Dental Plaque Is Healthy
Until It’s Not

Alvin H. Danenberg, DDS • Nutritional Periodontist
September 18, 2017

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Dental Plaque Is Healthy Until It's NotDental plaque is healthy, until it’s not.

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What? How could dental plaque be healthy?

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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?

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The answers to all the above questions seem to be, “Yes!” But, “Yes” may not be the correct answer. Here’s why.

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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.[1] The results could cause healthy dental plaque around the teeth to become unhealthy, which then could lead to gum disease and tooth decay.

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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.

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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. [2], [3], [4], [5] However, when dental plaque becomes unhealthy, it becomes pathogenic. Unhealthy dental plaque could become a major source of much infection.

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Medical Research

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.

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Study #1

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.[6]

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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”.

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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.

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Study #2

In 2009, Dr. Baumgartner reported a study that was set in an area of Switzerland.[7]

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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.

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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.

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Study #3

Dr. Johan Woelber and researchers performed a randomized clinical trial, which they reported in 2016.[8]

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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.

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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.

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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.

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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.

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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.

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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.

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Study #4

Dr. Sheiham reported on the pivotal role of free-sugars in the development of dental decay.[9]

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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.

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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.

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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.

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Summary

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.

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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.

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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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Be proactive.

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Satisfy Your Sweet Tooth

Alvin H. Danenberg, DDS • Nutritional Periodontist
August 21, 2017

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Satisfy Your Sweet ToothDo you love sweets? You’re not alone. But, how do you satisfy your sweet tooth?

 

Do you indulge in free-sugars? Have you substituted artificial sweeteners for free-sugars? What about natural sweeteners?

 

Basically, free-sugars are not healthy, and artificial sweeteners are not healthy. In contrast, natural sweeteners could be wise choices. Let’s examine this a little further.

 

 

 

 

Free-Sugars

Free-sugars are sugars that are added to foods plus those sugars naturally present in syrups, fruit juices, and concentrates. Agave, processed honey, coconut sugar, and high fructose corn syrup are free-sugars. If you do some research, you will find there is quite a bit of science that shows free-sugars are bad. They are bad for teeth and bad for health. If free-sugars are not healthy, then what are your choices if you want something sweet?

 

Naturally Sweet Foods

Fruit is sweet. Some fruits, like all the berries, have a sweet taste without a great deal of natural sugar. In addition, if you chewed your food slowly, you would discover that many foods you did not think were sweet would actually have a sweet taste. This is due to the initial breakdown in your mouth of some of the carbohydrates in your food by enzymes in your saliva. Your taste buds will tell you these foods are sweet.

 

Artificial Sweeteners

You might think that your healthiest choice would be to purchase foods that are sweetened with artificial sweeteners. Since artificial sweeteners have no calories, you might think they are better for you. However, you would be wrong. These can cause harm to your body – not immediately obvious but damaging over time with continued consumption. In addition, your body could actually become addicted to these chemicals.

 

Here are four of the most common and damaging artificial sweeteners:

 

Aspartame (NutraSweet, Equal)
Aspartame is about 180 times sweeter than sugar. Once ingested, aspartame can break down into some dangerous chemicals in the body including methanol, which can produce formaldehyde and formic acid. These chemicals could be toxic to the body if they were consumed in large quantities and if they were not further metabolized or eliminated naturally. Recent studies have demonstrated that aspartame is potentially carcinogenic.

 

Sucralose (Splenda)
Sucralose is another artificial sweetener and is about 600 times sweeter than table sugar. Research suggests consuming sucralose could harm beneficial bacteria in the gut. In addition, it might be carcinogenic.

 

Saccharin (Sweet ‘N Low)
Saccharin is almost 400 times sweeter than sugar. Many users notice it has a metallic aftertaste. Though the FDA has no limits on its consumption, saccharin is believed to contribute to health concerns, as described in this 1990 research.

 

Acesulfame K (Sunett, Sweet One, ACE, ACE K)
ACE has a slightly bitter aftertaste. Your body cannot break down ACE. Its side effects may cause nausea, decreased alertness, headaches, irritability, and slow reaction times. It also could affect cognitive function, which is described in this article.

 

Non-Caloric Natural Sweeteners

So, what are healthier ways to add sweetness to your foods? Organic whole leaf stevia and organic monk fruit extract are two alternatives.

 

Organic Whole Leaf Stevia
Stevia has some beneficial biological effects. It may lower blood pressure, reduce blood sugar levels, and may act as an antioxidant. It is more than 200 times as sweet as sugar and is available in liquid forms and powders. Stevia is close to an ideal natural sweetener.

 

Organic Monk Fruit Extract
Similar to stevia, monk fruit extract is an excellent option as a sweetener. It is about twice as sweet as stevia. And like stevia, it is an antioxidant with many beneficial effects for the body. Monk fruit extract is also known as luo han guo.

 

My Thoughts

I rarely add natural sweeteners to my food. I prefer to eat fruits to satisfy my sweet tooth, not to mention my love for dark chocolate. However, I have used organic whole leave stevia and organic monk fruit extract in some recipes that require a sweetener.

 

 

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Nutrition Facts,
Ingredients List,
Organic Seal

Alvin H. Danenberg, DDS • Nutritional Periodontist
June 12, 2017

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Nutrition Facts
Old vs New Label

Questions For You:

  1. Do you know what’s in the packaged and processed foods you buy?
  2. Do you know how to read the Nutrition Facts printed on food products?
  3. More importantly, do you know how to read the Ingredients List on the packaging?
  4. Do you know what the Organic Seal means?

 

 

The FDA has approved new regulations for the Nutrition Facts. July 2018 is the date for the new labels to be printed on all products. However, the Ingredients List has not been changed, and it may still be a challenge to understand. This list tells you most of the ingredients that are added to the packaged food you are purchasing, but some of the words may be confusing. Another important label is the Organic Seal. It adds another piece to the puzzle of understanding the contents of the food you buy. Here are some facts you need to know.

 

 

Nutrition Facts

The new Nutrition Facts will be easier to read and more helpful. This comparison chart summarizes the old and the new labels.

 

A new and important piece of information included on the new label is “Added Sugars”. “Added Sugars” are those extra sugars (or “free sugars”) that have been added to the product above and beyond the natural sugars, which are inherently part of the food you are buying. Why is this important?

 

Among many organizations warning of the harmful health consequences of added sugars, the World Health Organization (WHO) published a monograph in 2015 titled Guidelines: Sugars Intake for Adults and Children. This published research goes into the details of “free sugar” consumption and how “free sugars” affect chronic disease in the worldwide population.

 

Discerning consumers now will be able to see how much of this added carbohydrate is in the food they are buying.

 

 

Ingredients List

The Ingredients List tells what is put into the product deliberately. You will learn the foods that are in the package as well as some chemicals and added substances. The items are listed in descending order of the amount of the ingredient that is in the package. Healthier foods have very few ingredients, which should be recognizable to you. If you don’t like what you see, then don’t buy the product. If you don’t know the ingredient, look it up on the Internet. Any of the following listed substances should scream out to you, “Don’t buy me!” – high-fructose corn syrup, synthetic trans fats, artificial flavors, monosodium glutamate (MSG), artificial colors, artificial sweeteners, and preservatives. Be aware that many substances like glyphosate or mercury will not be identified in the Ingredients List.

 

I have photographed the Ingredients Lists of three different packaged foods. Read what they tell you:

 

1. This label explains clearly what is in the package. You probably recognize each ingredient. They all are healthy foods. The three most dominant items are almonds, coconut, and sunflower seeds.

 

 

 

 

 

 

 

2. This list tells a different story. The first three dominant ingredients are sugar, invert sugar, and corn syrup. As you read on, you will get more discouraged. Would you feed this to your family?

 

 

 

 

 

3. The last image includes a huge number of items, many of which are emulsifies, grains, sugars, and unhealthy oils. After reading about this frozen chicken product in the grocery store, I put it back on the shelf. It’s not for my family or me.

 

 

 

Organic Seal

One of the most meaningful labels on food packaging is the U.S. Department of Agriculture (USDA) Organic Seal.

 

For a product to be certified organic, it’s required to meet these requirements:

  • Organic crops cannot be grown with synthetic fertilizers, synthetic pesticides or sewage sludge.
  • Organic crops cannot be genetically engineered or irradiated.
  • Animals must eat only organically grown feed (without animal byproducts) and can’t be treated with synthetic hormones or antibiotics.
  • Animals must have access to the outdoors, and ruminants (hoofed animals, including cows) must have access to pasture.
  • Animals cannot be cloned

 

 

Summary

You are the master of your kitchen and your dining room table. You have total control of what you purchase to eat and share with your family. If you are trying to be proactive and provide nutrient-dense choices of food, you must become knowledgeable with the Nutrition Facts, the Ingredients List, and the Organic Seal. These tools are invaluable. You will learn a wealth of information by reading and understanding them.

 

 

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New Year’s Is Coming:
Get Your Health On

Alvin H. Danenberg, DDS • Nutritional Periodontist
December 19, 2016

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new year's get your health onOver the last four years, my emphasis has been, “Get your health on”. Since changing my diet and lifestyle to Primal, I have gotten my health on.

 

Doable New Year’s Promise

It seems like most people start making unrealistic promises to change their life in one way or another starting the first day of the New Year. Well, New Year’s is coming, and my suggestion for you is to make a doable promise you can achieve. My suggestion for you is to get your heath on.

My patients hear this all the time from me. When I get my patients excited about, and committed to, changing their diet to a nutrient-rich diet, their mouths become healthier and their bodies become healthier.

My extensive research using PubMed.gov has uncovered many peer-reviewed medical articles that have opened my eyes and reframed the way I think about food. What you will read at the end of this post is practical and doable. Of course, implementing my suggestions will require change and commitment. Don’t get discouraged. Make the commitment. Make the change. Move at your own pace. The benefits will be unbelievable.

 

Pearls From Research

The research that has made the most impact on me can be boiled down to four articles, which I have written about many times in the past. (1, 2, 3, 4) I am not going to describe these papers again, but I am going to list the specific pearls I have distilled from these researchers. Changing your diet to include what I explain below will improve your dental health and the health of your overall body. I am suggesting you eat real food, not man-made supplements stuffed into a capsule or tablet. Try to select organic food choices, which would be better than conventionally grown products:

 

  • DECREASE free sugars and processed grains from your diet as much as possible.
     

    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, and concentrates. In addition, all processed honey falls into this category.

     

    Processed grains include breads, pasta, cereal grains, cookies, crackers, muffins, bagels, popcorn, pizza, pretzels, rice cakes, etc.

     

  • INCREASE foods high in DHA and EPA. These are critical long-chain omega-3 fatty acids that are available in small, oily fish like salmon, sardines, and anchovies.

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  • INCREASE foods high in vitamin C. Examples are citrus, bell peppers, and broccoli.

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  • INCREASE foods high in vitamin D. Examples are cod liver oil, pastured eggs, and mushrooms.

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  • INCREASE foods high in antioxidants. Excellent examples are raw and unprocessed cacao and fresh berries of any type.

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  • INCREASE foods high in fiber. Most vegetables and whole fruits can provide all the fiber your body needs.

 

 

Healthier Food Reference Guide

I have prepared a Healthier Food Reference Guide that includes many foods that you may want to remove from your diet along with their healthier replacements. This guide may help you with your resolution for the New Year. Keep your commitment. The benefits will be immense.

 

 

 

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Why Do I Have Tooth Decay?
4 “Whys” & 5 “Solutions”

Alvin H. Danenberg, DDS   •   Nutritional Periodontist
October 17, 2016  

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why-do-i-have-tooth-decayBeing a periodontist, my patients come to see me for gum problems. However, they often ask me, “Why do I have tooth decay?” Here are some specific facts about tooth decay:

  • Tooth decay is the most common infectious disease known to modern civilization. HERE.
  • Our human species evolved for about 2.5 million years with little or no tooth decay. HERE.
  • Many people who brush and floss daily still have tooth decay. HERE.

 

4 “Whys”

  1. Free sugars feed unhealthy mouth bacteria.
  2. These unhealthy bacteria overgrow around teeth and produce acids that cause tooth decay.
  3. You may not be cleaning your mouth properly. Therefore, you may not be removing unhealthy clumps of bacteria from around your teeth.
  4. You may not be eating a nutrient-dense, anti-inflammatory diet, which would support your healthy mouth bacteria and would provide essential nutrients to strengthen your immune system and your teeth.

 

5 “Solutions”

  1. Eliminate (or drastically reduce) free sugars from your diet. Free sugars consist of sugars added to foods plus those sugars naturally present in syrups, fruit juices, and concentrates. Free sugars are the primary cause of tooth decay. HERE.
  2. Schedule an appointment with a dental hygienist to have a professional and thorough dental cleaning. This will remove harmful clumps of bacteria and calcified bacteria called dental tartar (dental calculus) from around your teeth. A cleaning like this will give you a clean and fresh start moving forward.
  3. Understand the importance of dental plaque. Dental plaque is a complex community of microbes that attaches to your teeth at the gum line. Dental plaque is not a bad thing. Healthy dental plaque plays an important role by fighting bad bacteria, remineralizing the tooth surface, and keeping acid levels stable. Your goal should not be to prevent healthy plaque from forming. However, free sugars feed certain bacteria in dental plaque and allow them to overgrow and become bad players.
  4. Learn how to effectively clean your teeth. Unhealthy plaque must be removed. Most patients I see think they are cleaning their teeth properly. But, when I show them how to do it correctly, they realize they were not doing a good job. I have written about how to clean your teeth HERE.
  5. Educate yourself about a healthy diet. A nutrient-dense diet will provide all the elements necessary to keep your teeth and immune system strong. I have written about nutrient-dense, anti-inflammatory diets HERE.

 

My Closing Thoughts

Free sugars cause tooth decay. They must be eliminated or greatly reduced. It is important to eat foods that support levels of healthy bacteria.

 

Much of the bacteria in your mouth serve an important purpose. You do not want to kill all bacteria in your mouth indiscriminately. However, it is important to remove unhealthy clumps of bacteria from around your teeth by cleaning your mouth properly.

 

Now you should be able to answer your question, “Why do I have tooth decay?” If you understand and follow my 5 solutions above, you will prevent tooth decay. The World Health Organization published a paper in 2015 about the horrors of free sugar in the human diet. You may find it informative. HERE.

 

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