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

Stevia’s Powerfully Sweet Benefits

Through recent years, we’ve seen research tout the wonders of this sugar substitute or that – xylitol, erythritol, and now the latest star?

Stevia plantStevia – technically known as Stevia rebaudiana.

A perennial shrub native to South America, stevia has been traditionally used by native peoples as a sweetener. Unlike xylitol and erythritol, which are highly processed sugar alcohols that may be sourced from GMO crops or the yeast that comes from them, stevia really is natural. Also unlike xylitol and erythritol, its sweetness is integral to the plant – a result of complex compounds in its leaf.

And according to a literature review recently published in Molecules, those compounds also appear to have antimicrobial qualities, as well, combatting oral pathogens – the harmful bacteria that contribute to decay and gum disease.

This is far from stevia’s only power. Other research has suggested significant therapeutic benefits, including

  • Anti-hyperglycemic effects that could potentially lower glucose levels in the blood.
  • Anti-hypertensive effects that may modulate hypertension.
  • Anti-tumor properties that may play a role in the body’s immune responses to pathogens and tumor cells.
  • Anti-diarrheal effects that may slow intestinal spasms and thicken stool.
  • Diuretic effects that may help your body shed excess water and salt.
  • Anti-bacterial effects.
  • Anti-fungal effects.
  • Anti-viral activity.

And unlike other zero calorie sweeteners, stevia won’t cause you to bloat, pass gas or run to the bathroom with incredible urgency. It won’t cause you to gain weight, increase your chance at developing diabetes, or predispose you to a multitude of cancers.

But before you run out to stock up on the stuff, you should know that many products that look at first glance like pure stevia are nothing of the sort. Perhaps the most glaring example is Cargill’s Truvia. Cargill was sued for having misleadingly labeled and marketed its product as “natural” when in fact they contained highly processed and GMO ingredients.

This serves as a reminder to always read labels before buying. The product you want is 100% pure stevia extract. (Here’s a good run down of fillers you’re apt to find in powdered stevia products.)

Coca Cola LifeAn interesting side note: To this day, the FDA still hasn’t given its stamp of approval to stevia. Only refined stevia products have. These aren’t considered stevia but Rebaudioside A, a steviol glycoside extracted from the plant. Some allege that the makers of other sugar substitutes pressured the FDA into this position so as to keep stevia off the market – until Coke and Pepsi had developed derivative products they wanted approved.

That said, stevia isn’t something you have to buy. You can grow your own plants and make your own liquid extract at home.

That feels so subversive and defiant, it makes you almost want to shout, “Power to the People!”

Images by Fluffymuppet, Mike Mozart

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 New Paste that “Heals Cavities”: Too Good to Be True?

pasteConsidering this post been shared more than 37,000 times on Facebook, you, too, may have heard about an “amazing” new dental paste from Japan that purports to “heal” cavities without drilling. Some folks hail it as a “miracle.”

Buzzwords like “new,” “amazing” and “miracle” hook us in. Who wouldn’t want to stop dental decay with a quick fix? But we should be careful that the desire for an alternative to the dental drill not disable our critical thinking when we hear claims that a product can heal cavities, remineralize decayed teeth, grow tooth enamel, allow teeth to self-repair.

For instance, read more closely and you’ll find that this new paste doesn’t promote true self-repair. It’s a synthetic enamel, and there are some important caveats to consider:

  • The paste must be applied by dentist because of its “chemicals.”
  • The paste works best on “microcaries.”
  • The treated tooth will become “whiter” than the natural tooth structure around it.

Dig a little deeper, and you also find that this product contains sodium fluoride in an acidic solution and 35% hydrogen peroxide. The acid dissolves the tooth on which it is applied so the fluoride can bond to the tooth.

If you’re a regular reader of this blog, you know the concern over systemic effects of fluoride. As for the peroxide? Here’s some of what the material safety data sheet has to say:

Very hazardous in case of skin contact (irritant), of eye contact (irritant). Hazardous in case of skin contact (corrosive, permeator), of eye contact (corrosive), of ingestion, . Slightly hazardous in case of inhalation (lung sensitizer). Non-corrosive for lungs. Liquid or spray mist may produce tissue damage particularly on mucous membranes of eyes, mouth and respiratory tract. Skin contact may produce burns. Inhalation of the spray mist may produce severe irritation of respiratory tract, characterized by coughing, choking, or shortness of breath. Prolonged exposure may result in skin burns and ulcerations. Over-exposure by inhalation may cause respiratory irritation. Inflammation of the eye is characterized by redness, watering, and itching. Skin inflammation is characterized by itching, scaling, reddening, or, occasionally, blistering.

The deeper you look, the less wonderful the product sounds. It’s not even available yet and is in clinical trials in Japan only. More testing, says the dentist who developed the paste, is needed to prove its safety. At this time, there are no plans to run trials in the EU or US.

Besides, the truth is, when it comes to microcaries, effective home care – especially flossing with proper technique – can be enough to spur natural remineralization. More extensive decay, however, is a different issue…

Image via Dr. Kazue Yamagishi

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!

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

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.

To Kick the Sugar Habit

People – such as this fellow – often point a finger at fast food and other take-out meals as the reason obesity rates have soared. It can be tasty, but it tends toward junkiness: huge portions of too-salty, too-fatty, too-caloric, too-sugary grub. And of course it does play a role – not just in obesity but a vast array of health problems, from increased risk of heart disease and cancer to gum disease and tooth decay.

But fast food may be the least of the trouble.

spilled white sugarIt turns out that the vast majority of added sugars we eat do not come from restaurants – less than 20%, in fact.

As much as 76% actually come from what we buy at the grocery store – this, according to a large study published earlier this year in the American Journal of Clinical Nutrition.

The researchers also found that about 14% of all calories come from sugar, with soda and other soft drinks (e.g., energy and sports drinks, flavored sweetened teas) being the greatest source, followed by grain desserts, fruit drinks, candy and dairy desserts.

The World Health Organization recommends that an adult get no more than 5% of their daily intake from sugar – and not just added sugars, but all sugars, even those naturally occurring.

To put it into perspective, that’s a little more than half a 12 ounce can of Coca Cola.

More recent research suggests we must consume far less – no more than 3% of our daily calories – to prevent tooth decay.

Considering all that sugar – and the role it plays in chronic inflammation – it’s no wonder we’ve seen rates of preventable chronic disease rise over recent years. Not only are we eating too much of what fuels inflammation, that sugar too often displaces healthier, nutrient dense foods such as vegetables, lean proteins, legumes, whole grains and the like.

We get too much of what our bodies don’t need and not near enough of what they do.

And when that happens, we’re the worse for it.

Yet we can be mightily resistant to quitting the stuff. After all, it tastes good – and makes other things taste good. We are, it seems, hard-wired to be drawn to the stuff.

Also, our foodways don’t spring from just anywhere. There are social and cultural elements to our eating. We all have traditional foods of some sort that we grew up with and wish to go on eating, regardless of their healthfulness or lack thereof.

So it’s no big surprise that when it comes to oral health, our ideas about how to prevent problems can be a little muddled – a matter nicely pointed out in a recent editorial by British Dental Journal Editor-in-Chief Stephen Hancocks:

It is…intriguing how when one asks a patient what causes tooth decay they answer ‘sugar’ but when asked how to prevent it they respond ‘by brushing your teeth’. Confusingly there is merit in this,…but the more logical answer would be to reduce or eliminate sugar.

It may be hard to believe until you actually do it yourself, as this blogger did with her family, but quitting sugar is not impossible. And that sugar is replaced with something far more valuable: renewed vitality.

It was subtle, but noticeable; the longer I went on eating without added sugar, the better and more energetic I felt. If I doubted the connection, something happened next which would prove it to me: my husband’s birthday.

During our year of no sugar, one of the rules was that, as a family, we could have one actual sugar-containing dessert per month; if it was your birthday, you got to choose the dessert. By the time September rolled around we noticed our palates starting to change, and slowly, we began enjoying our monthly “treat” less and less.

But when we ate the decadent multi-layered banana cream pie my husband had requested for his birthday celebration, I knew something new was happening. Not only did I not enjoy my slice of pie, I couldn’t even finish it. It tasted sickly sweet to my now sensitive palate; it actually made my teeth hurt. My head began to pound and my heart began to race; I felt awful.

It took a good hour lying on the couch holding my head before I began to recover. “Geez,” I thought, “has sugar always made me feel bad; but because it was everywhere, I just never noticed it before?”

After our year of no sugar ended, I went back and counted the absences my kids had in school and compared them to those of previous years. The difference was dramatic. My older daughter, Greta, went from missing 15 days the year before to missing only two.

Now that our year of no sugar is over, we’ll occasionally indulge, but the way we eat it is very different. We appreciate sugar in drastically smaller amounts, avoid it in everyday foods (that it shouldn’t be in, in the first place), and save dessert for truly special occasions. My body seems to be thanking me for it.

How to do it? Well, rather than reinvent the wheel, we’ll just point you to a few of our favorite tip sheets to get you started.

Have you kicked the sugar habit? Share your story in the comments! What did you experience? Any tips you care to offer?

Image by Lenny Photography

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