What Are We Talking About When We Talk Remineralization?

Last week, we looked at an unnatural – not to mention fluoride-laced – way to “heal” caries. But what about natural ways?

Microcaries 101

Before we get to your body’s amazing capability to heal itself, we’d like you introduce you to your teeth.

layers of toothEach tooth is made up of layers, The layer you see is the enamel. It’s the hardest layer – the hardest tissue in your whole body, in fact. You can think of it as your tooth’s defense layer.

Underneath is a softer layer, the dentin. Below that is the pulp chamber. It houses the tooth’s nerve and blood supply.

Caries is the clinical name for what you know as tooth decay. So when we talk about “microcaries,” we’re talking about tiny areas of decalcified enamel. That’s the doing of bacteria – and the acids they make, etching the tooth but not going through the enamel. They affect only the surface.

Once decay penetrates the dentin, a filling is usually in order. For while you can grow new dentin, you can’t grow new enamel. (Once the teeth are grown, we lose the cells required to make it.)

Microcaries are the beginning of a decay process. Left to its own devices, the decay will progress. But it can also be halted. It may also be reversed.

Remineralization 101

healthy teethWhile there are some dentists who feel it right to aggressively treat early surface decay, we generally believe – depending on your dental history and personal habits – your body is able to remineralize these acid-etched areas.

Importantly, remineralization doesn’t mean you grow new enamel. Rather, it means your body – via saliva – lays down new minerals in the etched area, which may protect it from advancing decay.

But like so many things, the likelihood of this happening depends largely on you. There are three keys to address:

Diet is key to overall wellness, including teeth. Research indicates a few especially important factors when it comes to your teeth’s remineralizing potential:

  • Get enough minerals in your diet, especially calcium and phosphorous.
  • Include fat soluble vitamins, particularly D3.
  • Ensure the bioavailability of nutrients by eating whole foods and dairy products that give your body the best chance at absorbing minerals.
  • Limit processed foods, sugar and diet beverages that deplete minerals.

Routine Dental Checkups
Routine dental exams and cleanings can prevent small problems from becoming big ones. Catching caries early gives you a better chance at remineralizing – and an opportunity to save dollars in the long run. Stay in touch!:

  • Schedule cleanings at least twice a year.
  • Schedule an exam at least once a year.

Effective Home Care, with Special Attention to Cleaning Between Your Teeth
Good home care is for everyone but particularly important for those dealing with decay. Your hygienist will coach you on the proper tools and techniques for making you’re your efforts are effective. After all, it’s what you do at home – not what we do in the office – that largely determines your mouth’s overall health.

  • Clean your teeth in front of a mirror to ensure proper technique.
  • Brush, brush, brush! Floss, floss, floss! Floss first if that will make sure you don’t “forget” to do it. (In fact, some research suggests that flossing before you brush is actually more effective.)
  • Use interdental or “proxy” brushes to clean hard to reach areas between teeth and at the gum line.

Our goal? Empower YOU to keep the area clean and to create a healthy mouth environment that enables remineralization to happen—without fluoride. Now that’s an alternative!

Photography by dozenist

Guest Post: Trace Minerals for Your Teeth

Our thanks to the office of Dr. Bill Glaros for letting us share the following post from their blog:

teethThe enamel coating that protects your teeth is 96% mineral – the highest mineral content in any human tissue. That makes it the strongest tissue in your body. But like any other tissue, you need to care for it – at least if you want it to stay healthy and whole.

One of enamel’s fiercest enemies is, of course, the sugary, acidic Standard American Diet. Not only does it thwart your body’s efforts to remineralize your teeth, it actually demineralizes them, as well.

A nutrient-rich diet, on the other hand, supports healthy, ongoing remineralization.

And it’s not just about calcium, although that indeed is a critical mineral for keeping teeth strong and sturdy. It’s not just about vitamin D or K or phosphorous. What we really need is a mixed mineral and vitamin cocktail in our diet, as many nutrients require the presence of others to work effectively.

There are many minerals that play a supporting role. They’re called “trace minerals,” as, normally, we only need tiny amounts of things like iron, chromium and zinc. But if one of those miniscule pieces of the puzzle is missing, the remineralization process can be set back.

Like all essential nutrients, minerals are best supplied through plants – which absorb them from the soil – or through the meat, milk, cheese, butter and eggs of animals that feed on those plants. Excellent whole food sources of minerals include dark, leafy greens and other vegetables, nuts, and seeds, whole grains, legumes and meat. (Whole food matters, as the more our food is processed, the more nutrients it loses.) Foods that deplete minerals include coffee, soda, sugar and alcohol.

Many herbs and spices contain minerals, too, and one in particular stands out as an excellent source of many of the nutrients critical to enamel integrity: stinging nettle.

stinging nettleThe herb Urtica dioica, commonly known as nettle, is probably one of the most useful plants available to mankind. Though it’s prickly nature makes it hard to harvest (a sting from a nettle plant can cause swelling and itching like a bug bite), it’s rich in protein, fiber, vitamins and, most importantly, minerals.

Humans have been braving nettle’s sting for centuries. With its spinachy-cucumbery flavor, it is found in many delectable recipes all over the world and was once prized by the Native Americans as a nutrient source in the spring when other food sources were scarce.

Medicinally, nettles have been used throughout history to treat allergies, kidney and urinary tract disorders, digestive disorders, musculoskeletal issues, skin irritation, hemorrhage, flu, arthritis and gout. In the old days, it was common practice to flog oneself with nettle branches to relieve joint pain!

Thankfully nowadays we have time tested recipes like Nettle Soup, Nettle Pesto and delicious teas, as well as products like capsules and tinctures.

And how much of a mineral-laden punch do you get? Check out this chart provided our friends at skipthepie.org:


Look at all those glorious minerals! Lots of calcium, a bunch of manganese, a dash of phosphorus and potassium, a little bit of protein, also a great source of Vitamins A, and K… Nettle equals nutrient heaven for your teeth and bones!

Learn more about cooking with stinging nettle:

Images: SuperFantastic & zen Sutherland

Gummy Bears, Teeth & the Fine Print

Check out this list from an article on “6 Fortifying Foods to Boost Oral Health”:

  1. Cheese
  2. Black coffee
  3. Gummy bears
  4. Red wine
  5. Steak
  6. Green and/or black tea

How could gummy bears possibly make this list?

Well, the study cited in support of this food is legit. But it didn’t look at just any old gummy bears. It looked at gummy bears sweetened with xylitol – a sugar alcohol that has anti-cariogenic (cavity-causing) properties. Its authors found that such gummies reduced plaque and oral pathogens (bad bacteria) over a 6 week period.

But despite the list-maker’s claim, xylitol is not “one of the main ingredients in the pre-packaged snacks.” For instance, take a look at the ingredients list for Haribo Gold-Bears, the original Gummi Bear:

Corn Syrup, Sugar, Gelatin, Dextrose, Citric Acid, Corn Starch, Artificial and Natural Flavors, Fractionated Coconut Oil, Carnauba Wax, Beeswax Coating, Artificial Colors Yellow 5, Red 40, Blue 1

gummy bearsThree of the four most prevalent ingredients are sugars. Not a bit of xylitol to be seen. The case is similar for other major brands, such as Black Forest, in which corn syrup and sugar again play the starting roles. (And while it’s true that they’re “made with real fruit juice,” just as it says on the front of the package, this is actually just another form of sugar.)

Suffice it to say, these sweets aren’t so hot for your teeth. Not only are they mostly sugar, but they easily get stuck between teeth, giving oral pathogens more time to feed on those sugars and do their damage.

As for the sugarless variety of gummy bears made by Haribo, even they are not sweetened with xylitol but a substance called lycasin – a hydrogenated syrup that’s mostly maltiol, a different sugar alcohol. As Olga Khazan wrote earlier this year at the Atlantic,

Maltitol is great because it doesn’t cause cavities, but not so great because our bodies can’t fully digest it, so it can ferment in the gut. The known side effects of the excessive consumption of lycasin are bloating, flatulence, loose stools, and borborygmi, the scientific term for tummy-rumbling.

Though the substance is considered safe to eat, in clinical studies, adults who consumed 40 grams of lycasin saw an increased frequency of bowel movements and “watery feces.” The gummy bears in question come in bags of 5 pounds, otherwise known as 2,267 grams, otherwise known as a world of hurt.

Keep in mind the Snackwell effect – how people will offset any benefit of “diet” foods by eating lots more of them than they otherwise would – and you can see the potential for disaster.

Image by peddhapati

Overgrown Gums & Other Dental Anomalies

Gum recession is a pretty common problem. Incredibly overgrown gums? Not so much.

hereditary gingival fibromatosisHence, it was news when a couple of girls – Muriel and Nicole Rayo, ages 11 and 12, respectively – had surgery to correct a condition called hereditary gingival fibromatosis. The sisters’ gums had become so enlarged that their teeth were fully encased, creating both functional and aesthetic concerns.

Not many people inherit this condition – only about 1 in every 750,000. The excessive growth tends to start once a child’s permanent front teeth come in. Not only can this excess tissue cover the teeth but the roof of the mouth, as well.

In severe cases, surgery is the only option – and those of the Rayos certainly qualified as that.

“We see cases of gingival overgrowth, where the gums grow, but it’s partial. It’s really not to the [extent] or the severity of what these two girls had,” said Dr. Maria Hernandez, post-grad director of the periodontal department at Nova Southeastern University.

And according to Miami Children’s Hospital,

Together, the team planned two surgeries, one for each child, to remove the overgrowth of the gum as well as some of the girls’ baby teeth which were also encased in the gums. The surgeries proved to be a success and both sisters were back home and smiling within two days of their surgeries.

This wasn’t the only strange dental case that turned up this summer. Maybe you heard about the Indian teen who had 232 “teeth” extracted. Only they weren’t teeth exactly. They were denticles, tooth-like growths caused by a non-cancerous oral tumor. The growths, which were removed in a six hour surgery, were all attached to the young man’s lower right jaw. Fortunately, doctors were able to save his permanent teeth.

supernumerary teethBut even though this case didn’t really involve teeth, there are indeed cases where a person may have more than the usual 32 permanent teeth – a condition known as hyperdontia. It’s hardly rare. Anywhere from 1 to 4% of the population have a couple extra or “supernumerary” teeth.

Such teeth don’t necessarily need to be removed. However, they can sometimes cause problems – for instance, alignment and occlusion (bite) issues that lead to chronic headaches and neck pain. They can also interfere with the eruption of adjacent teeth or cause crowding, leading to the need for orthodontics.

Most of the time, there’s just one tooth involved, but there have been documented cases of more than 30!

Next time flossing seems like a chore, maybe be grateful you have just the usual number of teeth to tend to.

Supernumerary teeth image via Dr. Steakley

A Can Full of Sugar…

Breaking news! Soda is bad for your teeth!

Wait. You already knew that, didn’t you? Well, who doesn’t need a reminder every so often?

A study published in the Journal of Dentistry back in April again confirmed that the more soda you drink, the higher your risk of developing caries (cavities). Analyzing data from across 4 years and more than 900 adults, the authors showed that adults who drank a sugary drink or two each day had a 31% greater chance of developing tooth decay than those who seldom or never drink the stuff. Those who drank three or more sweet beverages had a 33% higher risk.

sugar poured from soda canNow, sure, you know soda is sugary, but do you know how sugary it actually is? A 20 ounce bottle of Coca-Cola has the same amount of sugar as five Little Debbie Swiss Rolls – 65 grams, to be exact. A 20 ounce bottle of Pepsi contains even more: 69 grams. With each sip, you’re soaking your teeth in sugar, which gets bacteria in your mouth pretty jazzed. They feed on that sugar, then excrete acid, which eats away at the surface of your teeth and creates cavities.

When it comes to soda in particular, sugar isn’t the only villain either. Phosphoric acid – a preservative which also gives soda a crisper taste – erodes enamel and makes your teeth more vulnerable to decay. Check out the videos below to see phosphoric acid chemically reacting with tooth enamel and how a tooth is affected over time:



The acids in fruit juice are a problem, as well.

And if you needed any more reminding as to the trouble with sugary drinks, just take a look at this list of health problems they contribute to. (Just as we were preparing this post, we saw news of yet another study showing how sugary drinks increase abdominal fat.)

Image via Soza Clinic

How to Help Your Child’s Teeth Survive Halloween

fake_teethAny kid will tell you that a Halloween costume isn’t really, really scary unless it includes some gnarly, gnarly teeth. From top-of-the-line, glow-in-the-dark vampire fangs to twisted, stained and sparse “hillbilly” teeth and everything in between and beyond, fake teeth can make or break a spooky Halloween costume.

No one, of course, would like their child’s real teeth to look like that.

Yet here we are at the time of year when bucketfuls of Halloween candy can make the risks of developing a frightful smile go way up. Fortunately, there are things you can do to prevent this.

Sugars & Acids & Cavities, Oh My!

Strictly speaking – and despite what we all hear growing up – sugar alone does not cause cavities. What it does do is feed the oral microbes that form the biofilm known as plaque. The waste products generated by those microbes are highly acidic, and highly acidic is damaging to teeth.

But wait! There’s more!

Not only do you have the acidic conditions created by oral bacteria. Many sweets are highly acidic, as well – sour gummies and other tart candies being among the worst offenders.

Sugars + acids = a real one-two punch. (This is why soda pop is so notoriously bad for teeth, as well.)

So just have your child brush right after gorging on their trick-or-treat haul and all shall be well, right?

Not exactly.

While saliva will eventually neutralize the acid conditions that come with eating sweets – all manner of fermentable carbohydrates, in fact – it takes a while for that to occur. Brushing before then can actually be more damaging, effectively brushing acids into the teeth.

Here’s how one dentist explained it to the Wall Street Journal:

When you want to make etched glass, you apply an acid or an abrasive and scratch it — that is what happens if you drink a sports drink or a soda, or even wine, and brush right after.

Or after eating a lot of candy.

The solution? Have your child wait 20 to 30 minutes between feasting on candy and brushing their teeth. And don’t forget the floss! (Brushing alone cleans only about 60% of tooth surfaces.)

More tips for managing the Halloween candy haul:

  • Have your children pick through their Halloween treats and decide which ones they really want to eat. Keep those and get rid of the rest – or replace them with a healthier alternative that you know your kids like.
  • Limit tart and sour candies, as well as sticky, chewy candies that easily cling to – and between – teeth, such as taffy and caramel.
  • Don’t let your children graze on candy through the day. Instead, let them eat a certain amount of your choosing at a particular time. (After a meal is ideal.)
  • Offer water to drink after eating sweets or even some sugarless gum to help stimulate saliva flow that will help neutralize acids and clean the teeth.

Also keep in mind that, when it comes to handing out treats at your door, sugar isn’t the only possible giveaway. In fact, about half of kids say they’d welcome something different.

“YES!!!! YEEEESSSS!!! I DON’T KNOW HOW MUCH I CAN ENFORCE THIS, YES!!!!!!!!!!!!! I LOVE that other stuff.” – tween girl

jackolanternSome parents, for instance, hand out small trinkets, such as Halloween pencils, yo-yos or fake tattoos. Others opt to give more wholesome foods, like packaged trail mix, seeds or nuts, pretzels or low-sugar granola bars. Wax teeth or lips and sugar-free gum and candies can be good alternatives, as well.

Better yet, get your kids involved in the choice! Ask what non-candy items they’d be happy to see in their goodie bag this year. Chances are, plenty of other kids will be happy with it, as well.

More tips for parents from…

Images by Mauren Veras & Paul Dunleavy, 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