Ditch the Juice, Go for the Whole Fruit

oranges and juiceHow much juice should you let your kids drink? If they’re younger than one, zero, zilch, nada.

That’s according to new guidelines from the American Academy of Pediatrics. And that’s the best part of the news.

Fruit juice offers no nutritional benefit to children under age 1 and should not be included in their diet.

But that implies some nutritional benefit to kids over a year old. And that’s a sketchy claim at best. As nutritional consultant Dr. Mike Roussell has put it,

There aren’t any benefits to drinking fruit juice over eating whole fruits. In fact, eating whole fruit is a better choice. In regards to vegetables, the only benefit to vegetables juices is that it might enhance your consumption of vegetables; but you’ll miss out on some key health benefits by juicing.

As Dr. Royal Lee pointed out years ago, when you eat whole fruit, you get the total nutritional package: vitamins, minerals, fiber, phytonutrients. When you juice, these get delivered with concentrated sugar – sometimes even more sugar than you’d get in a can of soda pop.


And that’s not good at any age. As one 2016 review put it, while there are still research gaps to be bridged by science,

Sufficient evidence links a high intake of sugar to dental caries and obesity, and high intakes of sugar-sweetened beverages in particular to increased risk of type 2 diabetes.

Other research has confirmed that, like diet soda, fruit juice is not apt to be a “healthy alternative…to sugar sweetened beverages for the prevention of type 2 diabetes.”

“Fruit juice,” notes the AAP, “offers no nutritional benefits over whole fruit for infants and children and has no essential role in healthy, balanced diets of children.”

Whole fruit, on the other hand, has such a role. Many fruits also tend to be high in vitamin C, which is essential for healthy gums. Crunchy fruit such as apples also help stimulate saliva flow that helps protect the teeth.

And what does juice do? Bathes the teeth in sugar and acids, destroying tooth enamel and making the teeth more vulnerable to decay.

Ditch the juice. Go for the fruit.

With Sealants, BPA-free Matters

child at dentistPlaced well, sealants can help prevent cavities. On the surface then, it would appear the ADA’s recent “scientific” endorsement “BPA in dental sealants safe” makes sense. But it doesn’t.

Of the 12 sealants tested by the ADA’s Professional Product Review, all exposed children to BPA. But clearly that wasn’t a safety deal breaker. The ADA stands behind this industry research, insisting that

a 6-year old child is exposed to more BPA from food, drinks, sunscreen, shampoo, body wash and other cosmetics; and air and thermal paper, such as cash receipts, than from the amount that is in dental sealants.

The implication is that this makes exposure to BPA from dental sealants okay. It’s not.

As biological dentists, we know deeply the importance of using biocompatible dental materials. While there are some sealants that are BPA-free, many common materials aren’t. And that risk of BPA exposure is one we take seriously.

For one, it’s an endocrine disruptor. According to an independent scientific review in Endocrine Reviews,

It can stimulate rapid cellular responses at very low concentrations. According to a review on BPA, altered body weight, altered organization of the mammary gland, and cancers of the mammary gland and prostate; More than 40 of these studies examined doses less than the RfD (a reference dose). Many of these end points are in areas of current concern for human epidemiological trends. Indeed, it has been suggested that exposure to xenoestrogens such as BPA during early development may be a major contributing factor to the increased incidence of infertility, genital tract abnormalities, obesity, attention deficit hyperactivity disorder, infertility, and prostate and breast cancer observed in European and U.S. human populations over the last 50 years.

The ADA’s research indicated BPA exposure from sealants at 0.09 ng. That’s a minimal level, to be sure – especially when compared to the EPA established reference dose for exposure at 50,000 ng/kg body weight/day. So what’s the problem?

As the ADA indicates, children are exposed to BPA from multiple sources, making their daily exposure to BPA biocumulative. Each exposure adds up, including their exposure from sealants.

And, according to that paper in Endocrine Reviews, the EPA minimum exposure level for safety, may not provide immunity from BPA’s estrogenic side effects.

More than 150 published studies describe BPA effects in animals exposed to less than 50 mg/kg/day, including altered development of the male and female reproductive tracts, organization of sexually dimorphic circuits in the hypothalamus, onset of estrus cyclicity and earlier puberty.

Other research concurs:

There is substantial evidence from rodent studies indicating that early-life BPA exposures below the oral reference dose lead to increased susceptibility to mammary and prostate cancer.…BPA maybe anticipated to be a human carcinogen.

Not exactly what we want for our kids.

So while the ADAs scientists are technically right – it is a minimal exposure – the conclusion that sealants containing BPA are therefore safe is indefensible. It’s illogical. It does not follow from their own facts.

If your child’s dentist recommends sealants, ask for BPA-free options. As mentioned, they do exist.

Image by jason wilson

Thumb Suckers, Nail Biters, & the Hygiene Hypothesis

child sucking thumbIt’s hardly surprising that a new study finds thumb suckers and nail biters are exposed to more germs. After all, parents have lectured kids about those germs for generations.

What may surprise you is that the research found health benefits from that hand-to-mouth exposure.

Specifically, the researchers were testing the hypothesis that children who suck their thumbs or bite their nails are less prone to develop allergies, asthma, or hay fever. So they looked at data from more than 1000 children in New Zealand.

When the study members were age 5, 7, 9, and 11 years, parents were asked about their child’s thumb-sucking and nail-biting status. Parents were asked if the statements “frequently sucks their finger/thumb” and “frequently bites their nails” applied to their child. They could choose from 3 responses: not at all, somewhat, or certainly. Children were considered to be frequent thumb-suckers or nail-biters if their parents reported that the oral habit in question “certainly” applied to them at least once.

Additional follow-up was done through the teen years and into middle adulthood. While those who were classified as thumb suckers and nail biters were less likely to test positive on skin tests for allergy.

Children who were reported to have either of these habits were less likely to have positive skin-prick tests at age 13 years and this apparent protective effect persisted to age 32 years. These associations were independent of sex, a parental history of atopy, and a variety of environmental factors known to be associated with atopic sensitization within this cohort.

No association was found with asthma or hay fever, though.

But lest you think the benefits make it a-ok to let your child persist in these habits, there are some big dental downsides to these parafunctional habits. (That’s a fancy way of describing the habitual use of a body part – like the mouth – for something it’s not normally used for. Other parafunctional habits include clenching and grinding, tongue thrusting, and cheek biting.)

Depending on the intensity and duration, thumb and finger sucking can interfere with proper growth of the mouth, shape of the palate, even the shape of their face! (You can learn more about such issues here and here.) It may shift the teeth out of alignment, creating the need for orthodontics later.

Nail biting can shift the teeth, too, as well as cause excess wear and lead to tooth fractures – and big dental bills down the road.

So yes, these are habits you want to help break – whether through something like myofunctional therapy or DIY solutions. What remains worth paying attention to from that study, though, is the light it shines on the hygiene hypothesis.

Originally, the focus was on

allergic diseases. It claimed that their recent rise in Western countries was promoted by reduced exposure to microorganisms due to improved hygiene conditions. Since these early observations, many epidemiological data have reinforced this theory, first on allergic disorders and then extending to autoimmune diseases.

If the hypothesis is correct, the dramatic increase in these diseases in industrialized countries seems to show that we may, in fact, be too clean for our own good.

And keeping our kids’ hands out of their mouths is just the start. In our germaphobic attempt to fight pathogenic microbes with an army of household and personal products designed to defend cleanliness, we appear to disrupt the balance in our microbiome; a balance necessary for health. And the consequence of imbalance?

an immune system that essentially gets bored, spoiling for a fight and apt to react to harmless substances and even attack the body’s own tissues. This could explain the increasing incidence of allergies and autoimmune disorders such as asthma, rheumatoid arthritis and inflammatory bowel disease.

* * *
There is also the suggestion that a diminished microbiome disrupts hormones that regulate hunger, which can cause obesity and metabolic disorders.

But clearly, there are way better, tastier, ways for your kids – and you – to help a healthy microbiome bloom than sucking fingers and biting nails!

Image by Alvin Smith

Fluoride, Fluoride, Fluoride…

children's toothpasteWe all want the best for our kids, and like everything in life, there are different opinions on how to get there.

Maybe you go out of your way to read labels in your attempt to give your family the best quality products you can. But there’s one label you might have missed: the one on your family’s toothpaste.

warning on children's toothpasteBuying that bright, candy-esque packaged toothpaste because it might encourage brushing is naturally based on the best of intentions for the child.

But if it’s fluoridated, you’ll notice a poison control warning.


Seek first to understand, then to be understood.
– Dr. Stephen Covey

The Fluoridated Party Line

In January, a Norwegian study on oral health messages was published in the International Journal of Dental Hygiene. The aim was to investigate recommendations given to the general public by dentists, dental hygienists, dental nurses, and public health nurses on preventing caries (tooth decay).

More than 800 health professionals answered the authors’ questionnaire.

  • 59-71% judged oral hygiene education to be the most important part of preventing caries.
  • 84-98% recommended that all children use fluoride toothpaste.
  • Half recommended fluoride lozenges for 50% or more of children.

The message is clear: Fluoride, fluoride, fluoride. But does that make it right? Accurate? Effective?

It’s Too Much Sugar, NOT too little Fluoride

Frankly, it’s distressing to realize that diet seems not to have been mentioned at all – or not by enough to merit highlighting.

In terms of prevention, fluoride is, at best, a stop-gap measure – an attempt to minimize damage rather than keep it from happening in the first place. It’s a point that was made nicely in a paper published last year in the Journal of Dental Research.

The importance of sugars as a cause of caries is underemphasized and not prominent in preventive strategies. This is despite overwhelming evidence of its unique role in causing a worldwide caries epidemic. Why this neglect? One reason is that researchers mistakenly consider caries to be a multifactorial disease; they also concentrate mainly on mitigating factors, particularly fluoride. However, this is to misunderstand that the only cause of caries is dietary sugars. These provide a substrate for cariogenic oral bacteria to flourish and to generate enamel-demineralizing acids. Modifying factors such as fluoride and dental hygiene would not be needed if we tackled the single cause—sugars. [emphasis added]

Instead, preventive self-care for children gets reduced to a “how-to” message for parents: fluoridate. This is concerning.

Education as a Foundation of Health

When it comes to families with young children, the emphasis on fluoride is a culturally ingrained message that supersedes parental control. As a parent, you can regulate the cookie jar, but, how do you regulate, much less know, the quantity of fluoride your child ingests from toothpaste? Fluoridated water? Juices? Soft drinks? Processed meat? Other sources?

You can’t.

If you’ve ever left a dental office feeling shamed because you didn’t embrace fluoride for your kids, you should know there are alternatives. In biological dentistry, generally speaking, oral health care isn’t so much a “message” as it is a holistic philosophy.

Rather than just throwing fluoride recommendations at you, we seek to understand the desires and goals you have for your family’s dental care. Once we understand, we work to identify individual habits that may influence health outcomes and emphasize education regarding diet and effective cleaning techniques rather than fluoride.

We believe this approach not only empowers you and your family to achieve your health goals, but employs the truest sense of “self-care for children” in the prevention of tooth decay.

Secondhand Smoke May Make Kids More Cavity-Prone

Globally, 40% of children and more than 30% of nonsmokers are exposed to secondhand smoke. Each has a heightened risk of asthma, cancer, heart disease, respiratory infections and other chronic illnesses – all as a consequence of other people’s choices.

cigarette smokeMaybe you already knew that. But here’s something you may not know: Children routinely exposed to secondhand smoke seem to also have a higher risk of tooth decay.

The most recent study to document this association was published last month in the BMJ, which involved analysis of the records of almost 77,000 Japanese infants and toddlers. The authors found that those who were exposed to secondhand smoke at the age of 4 months were 1.5 times more likely to develop decay as they grew.

Children with family members who smoked had significantly more decayed, missing, or filled (DMF) teeth than those with no smokers in the family, according to the study. The mean DMF index at 18 months was 0.03 with no family members who smoked and 0.11 (p < 0.01) with infants exposed to tobacco smoke at age 4 months. At age 3, the mean DMF index was 0.44 for the children with no smokers in the family and 1.07 for those exposed to smoke at age 4 months.

Of course, it’s important to keep in mind that just because two things are associated, it doesn’t mean that one causes the other. Correlation is different from causality. And the authors note some other factors that are common to both oral disease and those children exposed to secondhand smoke:

Children at 4 months old with family members who smoked had their teeth brushed less frequently, [the authors] reported. And while the frequency of eating sweets was similar among the groups, exposure to smoke was associated with higher proportions of bottle feeding and drinking juice every day.

Such things may play a role, as well as the physiological impact of the smoke itself.

Either way, it’s still worth kicking the habit. According to the American Lung Association, more than 24 million kids are exposed to secondhand smoke.

Secondhand smoke is responsible for between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalizations each year. It also causes 430 sudden infant death syndrome (SIDS) deaths in the U.S. annually.

As with mercury, there is no safe level of exposure. Zero.

If you are – or someone you know is – thinking about quitting, there are lots of resources to help – including natural remedies that may help you kick the habit more easily. You can do it!