Alvin H. Danenberg, DDS • Nutritional Periodontist
September 18, 2017
What? How could dental plaque be healthy?
Isn’t dental plaque made up of unhealthy bacteria? Haven’t we all been told that you must get all the plaque off your teeth or you will develop gum disease and tooth decay? Don’t all dentists tell you to use antimicrobial toothpastes and mouthwashes to kill all those bugs or else there will be dental disease?
The answers to all the above questions seem to be, “Yes!” But, “Yes” may not be the correct answer. Here’s why.
An unhealthy diet and an unhealthy lifestyle could cause unhealthy changes in the gut. These changes in the gut may affect the overall host response and the balance of microbes in the mouth. The results could cause healthy dental plaque around the teeth to become unhealthy, which then could lead to gum disease and tooth decay.
Healthy Dental Plaque
Dental plaque starts off being healthy. When dental plaque is healthy, it exists in a state of homeostasis. That means that the bacteria in healthy dental plaque are in a state of equilibrium or balance. Plaque is made up of hundreds of bacteria – some by themselves are good and some by themselves are bad. Yet, when dental plaque is healthy, bacteria are living happily together in the biofilm attached to the base of teeth.
Healthy plaque provides benefits. It keeps the acid level around teeth stable, helps remineralize the tooth surface 24/7 with beneficial nutrients, and also destroys other pathogenic bacteria from getting to the surface of the tooth and below the gum tissues. , , ,  However, when dental plaque becomes unhealthy, it becomes pathogenic. Unhealthy dental plaque could become a major source of much infection.
Recently published medical research provides some clues about the transformation of healthy dental plaque into unhealthy dental plaque. I selected four critical papers that tell an important story about the causes of dental diseases.
Ian Spreadbury published a paper in 2012. It helped explain how some of the foods, which most of us eat everyday, create damage to the human gut.
Dr. Spreadbury described how acellular carbohydrates (processed carbohydrates that have been highly condensed with their cell walls destroyed) might create dysbiosis in the gut. Acellular carbohydrates consist of processed grains and free-sugars. In the gut, increased levels of unhealthy bacteria can damage the one-cell-layer-thick gut lining and create inflammation. Undigested food particles and bacterial remnants can penetrate the damaged gut lining and enter the bloodstream. The systemic immune system can be mobilized creating effects throughout the body. Disruption of various hormones may create additional health issues. Organ systems may become affected if there is a genetic predisposition for disease. The mouth bacteria can become “out of balance”.
Bottom line: A diet that excludes acellular carbohydrates (processed grains and free sugars) may remove the root cause of many of the chronic diseases that are prevalent in modern civilizations today. Dental diseases are chronic diseases.
In 2009, Dr. Baumgartner reported a study that was set in an area of Switzerland.
In this controlled experiment, ten individuals were not able to brush or floss for 30 days. Their diet consisted of primal foods endemic to their area in Switzerland about 5,700 years ago. No processed foods were available. These participants had to gather and forage for the majority of their food. At the beginning and at the end of the study, pocket depths and bleeding-on-probing around the teeth were measured, and cultures of bacteria in their plaque and on the tongue were taken. At the end of the study, there were a significant decrease in bleeding-on-probing and a significant decrease in pocket depths. Amounts of dental plaque increased greatly, but virulent bacteria in the plaque and on the tongue did not increase. Dental plaque and other oral microbes were in a state of homeostasis at the end of the four-week experiment.
Bottom line: A diet that completely removes processed foods reduces the signs and symptoms of gum disease. This type of diet allows the interactions of bacteria in dental plaque to become and stay balanced and healthy.
Dr. Johan Woelber and researchers performed a randomized clinical trial, which they reported in 2016.
Fifteen people were selected for this trial. Only those who had signs of gum disease and were eating a diet heavily based on processed carbohydrates were selected for the study. Ten individuals made up the experimental group, and five individuals made up the control group.
The experimental group had to change their diet. Their new diet consisted of foods low in processed carbohydrates, rich in omega-3 fatty acids, and abundant in vitamins C and D, antioxidants and fiber. The control group did not change their eating habits.
As far as oral hygiene was concerned, all fifteen participants were instructed not to clean between their teeth with dental floss or interdental brushes. However, they did not have to change the way they brushed their teeth.
The study began after each group had two weeks to acclimate to these changes I mentioned above. Then, the four-week study began. The signs of gum disease (bleeding-on-probing, pocket depths, degree of gingival inflammation) in all participants of this scientific project were recorded at the start of the four-week study and at the end.
At the conclusion of the trial, all disease parameters decreased significantly in the experimental group by approximately 50% from the starting point. In contrast, all inflammatory markers increased from the starting point in the control group.
Bottom line: A diet that eliminates free-sugars and processed grains and includes healthy foods can reduce the signs and symptoms of gum disease. Again, a diet that removes processed foods and includes nutrient-dense foods can maintain dental plaque in a healthy state.
Dr. Sheiham reported on the pivotal role of free-sugars in the development of dental decay.
He and his associate published their paper in 2015, which evaluated many previous research studies. The authors concluded:
- Dental decay is diet mediated.
- Free-sugars are the primary and necessary factors to develop dental decay.
- Acid-producing bacteria and other factors facilitate the development of decay, but free-sugars are required.
- Processed food starches possess very low decay potential.
Free-sugars include all sugars added to foods in any way. These sugars include white, brown, and raw sugars. All manufactured sweeteners, corn syrup, and high fructose corn syrup are free-sugars. Free-sugars also include those naturally occurring sugars in syrups, fruit juices, concentrates, and processed honey.
Bottom line: Dental caries is a diet-mediated disease. Free-sugars are the primary and necessary factor in the development in dental decay. These free-sugars feed decay-producing bacteria in healthy plaque, which in turn becomes unhealthy plaque. Free-sugars allow these specific bacteria to overgrow and produce excessive acids that demineralize the tooth surface.
Medical research is fine, but I need practical solutions for my patients and me. That’s why I added “Bottom line” comments after each “Study” I discussed above.
In essence, acellular carbohydrates (which includes free-sugars and processed grains) and all other processed foods containing chemicals should be eliminated from the diet. Foods high in omega-3 fatty acids (ex. healthy fish like salmon, sardines, anchovies); vitamin C (ex. citrus, bell peppers, broccoli); vitamin D (ex. healthy sun exposure, cod liver oil, pastured eggs, mushrooms); antioxidants (ex. dark chocolate, berries); and fiber (ex. fruits, vegetables) should be emphasized in the diet. These foods are nutrient-dense and support cellular health and a healthy immune system.
When the diet supports cellular function and does not create dysbiosis, dental plaque will remain healthy and not pathogenic. Once dental plaque becomes unhealthy, a vicious cycle begins between unhealthy food, unhealthy gut, and chronic diseases including gum disease and tooth decay. Once disease ensues, all sources of disease must be treated and brought back to health and balance.
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