Category Archives: Teeth

Are Rats Related to Tooth Decay?

From Karl Gruber at Scientific American:

You could be forgiven for thinking that tooth decay is an inevitable fact of life; even ancient Egyptians practiced dentistry. But the study of human teeth suggests that before our ancestors started cultivating plants for food, cavities were uncommon. Tooth decay, it seems, spread once we changed to an agricultural lifestyle.

New evidence from Omar Eduardo Cornejo Ordaz, a postdoctoral research fellow at the Stanford School of Medicine, and his colleagues back up this hypothesis. They analyzed the genomes of several strains of the prevalent caries-causing bacterium,Streptococcus mutans, to determine when new genes evolved in this species and its close relatives. The team’s statistical analyses suggest the bacteria’s population started expanding exponentially about 10,000 years ago, which coincides quite nicely with the birth of agriculture.

Smiling LipsThe article mentions Peter Brown, an Australian paleoanthropologist, who favors sugar and other refined carbohydrates as a cause of dental decay.  No need to invoke rats.  Australian aborigines and Japanese samurai in the Edo period saw deterioration of dental health after introduction of sugars and other refined carbs.

Maybe it’s true: No carbs, no cavities.

—Steve

h/t Amy Kubal

Does the Paleo Diet Affect Teeth and Gums?

That's more like it

Nice set of choppers

I got a little excited when I ran across this scientific article.  My hopes were quickly deflated and I’ll tell you why shortly.

In 2007, 10 study subjects did a Stone Age reenactment over the course of four weeks. It was covered extensively by Swiss TV.

Background First

Dental plaque is a complex biofilm that accumulates on teeth and oral tissue.  It’s influenced by diet and genetics.  Plaque can lead to gingivitis (gum inflammation and disease).  If untreated, gingivitis can lead to the more serious periodontitis with tooth loss.  A couple human studies in the 1980s showed that a high-carbohydrate diet leads to gingivitis, compared to a low-carb diet.  Dietary sucrose (table sugar) is linked to increased plaque and gingivitis.

The Experiment: Swiss Stone Age Lifestyle

The ten subjects included two families of four plus two young men.  Four were children or adolescents.  Anthropologists created an environment replicating living conditions close to the Rhine River between 4000 and 3500 BC.  “Living quarters, clothing , tools, and types of food stock were provided as known from archeological findings in the region.  Therefore, the diet was restricted to included a basic supply of whole grains of barley, wheat, spelt (“einkorn,” “emmer” = local ancient agricultural wheat), some salt, herbs, honey, milk, and meat from domestic animals (goats and hens).  A hunter would shoot one of the goats at the participants request….(T)hey were forced to seek supplemental food from nature, including berries, edible plants, and fish without nets.”  Subjects had no access to toothbrushes, toothpaste, tooth picks, or floss.  Oral hygiene was assessed before and after the four weeks in this environment.  We don’t have a nutritional analysis of individuals’ dietary habits during the experiment.  “Cereals and berries were primary food sources for the subjects.”

Some of you have already noted the source of my disappointment. The paleo diet most of us talk about today in the U.S. provides no wheat or milk, or at least very little.  The anthropologists considered this set-up early Stone age, but wasn’t it more late Stone Age or Neolithic?

What Did They Find?

Gum bleeding-on-probing and probing depth decreased (potentially healthy trends).  Plaque index increased (more plaque, but they had no increase in severity of gingival inflammation).  Gingival index (not defined in the paper) didn’t change.  Bacteria growing on the teeth and gums changed, but I won’t bore you with the details.

The investigators surmise that subjects avoided an increase in gingival inflammation due to table sugar restriction and intake of foods rich in anti-inflammatory and antibacterial components.

The researchers conclusions:

The experimental gingivitis protocol is not applicable if the diet (e.g., Stone Age) does not include refined sugars.  Although plaque levels increased, bleeding-on-probing and plaque index decreased.  Subgingival bacterial counts increased for several species not linked to periodontitis whereas tongue bacterial samples decreased during the study period.

Bottom Line for Me

I’m not aware of other paleo bloggers covering this study, and I can see why.  It’s a small short-term experiment.  The inclusion of grains and milk in the experimental protocol limits its applicability to the currently trendy paleo diet.

While I mostly wasted a couple hours on this, I hope I saved you the effort.  You’re welcome.

In the comment section, feel free to share your dental effects when you switched to a paleo diet.

Steve Parker, M.D.

Reference: Baumgartner, Stefan, et al.  The impact of the Stone Age diet on gingival conditions in the absence of oral hygiene.  Journal of Periodontology, 2009 (80): 759-768.

Why Do Our Teeth Rot?

The truth is that tooth decay is a relatively new phenomenon. Until the rise of agriculture roughly 10,000 years ago, THERE WAS NO TOOTH DECAY IN HUMANS.  Let that sink in for a moment. Humanity is 2,500,000 years old.  For the fist 2,490,000 years no one ever had a cavity.  If we understand that tooth decay started when people started farming instead of hunting and gathering for a living clearly you realize that tooth decay is a disease or mismatch between what you are eating and what your body expects you to eat.  If we examine the past as prologue it becomes clear that the path to proper health starts in the mouth and the answers are so simple that not only did a Cave Man do it.  They perfected it.

John Sorrentino in a blog post August 6, 2012

The Carbohydrate and Chronic Disease Connection

Simple dinner roll, or a future HEART ATTACK?

Adherents of the paleo diet and low-carb diets will love this post; it supports their choices.

Dentists are considering a return to an old theory that dietary carbohydrates first cause dental diseases, then certain systemic chronic diseases, according to a review in the June 1, 2009, Journal of Dental Research.  It’s written by Dr. Philippe P. Hujoel, who has been active in dental research for decades and is affiliated with the University of Washington (Seattle). He is no bomb-throwing, crazed, radical.

We’ve known for years that some dental and systemic diseases are associated with each other, both for individuals and populations. For example, gingivitis and periodontal disease are associated with type 2 diabetes and coronary heart disease. The exact nature of that association is not clear. In the 1990s it seemed that infections – chlamydia, for example – might be the unifying link, but this has not been supported by subsequent research.

The “old theory” to which I referred earlier is the Cleave-Yudkin idea from the 1960s and ’70s that excessive intake of digestible carbohydrates, in the absence of good dental care, leads both to certain dental diseases – caries (cavities), periodontal disease, certain oral cancers, and leukoplakia – and to some common systemic chronic non-communicable diseases such as coronary heart disease, type 2 diabetes, some cancers, and dementia. In other words, dietary carbohydrates cause both dental and systemic diseases – not all cases of those diseases, of course, but some.

In the context of excessive carbohydrate intake, the article frequently mentions sugar, refined carbs, and high-glycemic-index carbs. Dental effects of excessive carb intake can appear within weeks or months, whereas the sysemtic effects may take decades.

Hujoel compares and contrasts Ancel Keys’ Diet-Heart/Lipid Hypothesis with the Cleave-Yudkin Carbohydrate Theory. In Dr. Hujoel’s view, the latest research data favor the Carbohydrate Theory as an explanation of many cases of the aforementioned dental and systemic chronic diseases. If correct, the theory has important implications for prevention of dental and systemic diseases: namely, dietary carbohydrate restriction.

I agree with Dr. Hujoel that we need a long-term prospective trial of serious low-carb eating versus the standard American high-carb diet. Take 20,000 people, randomize them to one of the two diets, follow their dental and systemic health over 15-30 years, then compare the two groups. Problem is, I’m not sure it can be done. It’s hard enough for most people to follow a low-carb diet for four months. And I’m asking for 30 years?!

Dr. Hujoel writes:

Possibly, when it comes to fermentable carbohydrates, teeth would then become to the medical and dental professionals what they have always been for paleoanthropologists: “extremely informative about age, sex, diet, health.”

Dr. Hujoel mentioned a review of six studies that showed a 30% reduction in gingivitis score by following a diet moderately reduced in carbs. He mentions the aphorism: “no carbohydrates, no caries.” Anyone prone to dental caries or ongoing periodontal disease should do further research to see if switching to low-carb eating might improve the situation.

Don’t be surprised if your dentist isn’t very familiar with the concept.

Steve Parker, M.D.

Reference: Hujoel, P. Dietary carbohydrates and dental-systemic diseasesJournal of Dental Research, 88 (2009): 490-502.

Mendosa, David. Our dental alarm bell. MyDiabetesCentral.com, July 12, 2009.

Jimmy Moore’s 2012 interview with Dr. Hujoel.

Chronic Systemic Disease and Dental Problems: A Carbohydrate Connection?

Dentists are considering a return to an old theory that dietary carbohydrates first cause dental diseases, then certain systemic chronic diseases, according to a review in the June 1, 2009, Journal of Dental Research

Neither Moore nor Sorrentino, but a nice set of choppers

Jimmy Moore has a recent podcast interview with Dr. John Sorrentino, a dentist who advocates a carbohydrate-restricted paleo diet for prevention and treatment of certain common dental problems.  By coincidence, Sorrentino is an old dental school classmate of Dr. Jack KruseDr. Sorrentino has a brand new dental blog.

We’ve known for years that some dental and systemic diseases are associated with each other, both for individuals and populations.  For example, gingivitis and periodontal disease are associated with type 2 diabetes and coronary heart disease.  The exact nature of that association is not clear.  In the 1990s it seemed that infections—chlamydia, for example—might be the unifying link, but this hasn’t been supported by subsequent research.     

The aforementioned article is written by Dr. Philippe P. Hujoel, who has been active in dental research for decades and is affiliated with the University of Washington (Seattle).  He’s no bomb-throwing, crazed, radical. 

That's more like it

The “old theory” to which I referred is the Cleave-Yudkin idea from the 1960s and ’70s that excessive intake of fermentable carbohydrates, in the absence of good dental care, leads both to certain dental diseases—caries (cavities), periodontal disease, certain oral cancers, and leukoplakia—and to some common systemic chronic non-communicable diseases such as coronary heart disease, type 2 diabetes, some cancers, and dementia.  In other words, dietary carbohydrates cause both dental and systemic diseases—not all cases of those diseases, of course, but some.   

Dr. Hujoel doesn’t define “fermentable” carbohydrates in the article.  My American Heritage Dictionary defines fermentation as:

  1. the anaerobic conversion of sugar to carbon dioxide and alcohol by yeast
  2. any of a group of chemical reactions induced by living or nonliving ferments that split complex organic compunds into relatively simple substances

As reported in David Mendosa’s blog at MyDiabetesCentral.com, Dr. Hujoel said, “Non-fermentable carbohydrates are fibers.”  Dr. Hujoel also shared some personal tidbits there. 

In the context of excessive carbohydrate intake, the article frequently mentions sugar, refined carbs, and high-glycemic-index carbs.  Dental effects of excessive carb intake can appear within weeks or months, whereas the systemic effects may take decades. 

Hujoel compares and contrasts Ancel Keys’ Diet-Heart/Lipid Hypothesis with the Cleave-Yudkin Carbohydrate Theory.  In Dr. Hujoel’s view, the latest research data favor the Carbohydrate Theory as an explanation of many cases of the aforementioned dental and systemic chronic diseases.  If correct, the theory has important implications for prevention of dental and systemic diseases: namely, dietary carbohydrate restriction.

Juvenile male Homo sapiens on Neolithic diet

Adherents of low-carb diets will love this article; it supports their choices.  The standard American diet provides 55% of energy in the form of carbohydrates.  Stone Age diets on average provided 35 to 40% of energy as carbs, but rarely as the simple sugars and refined starches that characterize modern Western diets.

I agree with Dr. Hujoel that we need a long-term prospective trial of serious low-carb eating versus the standard American high-carb diet.  Take 20,000 people, randomize them to one of the two diets, follow their dental and systemic health over 15-30 years, then compare the two groups.  Problem is, I’m not sure it can be done.  It’s hard enough for most people to follow a low-carb or paleo diet for four months.  And I’m asking for 30 years?!   

Dr. Hujoel writes:

Possibly, when it comes to fermentable carbohydrates, teeth would then become to the medical and dental professionals what they have always been for paleoanthropologists: “extremely informative about age, sex, diet, health.”

Dr. Hujoel mentioned a review of six studies that showed a 30% reduction in gingivitis score by following a diet moderately reduced in carbs.  He mentions the aphorism: “no carbohydrates, no caries.”  Anyone prone to dental caries or ongoing periodontal disease should do further research to see if switching to low-carb eating might improve the situation. 

Don’t be surprised if your dentist isn’t very familiar with the concept.  Has he ever mentioned it to you?

Steve Parker, M.D.

Reference:  Hujoel, P.  Dietary carbohydrates and dental-systemic diseasesJournal of Dental Research, 88 (2009): 490-502.

Mendosa, David.  Our dental alarm bell.  MyDiabetesCentral.com, July 12, 2009.