries and other problems soon appeared.

Better food: A better way than fluoride to support good oral health.

Image by Xauxa

And the Current Verdict on Xylitol Is…

xylitol gum packetsOver the past few years, there’s been a lot of hype about xylitol – an artificial sweetener believed to prevent cavities. But as we’ve seen, research supporting that claim has been mixed at best. There’s seemed to be some benefit, but moderate and limited.

Now a new study in Cochrane Reviews has more clearly shown that, at present, there really isn’t much good evidence to justify the xylitol hype.

The authors analyzed results from 10 studies involving nearly 6000 subjects. The xylitol products ranged from lozenges to syrup to toothpaste and wipes. The only real positive evidence they found was for xylitol toothpaste, which was found to be more effective than a control product, with no adverse effects.

But overall, they found the evidence low quality and very limited.

One particularly glaring problem was that 7 of the 10 studies considered – including the toothpaste studies – were deemed “highly biased.” As for the rest?

The remaining evidence we found is of low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children, or adults.

If there’s one thing this study makes clear, it’s that more and better research needs to be done.

That said, it’s also a fact that xylitol is hardly a necessity for your teeth. Like herbal and other specialized hygiene products, it may support good oral health. It doesn’t create it. That comes most from a healthful diet – with minimal added sugars and other hyper-processed carbs and starches – and optimal hygiene, including brushing, flossing.

Keep in mind, though: Some dental situations – such as bruxing and chronic dry mouth – can raise your risk of caries (tooth decay). In those cases, your dentist can help you successfully deal with those to keep your risk low.

Obesity & Oral Disease: A Weighty Connection

Though you often hear people talk about “science” as kind of a single, solid body of fact, it’s actually a process and a way of understanding the world. Ideas are tested and retested. Evidence builds up – sometimes in support of a hypothesis, sometimes against – but until it reaches critical mass on one side or another, the mixed results of scientific research can sometimes seem confusing.

Consider a trio of studies published over the past several months on the long-observed relationship between oral health and obesity.

One study, published in the Journal of Evidence-Based Dental Practice, found that obese children tended to have more cavities, though results varied according to socio-economic status. Parents’ income levels seemed to predict preventive oral health practices such as home hygiene and regular dental visits.

Another study – this, in PLoS ONE – came to a contrary conclusion, finding that Kuwaiti children who were obese actually had fewer cavities than their slender peers. No explanation was given for this surprising result.

The finding of an inverse obesity-dental decay relationship contradicts the obesity-sugar and the obesity-dental decay relationship hypotheses. Sugar is well recognized as necessary and sufficient for dental decay. Sugar is also hypothesized to be a leading co-factor in obesity. If the later hypothesis is true, one would expect dental decay to increase with obesity. This was not found. The reasons for this inverse relationship are not currently clear.

Then there was the research published in the European Archives of Paediatric Dentistry. This study found that while obese children don’t necessarily have a higher risk of tooth decay, they do seem to have a higher risk of dental erosion.

5411920162_852d19475c_bOf course, as enamel is lost and dentin is exposed, the affected teeth become much more vulnerable to decay.

Overall, though, the research generally supports some connection between obesity and caries (that’s the dentist’s term for cavities). And if you think about it, this makes a lot of sense. After all, the mouth is where eating begins, and the foods most prone to add to your fat stores – sugary, starchy, hyper-processed carbs – are the exact same foods that can lead to dental problems.

Some, of course, are more damaging than others. Soda may be one of the worst offenders, though fruit juice is not so much better. A single 12 ounce serving of pop can contain more than 50 grams of the stuff; juice-based drinks fall into the same range. (Tropicana Farmstand, for instance, contains just a half teaspoon less than a regular Coke.)

This sugar is the preferred fuel of the microbes that colonize into the tooth-coating biofilms we call “plaque.” The metabolic waste they produce is highly acidic, and that’s what ultimately damages teeth, making them vulnerable decay.

Add to that the phosphoric acid found in soda, and you get a real recipe for disaster.

But it’s not just soda that’s the problem. All highly processed carbs and sugars tend to stick to the teeth, especially along the gum line, feeding those oral pathogens, helping them to thrive.

These are also the kinds of foods that fuel chronic inflammation – a key player in both obesity and gum disease. Not only are they themselves triggering but they also often displace healthier foods from the diet, such as vegetables, whole grains, unprocessed meats and healthy fats such as omega 3s. In light of this, it’s not especially surprising that research has found obesity to be a predictor of periodontal disease.

That said, being obese doesn’t necessarily doom you to oral health problems – or vice versa. But the presence of both together does suggest that the reason may be shared triggers such as diet.

Even though there may not be a causal connection, healthy choices can impact both. This doesn’t mean that one solution exits, but changing your diet and exercising more are fantastic steps towards better oral, heart, and overall health.

For starters, instead of eating sugars, refined flours, and starches, fill your diet with:

  • Vegetables
  • Fresh fruits (not canned)
  • Natural fats from foods like like nuts, avocados, fish, and olive oil
  • Unprocessed meats (found in the meat aisle, not the deli)
  • Whole grains

Finally, remember to clean your teeth and gums regularly. No matter what you eat, your teeth need brushing at least twice a day and flossing once a day.

Image by Jacob Deatherage, via Flickr

56% of Dentists Say “No” to Fluoridation

The official pro-fluoridation position is unambiguous:

The American Dental Association unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay. This support has been the Association’s position since policy was first adopted in 1950.

fluoride_comic_cropConsidering itself to be the voice of dentists as a whole, however, the organization might want to start rethinking their position.

Recently, The Wealthy Dentist – a marketing website for dental practices – conducted a survey that included a very simple question: Do you support water fluoridation?

Overall, 70% said no. Counting only responses from dentists, a clear majority still said no – 56%, to be exact.

Here’s what some of those dentists had to say when asked if they “see fluoride as a wonder drug or deadly chemical” (all emphases in the original):

  • Fluoride belongs in toothpaste, not water. That way, those who want it can have it. Besides, fluoride is only effective topically, not systemically.”
  • Fluoride should not be added to the water supply as its effects on individuals cannot be monitored and the dose cannot be controlled. Treatments may be indicated in the dental office and people can choose to use fluoride toothpaste and rinses as well.”
  • “I think the classification of it as a toxic waste is pretty self explanatory.”

Yet, as the Fluoride Action Network notes,

Despite this, many in the public health community continue to advocate for fluoridating water supplies. Unlike their predecessors, today’s advocates insist that fluoridated water provides an effective source of topical fluoride by increasing the fluoride content in both saliva and plaque. Even if true, however, recent studies show that there is virtually no practical difference in tooth decay rates between fluoridated and non-fluoridated areas. Accordingly, if fluoridated water does have a topical effect on teeth, it appears sufficiently miniscule that use of topical fluoride products can readily replace it.

It certainly doesn’t seem enough to justify the real, documented health risks of ingesting fluoride, from fluorosis to developmental problems to cancer.

There is also growing concern that we are getting too much of the stuff, which has lead the Department of Health and Human Services, among others, to recommend that EPA lower the levels allowed in water. Those who want fluoride are welcome to it and can easily get it through toothpastes and rinses. (Indeed, in some stores, it’s impossible to find toothpaste that does not contain fluoride – even “natural” products such as some varieties of Tom’s of Maine.)

Besides, there is a better way.

“The commendable goal of prevention,” says the International Academy of Biological Dentistry and Medicine,

should be advanced by effective routes, not by fluoride. When the public water supply is fluoridated, fluoride is taken into the body systemically when people drink water. Fluoride taken systemically has little to no effect in decreasing tooth decay.

As health professionals, we favor effective national and community efforts for cavity prevention; for example, a campaign for children to reduce sugar intake would have demonstrable effects on cavity reduction.

Fluoride just isn’t necessary for good dental health – but other things are. Proper nutrition and hygiene, for instance, are vital.Teeth need minerals such as calcium, magnesium and phosphorus ; vitamins such as D and K. They need to be cleaned regularly and well, not just with brushing but flossing, too. (Brushing alone cleans only about 60% of your total tooth surface.) They need to be spared added sugars and refined carbs, which serve mainly to feed the bacteria that form biofilm (plaque) and acidify the oral cavity.

Not only are such steps are more effective than fluoride, they have the bonus of contributing to whole body health, as well.

When It Comes to Preventing Cavities, Is Xylitol Really All That?

xylitolXylitol – a sugar alcohol that may actually help fight tooth decay – isn’t quite the silver bullet some have touted it to be.

Though a recent study found some positive results in using xylitol lozenges, there’s not too much to write home about. Following up on earlier research, this study aimed to see if xylitol had different effects on different tooth surfaces (e.g., the biting surface, roots and so on).

Participants in the xylitol arm developed 40% fewer root caries lesions…[but] there was no statistically significant difference between xylitol and control participants in the incidence of smooth-surface caries, occlusal-surface caries, or proximal-surface caries. (emphasis added)

cariesCommon in older adults, root caries (“caries” is the clinical term for cavities) involves decay on exposed root, where gum tissue has receded due to brushing too hard or too much, chronic bruxing (clenching and grinding) or other factors. That sucking xylitol lozenges helps prevent them is a good thing: 40% is significant, and it certainly wouldn’t hurt to use them as an adjunct to regular brushing and flossing.

Then again, we might ask: Is it really the xylitol? Studies of xylitol-sweetened gum have suggested that saliva may actually make the difference. As a paper published in Community Dentistry and Oral Epidemiology put it, “The results indicate that the caries preventive effect of chewing sugar-free gum is related to the chewing process itself.”

Why saliva? It has several roles in preventing caries:

buffering capability; the ability. . .to wash the tooth surface, to clear bacteria, and to control demineralization and mineralization; saliva’s antibacterial activities; and perhaps other mechanisms all contribute to its essential role in the health of teeth.

Clearly, promoting saliva is beneficial to your oral health, and both chewing and sucking increase its flow.

There’s also an inherent danger in exalting any one substance as beneficial. We may misread the claims and see that product as a quick fix or a viable alternative to the tools we know will help us stay healthy. We can’t fall victim to the “health halo” effect and assume all things xylitol will be good for our teeth.

Also keep in mind that xylitol is a sugar alternative, so may sustain our natural preference for sweets. Feeding it may only beget eating more sugar and sweeteners of all kinds. Sugar, in turn, may encourage us to eat more food beyond overall because, in the words of one research paper, “chronic consumption of sugar blunts activity of pathways that mediate satiety.”

Xylitol lozenges or gum alone are just not enough to prevent caries. Even pro-xylitol dentists believe you need to practice good oral hygiene to maintain good oral health. Instead of looking for a panacea, just hang on to that toothbrush, toothpaste, and floss – and use them! Regularly!

Xylitol image by HeatherMG, via Flickr;
caries illustration by Nerdture, via Wikimedia Commons