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Your Teeth and Your Diet: What’s the Deal?

(This the 3rd article in the series of three. See the first here, and the second here.)

Can Diet Affect the Health of Your Teeth?

After researching the conventional approach to preventing cavities, I started to dig into the potential relationship between teeth and nutrition.

A bit of background, first. I spend a lot of time reading about food and nutrition. The dietetic wars fascinate me. There’s a lot of big-brained, highly-qualified, critical-thinking, research-waving people out there who vehemently disagree with one another about the most health-optimizing diet. They’re blogging, researching, teaching, publishing, and raking through data with a fine-toothed comb.

For transparency’s sake: I do not recommend one diet over another. I try to work with my patients from a Traditional Chinese Medicine perspective and help them find the diet that works best for them. Modern research has shown that there is no such thing as the “perfect diet.” Because there is tremendous variation among populations with diet, there is also tremendous individual variation. For instance, some people do better with no dairy products in their diet, yet others thrive on moderate amounts. Some feel better with a low-carb approach, while others feel better eating more carbohydrate. Beyond that, I’m also an advocate of finding pleasure and enjoyment in food, which helps with the sustainability of any particular approach to food.

More than anything, though, I recommend one thing the most: chewing.

Which is kind of hard, actually, with a bad tooth.

Over time, I’ve become familiar with the dietary tenets of a double-fistful of folks who lead the debate(s), including T. Colin Campbell, Chris MasterjohnMichael Greger,  Neal Barnard, Michael Pollan, Andrew Weil, Mark Sisson, Dean OrnishJoel Fuhrman, George MateljanStephan Guyenet, Chris Kresser, Paul Pitchford, and Gene Baur. I’m endlessly reading or listening to people debate issues of food and diet, genetics and epigenetics, and the role of the exposome on our health. I regularly visit websites like Authority Nutrition, The Weston Price Foundation, The Vegan Society, and The Vegetarian Resource Group to get a gauge for what people are saying, what research they’re citing, and what creative insults they’re slinging.

It’s worth mentioning that it can be difficult to do blinded, randomized, controlled trials of diet. For instance, it’s hard to adequately ‘blind’ subjects to what they are putting in their mouths (though some blinded research has been done, for instance, with the type of fats used in cooking since it can be hidden). If you want to know more about the difficulties of studying diet, see here.

One of the most problematic issues (as well as one of the most common) involves sharing correlational findings as if they are causal, which is straight up unethical when done purposefully in order to capture attention and wallets. This happens a lot.

Anyway, back to my burning question. Can nutrition affect teeth? If so, how? And if so, what should I add to or subtract from my diet in order to increase the resilience and health of my teeth? Below is what I did to try to find an answer to my questions. And not to ruin the results, but I never found the “answer.” I did, however, put together an approach that I felt confident might help me avoid future cavities. As for treating the ones that already exist…well, we’ll see at my next dental appointment. (Update as of 1/2016: Just met with my dentist; no new cavities!!!! Just a cleaning!!!!)

1. I read everything I could find about the conventional dentistry approach to caries. See here.

2. I read everything I could find about nutrition and teeth. vegetables and greens in the garden

Let’s start with this. Here’s a website that’s been given the official stamp of the American Dental Association (ADA). If you like reading about nutrition, you’re going to find this website lacking; granted, the ADA is writing for the average American whom likely consumes the Standard American Diet (SAD) and whom may not have the time, money, or resources to delve deeply into nutrition…so to some extent it’s wise to keep dietary recommendations simple. (The question of how simple is too simple bears asking).

The ADA also follows the general guidelines of the MyPlate USDA food guide, which replaced the food pyramid, and is riddled with its own set of issues. Some of the information on the ADA site was of mild interest to me because it appears as if there ARE some basic nutritional guidelines/suggestions endorsed by the ADA. I remain curious to why my dentists have neglected to share this basic information with me. Ever. Even when asked twice.

So, why is this, anyway? Why was it relatively simple for me to get some nutritional advice with a 2 second google search, but could get nuthin’ from the leather dental chair? Well, for starters, only about 1/4 of American med schools offer the 25 hours of nutrition training recommended — but not required — by the National Academy of Sciences. I interpret that to mean that we shouldn’t expect our doctors to be the ones to administer advice about nutrition, which seems only a tiny bit !CRAZY! to me.

I completed a 4 year Master’s degree in Traditional Chinese Medicine; as part of my training, we were required to complete 48 hours of study in nutrition. (I wish it had been more.)  The biggest difference is that TCM considers nutritional therapy an essential treatment approach, and most acupuncturists use food therapeutically in daily practice. This is not to say that all acupuncturists always give good advice; this is to say that acupuncturists think about food as medicine. In other words, if you were to ask an acupuncturist about food recommendations to support the health of your teeth, you may have a hard time getting them to shut up.

The most content I could find (that wasn’t from a TCM perspective) regarding the relationship of nutrition to dental health came from followers of the dietary tenets of Weston Price. Weston Price was a dentist in the early 20th century who founded what eventually became the research section of the American Dental Association. The Weston Price folks had a great deal to say about the relationship of diet to teeth; doubly fascinating to me was that many vegans (who often lament ol’ Weston and his meaty prescriptions) agreed with the underlying theory, but differed on how to fill these nutritional holes.

Weston Price, in some circles, is referred to as the legendary dentist, but he’s not nearly as glorified in other circles. For those of you needing your information to come in the form of the double-blind, placebo-controlled, and largely populated, well…you aren’t going to be overly excited about Price’s data. His research was done in the early 20th century and wasn’t nearly as rigorous as your modern research geek would require. Also, I later discovered that Price’s research was problematic in another way (see how Price and the eugenics movement were related here).

So, what were people saying about nutrition and teeth? Here’s what’s been theorized:

  • The modern Western diet (particularly flour, sugar, and modern processed vegetable fats) cause nutritional deficiencies that are a cause of many dental issues and health problems.
  • The modern diet does not contain enough fat-soluble vitamins (for the sake of this article, we’ll look at D and K).
  • The presence of phytic acid in a diet heavy in nuts, seeds, grains, and legumes influences our ability to absorb minerals.

Food remedies that may heal cavities and prevent tooth decay

So, assuming that optimal tooth formation is positively influenced by a diet that is sufficient in minerals, fat-soluble vitamins, and low in phytic acid, here are specific recommendations.

Vitamin D and Your Teeth

From the Vitamin D Council (see link for references to research):

Enamel is the most mineralized substance in the human body. It is made up of mostly calcium and phosphate. Vitamin D is important for increasing the absorption of calcium and phosphate from the food you eat. Increasing the absorption of calcium and phosphate can improve the strength of your teeth and their ability to fight demineralization from bacteria.

Vitamin D receptors are found on cells in your immune system and in your teeth. Vitamin D can bind to these receptors and increase the amount of good antimicrobial proteins in your body which help to fight the bacteria that cause dental caries.

In addition, the cells in the teeth that form dentin and enamel contain vitamin D receptors, meaning that vitamin D may play a role in their functioning. Some studies show that dental caries are most common in late winter and early spring, when vitamin D levels are likely to be at their lowest. Many studies have found that geographic location and sun exposure are related to dental caries. People living closer to the equator with greater amounts of sun exposure are less likely to develop dental caries.

Mothers of children with early childhood caries have lower vitamin D levels during pregnancy than mothers whose children don’t have caries.

Studies that give people vitamin D supplements to prevent caries have found that vitamin D is effective at preventing the development of caries.

Vitamin D: Sources

Real sunshine is the best, but not always practical. If your arms and face (or the equivalent amount) is exposedVector illustration beautiful panorama of blue sky to the following amounts of midday sun (11 am to 3 pm), without sunscreen, on a day when sunburn is possible (i.e., not winter or cloudy), then you should not need any dietary vitamin D that day:

  • Light-skinned: 10 to 15 minutes
  • Dark-skinned: 20 minutes
  • Elderly: 30 minutes

Animal sources of Vitamin D include the egg yolks of free-range chickens, cold-water, fatty fish (like sardines and salmon), and dairy products from cows that ate green grass (not corn). Shiitake mushrooms have vitamin D in small amounts. For a more detailed list of Vitamin D food sources, see here and here. It’s also relatively inexpensive to supplement with Vitamin D, though it’s ideal to have your levels tested in order to avoid over-supplementation, which is dangerous).

As a breakfast food, natto is usually served over steamed rice and mixed with mustard and soy sauce.
As a breakfast food, nattō is usually served over steamed rice and mixed with mustard and soy sauce.

Vitamin K, specifically K2:

Vitamin K is actually a group of fat-soluble vitamins that are involved in blood coagulation and calcium binding. Low levels of vitamin K weaken bones and may promote calcification of arteries and other soft tissues.

There are three basic types of vitamin K. Their common names are K1, K2, and K3.

K1 is the “plant form” of this vitamin; the best sources of this vitamin are green vegetables. K1 is known for its role in blood-clotting. For instance, newborns are often given a K1 shot (or K1 drops) at birth to decrease risk of hemorrhage.

K3 (menadione) is a synthetic form of Vitamin K. Though it’s used for certain medical treatments, it’s generally considered unsafe and unnecessary for general use.

K2 is produced in animal tissues or as a result of bacterial fermentation (K2 comes in various forms, called menaquinones). Menaquinone-4 (MK-4) is produced by animal tissues. One of the richest sources of MK-4 is goose liver.

Menaquinone-7 (MK-7) is produced by bacterial fermentation and is found in products like natto and blue cheese.

A number of other forms of K2 (like MK-9) are found in fermented dairy products, though MK-4 and MK-7 are the best studied forms of Vitamin K2.

Vitamin K2 can be made from K1 by bacteria and other microorganisms. In plant foods, you won’t find much preformed K2, unless those plant foods have been fermented or transformed by bacteria. Nattō is one of the only good vegan sources of Vitamin K2. Nattō is a fermented soybean product that is notorious for it’s stench and sliminess (it’s also not easy to find in Maine).

K2 appears to be a key vitamin in maintaining bone mineralization and limiting the formation and lifespan of osteoclasts. Researchers are also increasingly optimistic about K2’s potential for those with or at risk for osteoporosis. In addition, it’s being looked at as an important factor in cardiovascular health, in the treatment of rheumatoid arthritis, in the treatment and prevention of tooth decay, and as a factor in the prevention of prostate cancer. So far, research is in it’s early stages (and more must be done), but I intend to watch developments with interest.

Sources of K2

Good sources of K2 include nattō, pâté, grass-fed butter and ghee, and egg yolks from chickens. Moderate sources of K2 include blue cheese, Gouda, Brie, Jarlsberg’s and Edam. Here’s a more detailed look at the types and sources of K2 if you’re interested.

Phytic acid: The issue of phytic acid is controversial. This is the most comprehensive info I found on phytic acid. I try to soak and sprout as often as possible, since it does seem to make some (controversy exists regarding exactly how much) nutrients more readily available for the body to use.

How Does Traditonal Chinese Medicine Think About Teeth?

Eventually, I closed my laptop, all my books, and shut my peepers for a second to consider myself as a case study.  What would be my Traditional Chinese Medicine diagnosis, and what would be my treatment? Over the past couple of years, my diet hasn’t been as consistent or nutrient-rich. Basically, I had a kid and my food prep and homemade food-makin’ time got squeezed pretty thin for a while (I’m workin’ on it!). Any of the health issues I’d experienced in the past couple of years (mostly minor, but bothersome) pointed to an imbalance in of the TCM concept of Kidneys – the organ associated with the teeth. Typical nutritional recommendations for a kidney imbalance? There was definitely some overlap, notably marrow (bone broth), cold-water fatty fish, small amounts of raw milk, and ghee.

A Lauren-designed, Lauren-experiment

So, what to do with all of this information? I came up with a plan simple enough for me to sustain, ordered from most exciting (pleasurable) to least.

  • As always, continue to fill much of my plate with lots and lots of veggies and some fruit
  • Add small amounts of grass-fed organic dairy, especially pasture butter and raw yogurt (I’ve recently committed to buying all of my dairy from a local co-op; it’s not cheap, but I did have enough wiggle room in my budget for this allowance. I made this decision because of this and this.)
  • Moderate amounts of sardines and wild-caught Pacific salmon
  • When eating foods high in phytic acid (like grains, beans, nuts and seeds) soak and sprout when possible
  • After eating, chew a piece of xylitol gum. Many studies show that chewing xylitol gum reduces salivary Streptococcus mutans, the the chief bacteria responsible for dental caries.
  • Try to find natto in Maine; see if I can deal with the smell and taste and if so…. eat it up!
  • Small amounts of grass-fed, local meats (see above note on dairy products)
  • Make bone broth; freeze and use instead of boxed broths or bouillon when making soup (which are typically not nearly as nutrient dense and full of MSG)
  • Consider supplementing with K2; supplement carefully with Vitamin D during the 9 month Maine winter

This the 3rd post in a series of three. See How to Avoid a Root Canal and Fighting Cavities for the previous posts.


Fighting Cavities

Here’s what we know about teeth, according to the hundreds of years of research in conventional dentistry.  Most of this information comes directly from the American Dental Association (ADA), a not-for-profit dental association. The ADA is considered the leading source of oral health related information for dentists and their patients. If you’re super dorky, like me, here’s the link for the ADA’s Center for Evidence-Based Dentistry. tooth medical anatomy

  1. There are four tissues that make up a tooth.  Enamel, dentin, and cementum are the hard tissues of a tooth.  The pulp is the soft tissue in the center.
  2. Enamel forms the outer surface of the crown of the tooth. It’s the hardest tissue in the body. Enamel allows the tooth to able to withstand a great amount of stress, seeing as your teeth are your chompy-chompers!  Once enamel is completely formed, it can’t grow more or repair itself, but it does have the ability to remineralize.  This means that areas experiencing early demineralization (loss of minerals) are able to regain minerals and stop the caries (cavity) process. I have difficultly understanding why that’s not considered an ability to repair…
  3. Dentin makes up the main portion of the tooth; it’s softer than enamel but harder than bone.  Dentin is permeated with microscopic canals (dentinal tubules).  These tubules contain fibers that transmit pain stimuli and nutrition throughout the tissues. Dentin does have the ability for further growth.
  4. Cementum is the tissue that covers the root of the tooth in a very thin layer.  It is not as hard as enamel or dentin, but it is harder than bone.  It contains fibers that help stabilize the tooth within the bone.
  5. The pulp is located in the center of the tooth, and is surrounded by dentin.  The pulp is made up of blood vessels, connective tissue, nerve tissue, and cells that are able to produce dentin. The pulp nourishes the tooth and produces and repairs dentin.  If the pulp tissues dies, then a root canal procedure is recommended to save the tooth.

Here’s what else we know about teeth:

  1. Approximately 96% of tooth enamel is composed of minerals. These minerals will become soluble when exposed to acidic environments. All acidity weakens teeth, but the amount of time that acids are in contact with teeth that determines the amount of damage. If mineral breakdown is greater than build up from sources such as saliva, cavities can result. Remineralization can also occur if the acid is neutralized by saliva. Rinsing with water can help.
  2. At 77°F, the pH of pure water is very close to 7, and is considered neutral.
  3. Enamel begins to demineralize at a pH of 5.5. When the pH at the surface of the tooth drops below 5.5, demineralization proceeds faster than remineralization.
  4. Dental caries (caries is Latin for “rottenness”), is also known as tooth decay or cavities. Cavities are considered a breakdown of teeth due to the activities of bacteria, most notably Streptococcus mutans. (Of interest: Many studies show that chewing xylitol gum may reduce salivary S. mutans levels.) Before the cavity forms in the dentin, the process is reversible, but after it spreads to the dentin, it is not.
  5. In the presence of sugar and other carbohydrates, bacteria in the mouth produce acids that can demineralize enamel, dentin, and cementum.The bacteria break down the hard tissues of the teeth by making acid from food debris or sugar on the tooth surface. The more frequently teeth are exposed to this environment the more likely dental caries are to occur.
  6. Bacteria collect around the teeth and gums in a sticky, creamy-colored deposit called plaque, which acts as a biofilm (a thin, slimy film of bacteria that adheres to a surface).
  7. Some sites collect plaque more commonly than others, like in the pits and fissures of the surface of the molars and cervical margins of the teeth.
  8. The primary focus of brushing and flossing is to remove and prevent the formation of plaque.
  9. As the amount of bacterial plaque increases, the tooth is more vulnerable to dental caries when carbohydrates in the food are left on teeth after every meal or snack.
  10. A toothbrush can be used to remove plaque on accessible surfaces, but not between teeth or inside pits and fissures on chewing surfaces. When used correctly, dental floss removes plaque from areas that could otherwise develop caries.
  11. There are certain things that can increase your risk for dental caries, such as tooth location and surface. Caries are most commonly found on incisors, canines, premolars, and fissure sites in molars.

Other things that increase your risk of caries include: vector illustration of diagram for anatomy of human mouth

  • Foods that cling to the teeth, such as candy or chocolate.
  • Frequent snacking and sipping on sugary drinks.
  • Bedtime infant feeding.
  • Inadequate brushing of teeth.
  • Dry mouth.
  • Heartburn.

Here’s what we know about taking care of your teeth and preventing cavities:

  1. Regular professional cleaning of the teeth – 2 prophylactic cleanings are recommended per year. (This can be problematic for many, for multiple reasons outlined in my previous post.)
  2. Brush your teeth at least two times per day (make sure one of these times is before you go to bed).
  3. Floss between the teeth at least once a day; more so if you have a problematic tooth that catches food. Toothpicks can be helpful for getting food out of hard to reach areas.
  4. Do not brush immediately after meals, especially those that are high in acid. Instead of brushing, consider rinsing your mouth with plain water.
  5. Chewy and sticky foods (such as dried fruit or candy) tend to adhere to teeth longer, so they are best eaten as part of a meal. For children, the American Dental Association recommends limiting the frequency of consumption of drinks with sugar, and not giving baby bottles to infants during sleep.
  6. The ADA recommends brushing twice a day with a fluoride toothpaste.

This is the 2nd post in a series of three. See How to Avoid a Root Canal and Fighting Cavities for the other two articles.