You may be wondering... what does nutrition have to do with oral health? I can start by telling you it is more than just sugar and cavities.
In fact, oral health goes way beyond good oral hygiene habits and regularly scheduled professional cleanings.
Your stress levels, the quality and quantity of your sleep, your hormone balance, your exposure to toxins (tobacco use, environmental toxins, etc), your micronutrient status, genetic background, inflammatory status, microbiota, and epigenetics all come into play when we look at your bodies' response to oral pathogens. And this response can be exacerbated or lessened depending upon multiple factors. When you go to the dentist you are trying to control a small number of the factors that are involved in oral diseases – you and your dental team are trying to combat the oral biofilm called plaque as well as the oral pathogens. It is impossible to completely remove the oral biofilm, but when the biofilm is disrupted sufficiently on a regular basis, your body can often take care of whatever remains and thereby maintain oral health. This process is sufficient for a portion of the population that is not metabolically deranged and is generally “healthy”. However there are many people whose oral status continues to decline despite good homecare and the painstaking thoroughness of great dental practicioners. And I believe the next step that we can take in our attempt to improve oral and overall health is through nutrition.
Your teeth, gums, bone levels, and occlusion (the way your teeth come together when you bite) can tell you much more about your health than you would initially suspect. An inquisitive and daring dentist, Westin A. Price, travelled the world in the 1930’s in search of health. What he found was that remote indigenous populations of people that were not exposed to processed foods had vastly improved dental and overall health as compared to those on Western diets. He documents thousands of cases of people of all ages with no access to dental care or oral hygiene measures, yet they have perfect wide dental arches (meaning they don’t have crowding and overbite/underbite issues), minimal tooth decay, and excellent overall health. Yet after these populations were introduced to sugar, white flour, and other processed foods, their health quickly diminished. His book, Nutrition and Physical Degeneration, changed the way I approach dentistry as well as the approach I take for my own health and that of my family. The Westin A. Price Foundation can be a valuable resource for more information.
So… how does one eat for oral health?
Well, let’s start with simplicity: eat real food.
So here's what I am suggesting as a rough guideline for healthy eating - for your entire body and mind - not just your mouth. Eat real food. Seriously, that is it in a nutshell. Avoid most packages, preservatives, added sugars, and complicated lists in which you cannot even pronounce the names of the ingredients.
Something I’ve learned from looking into thousands of mouths: every single mouth is different. Just like we are all unique on the outside, we all unique on the inside as well. And biologically, genetically, and biochemically, we are all unique. That said, there are many approaches you can take to eat a Real Food Diet – this can be done on a paleo, vegan, vegetarian, Mediterrenian, low carb, or even on a low fat diet. As well as a multitude of other types of diets. Clearly there is no one-size-fits-all diet, but when we are talking about nutrition for oral health, we are really addressing two topics – decreasing inflammation as related to periodontal disease (gum disease) and decreasing our risk for tooth decay. If you address these things, overall health can and likely will follow.
Cavities and periodontal disease are the two most common causes of tooth loss, so let's focus on those.
Let’s consider tooth decay (cavities) first.
About Dr. Sarah
As a periodontist, I went to 3 extra years of training after dental school to specialize in treating periodintitis, a condition affecting the bone and gums around teeth. I learned so much about disease and surgery, but suprisingly little about nutrition and health, and how best to support your body as you recover from surgery. Due to my own personal journey through IBS and major back surgeries, I have since become slightly obsessed about these topics, listening to literally thousands hours of health podcasts, going to numerous health conferences, and reading many books on the topic. I have found that many of my patients are also starving for this information, but don't know where to start. I hope this can be the place!
I cannot say it better than Hippocrates...
There are several essential ingredients for tooth decay to occur. You need a susceptible surface (a tooth), a sticky substance (sugar and acids), time (the amount of time that the tooth is exposed to the sugar and acids), and bacteria (Strep Mutans is the most common cariogenic bacteria but there are many others). Let’s face it, carbohydrates are basically sugars. And it’s pretty clear that the SAD (Standard American Diet) is full of carbs. Of course, not all carbohydrates are created equal, but many people are eating far more sugar-laden foods than is reasonable on a daily basis.
Now let’s consider periodontal disease, which is when the supporting structures around the tooth break down. This means that bone loss has occurred around the tooth root.
Again, there are essential ingredients for this disease process to occur. You need a susceptible host, aggressive bacteria, and inflammation. Here’s a very basic rundown of how gum disease occurs. You have a pocket around the tooth, where the gum tissue attaches to the tooth root. As you get plaque and tarter that accumulate, you may get changes in the bacterial species that reside in that area. Bacteria are very advanced in their ability to set up complex communities in a sticky surface called a biofilm. As the biofilm matures, the bacterial complexes shift to allow more aggressive species. These species are more likely to be anaerobic, and can only live in the deepest pockets where there is no oxygen. As part of their defense system they release toxins called LPS, or lipopolysaccharide, which will create an inflammatory response. We need a certain amount of inflammation in our bodies as part of our normal ongoing defense against daily pathogens. However in periodontal disease, a heightened inflammatory response occurs. This may be due to a number of reasons, including faulty inflammatory receptors, genetic predisposition, sluggish PMNs, etc, but most of the time we don’t know the exact cause, we simply know that a person appears to have a high amount of inflammation.
The sulcus (gum tissue pocket around the teeth) is a unique part of the body in that it directly transmits bacteria into our blood supply. You have probably heard that scientific studies show correlations between periodontal disease and heart disease. Well, this is why.
This is also why death from dental abscesses can occur, as they can cause septicemia, a brain abscess, or meningitis if left untreated.
Thankfully, this is an uncommon occurrence presently, but dental abscesses were within the top 10 causes of death prior to the advent of local anesthesia. Yikes! Nobody particularly enjoys dental injections, but I for one am very thankful that we have them...
So, let's go back to the beginning. Digestion starts in your mouth. Ok, technically it starts in your brain. Consider Pavlov’s dogs – think about food and you’ll start to salivate. So yes, it starts in your brain from a mental standpoint. But on more of a physical level it starts in your mouth. Mastication breaks the food into small pieces so that salivary enzymes can begin the process of digestion. Chewing stimulates stomach acid, which stimulates improved fat breakdown. Not so easy without teeth. Of course people get by without teeth with the help of dentures or an extremely mushy diet, but their digestion will not be the same. Without proper digestion you will not get the benefits of complete assimilation of nutrients from your food. And you’ll increase your chances of heart burn, bloating, osteoporosis, gallstones, constipation, and diarrhea. Not pretty, no, but most of us have dealt with or are dealing with at least one of these issues.
And now we've come full circle: oral health is important for digestion and gaining the most from your nutrition, and what you put in your mouth affects your susceptibility to periodontal disease, dental caries, and affects your overall inflammatory status.
Ultimately, I hold no judgement over what you choose to put into your mouth. What you eat has no direct impact on me. But how you choose to nourish yourself does have a huge impact on your inflammation. And on how you feel. So it’s my goal to give you the information that you need to go against the conventional wisdom and make an educated decision on how to do this.
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