Cross-section of a tooth
When I think about a Paleolithic approach to dental disease, the first expert that comes to mind is dentist John Sorrentino, D.D.S. The only other living “authority” that pops up is Stephan Guyenet, Ph.D., and he’s not even a dentist. Stephan focused his literature review more on malocclusions than teeth per se, as I recall. Dr. Sorrentino cites dentist Weston A. Price as a ground-breaker, documenting the deterioration of dental health as traditional cultures moved to modern diets loaded with refined and concentrated sugars and starches.
Fortunately for us, Dr. Sorrentino has blogged about the intersection of dentistry, evolution, and the paleo diet. Malocclusion and caries (cavities) weren’t problems for our Paleolithic ancestors, although “…they wore thru their enamel by the time they were middle aged.” Then what happened?
Regarding caries, Dr. Sorrentino wrote:
Caries was just about non-existent because simple sugars and the refined carbohydrates that cause them were just not present in any Paleolithic diet. Since the Paleolithic covered such a vast period of time and many, many different populations it is important to remember that there is no one “Paleolithic Diet,” but rather a continuum or “envelope” of certain related types of foodstuffs that were consumed. These included but were not limited to fish, shellfish, leafy green plants, root vegetables, and fruit in season. It was interesting to note that there is decay in some lowland gorillas. It is present mostly as interproximal decay on the upper anterior teeth. It was speculated that sucking on fruit or raiding human garbage dumps, common in the area, caused this. In either case it shows that our closest living relatives are not very well adapted to eat sugar either.
Are these healthy teeth a result of proper diet, dental self-care, dentistry, Photoshop, or a combination?
I was perusing his website looking for reliable information on flossing and Water Pik-like devices and their proper roles in periodontal disease and caries prevention. I didn’t find much other than recommendations to eat a paleo diet, naturally low in concentrated sugars and refined starches, especially grains.
Paleo Diabetic 
Refined sugar is the culprit, not by mere presence, but by frequency of exposure, as are all carbs (see your comment about sucking fruit above). It takes an acidic environment to promote caries. The acids leach calcium and phosphorous from the teeth, making them weak; then the surface will eventually break. Original studies (from the 50’s) that “showed” sugar = decay were flawed….test subjects went missing and results were inventeded. Brushing, flossing, waterpiking….none of it actually overcome our ability to damage ourselves with constant exposure to acids. (Read that as….if it tastes good, it’s acidic. 😉 Sorry!!)
The positive effect of fluoride in the water has seen a reversal since the introduction of high-fructose corn syrup in about 1970. Want to type more….could be dangerous to my career. This is a much more complicated area than is presented by your dental marketers (P&G, Colgate, etc.). And the medications we take, also influence the problem, many times irreversibly by decreasing salivary flow (which makes us more acidic and sticky).
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