Want to Beat Tooth Decay? Address the Cause

There are plenty of reasons to say no to fluoridation, but what about fluoride applied directly to the teeth?

If the idea is to prevent decay, a new study in the Journal of Dental Research suggests that, at best, it may minimize damage but not prevent it all together.

fluoride varnish For this study, researchers followed 1248 young, caries-free children over the course of three years. (“Caries” is the clinical term for tooth decay.) Half the kids got a “preventive package” of fluoride varnish, fluoride toothpaste, toothbrush, and standard dental education every 6 months. The other group got education only.

By the end of the study, 39% of the kids in the control group had developed caries. So had 34% of those who got fluoride.

The mean number of cavities was 9.6 in the control group…and 7.2 in the fluoride group.

The “success” of fluoride here is clearly underwhelming.

The trial had high retention and compliance rates but failed to demonstrate that it did keep children caries free. There is evidence from the trial that once children develop caries, the intervention does slow down its progression. [emphasis added]

So what if, instead of trying to mitigate damage we were to actually prevent it by addressing its cause?

That cause is, of course, the overconsumption of sugars. In the rush to fluoridate, this tends to be forgotten. As another paper in the JDR put it,

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]

Other research suggests that caries can be prevented by limiting sugar intake to less than 3% of your total daily calories. (For a 2000-calorie per day diet, that’s just 60 calories or about 15.5 grams of sugar a day; for a 1500-calorie diet, a mere 45 calories or about 11.5 grams. To put that in perspective, there are 39 grams of sugar in a 12-ounce can of Coca-Cola and 47 grams in a bag of Skittles.)

At the same time, increasing intake of nutrient-dense whole foods further supports your teeth’s natural ability to remineralize, protecting them from the oral pathogens (“bad bugs”) that cause decay. Toothpastes containing theobromine may also be helpful as a part of a good, overall home hygiene plan.

Bottom line? Decay and cavities are not inevitable. But preventing them isn’t up to fluoride. It’s up to you.

Image via healthcare-news

A Look Back at…A More Comprehensive Approach to Prevention

Updated from the original post for October 9, 2014

young girl smilingA 2014 report from the Centers for Disease Control shows that less than half of all children in the US are getting “preventive dental services” – particularly older teens and the very young. “In 2009,” reported Dr. Bicuspid,

more than half (56%) of children and adolescents did not visit the dentist in the past year, and nearly 9 of 10 (86%) children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.

Dental visits, fluoride and sealants? That’s a pretty narrow definition of “prevention.”

Fluoride’s benefit is arguable, especially in light of its risks and, where there’s fluoridation, the ease with which you can overdo it.

Sure, regular dental visits are important, but getting your child’s teeth professionally checked and scrubbed once every 6 months isn’t enough to override poor diet, oral hygiene and other factors.

Absolutely, sealants can be helpful in preventing cavities in deep grooves and crevices, but they, too, are only a partial solution.

Effective prevention happens mostly outside the dental office. As one physician put it in his keynote address at the 2014 Oral Health Conference in Alabama,

“Prevention is the word….” [A]nd it shouldn’t fall to just the dentists and dental hygienists. Other health care professionals, including nurses, physician assistants and pediatricians, can be part of prevention interventions; so too can daycare workers, teachers and Head Start personnel.

But most of it happens with you. At home. Above all, it takes a daily commitment to making healthful choices.

There’s so much you can do to prevent cavities and other oral health problems – for yourself and by teaching your children healthy habits.. Here’s a quick list:

  • Eat well. It’s no secret that eating too many sugars and refined carbohydrates – the stuff that so many hyper-processed foods is made of – raises your risk of cavities and periodontal disease. The World Health Organization recommends that no more than 10% of your daily calories – about 50 grams – come from sugar. But to prevent tooth decay, new research suggests a 3% max.
  • Brush and floss regularly, making sure you clean every surface.
  • Relax. Stress makes us more prone to disease and dysfunction of all kinds. Make sure you take some time to relax each day, whether it’s doing yoga, writing in a journal, or chilling to your favorite music.
  • Avoid drugs – all kinds, including tobacco. Tobacco has an especially pernicious effect on the mouth, contributing to gum disease and, ultimately, tooth loss.
  • Get enough sleep. Sleep rejuvenates your body and replenishes your energy levels. Without enough sleep, your body can’t do everything that it needs to do to keep you healthy.
  • Exercise. Just as a car won’t run well if it’s not used, so, too, your body. We were designed to move! (And yes, we’ve seen those headlines insisting that exercise is bad for your teeth, but the vast majority of people don’t exercise enough to experience the problems that some elite athletes do.)

All these suggestions should sound familiar. They’re the stuff that promotes a healthy mind, spirit, body and mouth. (The mouth is connected to the rest of you, after all!) Whenever you take these steps, you are committing to yourself. Your body will reward your for smart choices.

Image by suzi quiban

Better Diet’s the Remedy for Our Epidemic of Decay

We all know that sugar causes tooth decay. In the words of a recent Finnish study,

Dental caries is considered a diet-mediated disease, as sugars are essential in the caries process.

M&MsBut how much sugar is too much? One of the things this study set out to do was to gauge “the shape of the dose-response association” between caries and sugar intake. What they found was “a linear dose-response relationship…, with the amount…being more important than frequency of ingestion.”

In other words, the dose makes the poison. The more sugar, the more decay.

The researchers also wanted to know whether fluoride exposure made any difference. The answer?

Daily use of fluoride toothpaste reduced, but did not eliminate, the association between amount of sugars intake and dental caries. [emphasis added]

In other words, fluoride didn’t cure or stop caries. At best, it reduced them.

As we noted last time, fluoride is, at best, a stop-gap measure – an attempt to minimize damage rather than keep it from happening in the first place.

No matter what side of the fluoride fence you’re on, perhaps we can all agree that we’re not struggling with an epidemic decayed, missing, and filled teeth because we have too little fluoride. It’s because we are buried in sugars.

If we can agree on that, maybe we ought to be working to eliminate caries instead of putting a bandage on it.

“We can argue all we like about chipping away at the surface with fluoride,” suggests Dr. Steven Lin, a Sydney-based dentist.

But unless we address the deep seeded and endemic dietary issues that reside in our society, the efforts will continue in vain.

If there’s any common ground to be found in the fluoride argument it’s that both sides care immensely about our health. For the sake of future generations it’s time to agree to disagree on fluoride and join to fight the real cause of tooth decay.

And to that, we can say only, “Amen.”

Image by Pete G

A Holistic Approach to Prevention: 9 Keys to a Naturally Healthy Smile

smiling womanA couple weeks ago, we left off by noting that while there are excellent, safe alternatives to mercury amalgam, even better is to avoid needing to repair teeth at all.

Indeed, smart dentistry begins with prevention.

But prevention is much more than just brushing for two minutes twice daily and flossing once a day. It’s not just trying to minimize damage with interventions such as fluoride and sealants. It’s a whole slate of habits that support naturally healthy smiles for a lifetime. Some of them may surprise you – but probably not #1 on the list:

  1. Eat real food. For oral and systemic health alike, good nutrition is critical. Your teeth – and gums and the bony structure supporting them – need an array of vitamins and minerals to stay strong. The key nutrients are vitamins D and K, calcium, magnesium, phosphorous, zinc and other trace minerals. Antioxidants such as vitamins A, C and E are likewise important for periodontal health.

    Good mineral intake is especially important to help replace the minerals your teeth lose every day – to remineralize them on an ongoing basis.

    Eating a varied diet based on whole – rather than processed – foods generally assures you’ll get all the nutrients you need without the things you don’t need, such as synthetic additives, preservatives, flavors and colors, as well as a lot of added sugar. Local, organic and sustainable is best. (Here’s one resource for finding such foods in your area.) If going completely organic puts too much of a strain on your budget, resources such as EWG’s “Dirty Dozen” list can help you prioritize your purchases. (For some great tips on eating healthy on a budget, see this post over at The Art of Simple.)

  2. Drink water. Water is essential to everything your body does. From breathing, to transferring minerals throughout your body, to helping your kidneys filter blood, to helping your muscles move, water is involved all of your body’s metabolic actions.

    That means we lose water every day, too, and must replace it. We get some water through food, but most of it, we have to drink. As for how much, the general rule is half your body weight in ounces daily (e.g., 75 ounces for someone who weighs 150 pounds).

    One thing that’s not essential – in fact, not wanted at all – is added fluoride. If your water supply is fluoridated and you can’t afford a reverse osmosis filtering system to remove the fluoride, look to buy non-fluoridated bottled drinking water.

  3. Exercise. Scientific research has shown that exercise helps reduce risk of periodontal disease, among other conditions. It also lowers your risk of early death. So get up and get moving! After all, your body was designed to move.

    And let it be fun! Nowhere does it say you have to pay a gym membership or use fancy machines in order to be fit. The only “machine” you need is your body. (Motivation and commitment help a lot, too.) Go for a brisk walk with a friend and catch up on the news. Go for a run and see all the flowers in bloom. Kick a soccer ball around with your kids. Go hiking with your spouse. Play tennis with a co-worker. Attend yoga or tai chi classes.

    The possibilities are limitless!

    Still strive for at least 150 minutes of moderate aerobic activity each week, plus two days of muscle-strengthening activity. A combination of cardio and weight training may give you the best results in helping to lose weight, build muscle, and be healthier.

  4. If you clench or grind your teeth, seek help. Bruxism can place a lot of stress on your teeth, causing headaches and other pain, as well as damage your teeth. Eventually, it can lead to TMJ damage or dysfunction. Fortunately, treatments are available, including use of fitted night guards and other oral appliances.
  5. Reduce stress. Chronic stress is a common trigger for bruxism and a major contributor to a host of health problems, including inflammatory conditions such as gum disease, heart disease and stroke. No matter if you’re a parent, a working professional, or college student, stress will find you, and how you deal with that stress makes all the difference. Taking time for yourself to do what you love or spend time with loved ones, to get some exercise, meditate or pray, or simply relax – such things can help keep stress levels in check. There are also numerous stress management techniques you can learn and use on a daily basis to face challenges and remain resilient.
  6. If you snore loudly and often, seek help. Snoring is a sign that you’re not getting enough air during sleep. Often, this is due to the tongue or excess tissues around the top of the throat falling back as you relax, partially blocking the airway. In such cases, a simple oral appliance may be able to offer relief – and a better night’s sleep.

    But snoring can also be a sign of a greater problem: sleep apnea. People with this condition actually stop breathing for brief periods repeatedly through the night. It can be deadly. A sleep study – either in a lab or with a take-home device – is needed to properly diagnose this condition. Once we know what the problem is, we can choose the best solution among the number of options available. In cases of mild to moderate apnea, an oral sleep appliance may be enough to correct the problem.

  7. Clean dental appliances regularly. If you wear a partial, retainer, removable dental work or use any kind of oral appliance, be sure to clean it regularly to avoid bacterial build up. There are cleaning products available, but often baking soda and peroxide will do just fine.
  8. Live tobacco-free. Smoking might make you look like a rebel – but only until you start losing teeth, as most smokers will over time. Simply, the gum disease and bone loss that smoking aggravates means less support for the teeth. In fact, smokers are 4.5 times more likely to lose teeth than non-smokers – but that risk drops significantly after quitting. (More.)

    Chew is scarcely better. Most are aware of the threat of oral cancer, but those who use smokeless tobacco also have a higher risk of caries and gum recession, not to mention stained teeth, bad breath and a dulled sense of taste and smell.

  9. Visit your dentist regularly. The dentist isn’t just someone to go to when you’ve got a toothache or other oral problem. Regular exams and cleanings are key to maintaining good oral health. If your teeth and gums are in good shape, twice yearly visits are fine. If you have periodontal problems, more frequent visits are recommended – as often as every three months, depending on the severity of your condition.

Image by Ana_J

A More Comprehensive Approach to Prevention

young girl smilingA new report from the Centers for Disease Control shows that less than half of all children in the US are getting “preventive dental services” – particularly older teens and the very young. “In 2009,” reports Dr. Bicuspid,

more than half (56%) of children and adolescents did not visit the dentist in the past year, and nearly 9 of 10 (86%) children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.

Dental visits, fluoride and sealants? That’s a pretty narrow definition of “prevention.”

Fluoride’s benefit is arguable, especially in light of its risks and, where there’s fluoridation, the ease with which you can overdo it.

Sure, regular dental visits are important, but getting your child’s teeth professionally checked and scrubbed once every 6 months isn’t enough to override poor diet, oral hygiene and other factors.

Absolutely, sealants can be helpful in preventing cavities in deep grooves and crevices, but they, too, are only a partial solution.

Effective prevention happens mostly outside the dental office. As one physician recently put it in his keynote address at the 2014 Oral Health Conference in Alabama,

“Prevention is the word….” [A]nd it shouldn’t fall to just the dentists and dental hygienists. Other health care professionals, including nurses, physician assistants and pediatricians, can be part of prevention interventions; so too can daycare workers, teachers and Head Start personnel.

But most of it happens with you. At home. Above all, it takes a daily commitment to making healthful choices.

There’s so much you can do to prevent cavities and other oral health problems – for yourself and by teaching your children healthy habits.. Here’s a quick list:

  • Eat well. It’s no secret that eating too many sugars and refined carbohydrates – the stuff that so many hyper-processed foods is made of – raises your risk of cavities and periodontal disease. The World Health Organization recommends that no more than 10% of your daily calories – about 50 grams – come from sugar. But to prevent tooth decay, new research suggests a 3% max.
  • Brush and floss regularly, making sure you clean every surface.
  • Relax. Stress makes us more prone to disease and dysfunction of all kinds. Make sure you take some time to relax each day, whether it’s doing yoga, writing in a journal, or chilling to your favorite music.
  • Avoid drugs – all kinds, including tobacco. Tobacco has an especially pernicious effect on the mouth, contributing to gum disease and, ultimately, tooth loss.
  • Get enough sleep. Sleep rejuvenates your body and replenishes your energy levels. Without enough sleep, your body can’t do everything that it needs to do to keep you healthy.
  • Exercise. Just as a car won’t run well if it’s not used, so, too, your body. We were designed to move! (And yes, we’ve seen those recent headlines insisting that exercise is bad for your teeth, but the vast majority of people don’t exercise enough to experience the problems that some elite athletes do. )

All these suggestions should sound familiar. They’re the stuff that promotes a healthy mind, spirit, body and mouth. (The mouth is connected to the rest of you, after all!) Whenever you take these steps, you are committing to yourself. Your body will reward your for smart choices.

Image by suzi quiban