Many people do not realize how important oral health is for digestion. Digestion begins in the mouth. Teeth masticate, our tongue tastes our food for enjoyment, and our saliva moistens our food, oral cavity, and numbs our mouth with an endogenous produced opioid. Why do we need to reduce sensations in our oral cavity? Because of the mouth a very vascular area with many nerves. We take our oral health for granted and because of that many of us have dental issues. For many, the cause is their diet, lack of proper ingestion of nutrients that are needed for appropriate oral health including vitamin K2, ascorbate, niacin, calcium, magnesium, phosphorus, and retinol. They also ingest acidic beverages including soda that weaken enamel. For others, they lack proper sunlight exposure to produce endogenous vitamin D, which is essential for the health of our teeth. Finally, because we take our oral health for granted, we have to take drastic measures to make sure we have those coveted pearly whites to ingest our food functionally and to show off for everyone of course!

The drastic measures we take for optimal oral health leads to many mistakes which cost us our health. I cannot tell you how many people I have coached where their gut issues stemmed from mistakes they have made in their past over what they thought was for “optimal” oral health. I cannot blame them, the media and the American Dental Association brushes their teeth with lies. Because of those lies their mouths are filled with toxic mercury amalgams, they suffer from some degree of fluoride toxicity from conventional dental floss and toothpaste, and chronic low-grade infections from root canals and cavitations. Call me an anti-dentite if you want, but I believe that more people would be healthier if they listened and acted on the Weston A. Price foundation’s advice for oral health then the American Dental Association.

Dental Amalgams

Why would anyone think putting mercury or bisphenol-A resin in one’s mouth is safe or a good idea? We try our best not to permanently leave foreign substances in our body. I understand why people want to save their teeth for aesthetic and practical reasons. Then again why do we willingly accept cavity fillings made out of either toxic mercury or xenoestrogen bisphenol-A resin?

Mercury is one of the most toxic heavy metals in our environment that does not have any known human physiological role. Three forms of mercury exist in our environment, elemental, organic, and inorganic and the different forms have different levels of toxicity. Mercury has had many uses throughout history and was regarded as somewhat safe until modern wisdom shined a light on its toxicity. My grandfather used to tell me stories of how he played with mercury in pharmacy school and used it on cuts, therefore, to him it has to be safe. Just like the lead crystal carafes we would drink from were poisoning us, the mercury we are ingesting, exposed to, and in our mouth are poisoning us.^{1 2}

Acute mercury exposure in the first world occurs from the breaking of fluorescent light bulbs. CFL (compact fluorescent light) bulbs that are unused contain liquid organic mercury when broken is aerosolized and inhaled, entering the bloodstream and is distributed throughout the body. However, over time inorganic mercury is slowly formed with blub use and sticks to the sides of the bulb which is harder to inhale when broken. Chronic mercury exposure comes from ingestion of elevated mercury-containing seafood including tuna (methylmercury), and mercury dental amalgams (elemental mercury which can be turned into methyl mercury by our microbiome). The toxicity of metals and metal compounds depends on how bioavailable they are for accumulation and if they are readily detoxed. Methylmercury is readily absorbed in the gastrointestinal tract (up to 90% upon ingestion) and is bio-cumulative. Inorganic mercury (7% – 15% upon ingestion) and elemental mercury (<0.1% upon ingestion) are not absorbed well, however more can be absorbed if someone is suffering from differing degrees of "leaky gut." Methylmercury and elemental mercury are absorbed when inhaled; inorganic mercury is not. Methylmercury is extremely toxic. Methylmercury can accumulate in organs; it can cross the blood-brain barrier and accumulate in the brain, it can also harm our mitochondria. Elemental mercury that is not oxidized or charged is highly diffusible and lipid soluble, able to cross the blood-brain barrier and blood-placenta barrier. It is also able to cross lipid bi-layers of cellular and intracellular membranes. Inorganic mercury mainly damages kidney cells causing kidney disease and failure. Inorganic mercury is not lipid soluble, so it does not readily cross the blood-brain barrier or the lipid bilayers of our mitochondria.^{3 4 5 6 7 8}

Mercury amalgams appear to be a primary source of chronic mercury exposure in the first world. “It is generally accepted that dental amalgam restoration may play the role of a major source of elemental mercury in the general population. Several studies report that mercury levels of urine and blood are associated with amalgam exposure by dental filling in the general population and by professional practice in dental practitioners.” Mercury-containing amalgams have been used for 150 years. Just because something has been used forever does not make it safe. The pathway of mercury absorption from mercury amalgams occurs from mechanical forces of teeth that contain amalgams. Chewing releases elemental mercury vapors which we inhale. Twenty percent of the mercury is exhaled, the rest is absorbed, accumulates in the central nervous system and tissues. Peroxidase oxidation occurs causing mitochondrial damage, and the elemental mercury is secreted slowly over a few months. Uncharged organic monoatomic mercury which is used in amalgams is lipid soluble and can readily cross the blood-brain barrier and can enter the lipid bilayers of the mitochondria, causing oxidative stress (half-life for mercury within the brain can be as high as thirty years without chelation). Though elemental mercury vapor is rapidly oxidized to ionic mercury, it remains as vapor in our bloodstream for a short period. While the vapor is unoxidized in the bloodstream, it will penetrate the blood-brain barrier and bioaccumulate in the brain. The oxidized form will not effectively cross the blood-brain barrier. Finally, elemental mercury can pass through the mucosa and connective tissue of the nasal cavity, and from there it can be accumulated in the brain via the nerve cells of the olfactory system.^{9 10 11 12 13 14}

Organic mercury from breathing in amalgam vapors is bio-accumulative over time in our brain, tissues, cells, and mitochondria. The more amalgams one has in their mouth, the higher amount of mercury accumulation. Also, if the person ingests a lot of elevated mercury seafood (methylmercury which is readily absorbed through the digestive tract) their mercury burden further increases. Finally, if they breathe in the mercury vapors from the occasional broken fluorescent light bulb, their burden can increase as well. Remember when it comes to mercury toxicity, exposure frequency, bio-accumulation, and forms matter. Some people might show no symptoms of mercury toxicity with one or two mercury amalgams, but the more amalgams one has and their mercury exposure from diet, occupation, and environment, the more likely they will develop chronic mercury toxicity.^{15 16 17 18 19 20}

So what can be done to diagnose and reduce one’s mercury burden? I would recommend getting a Mercury Tri-Test from Quicksilver Scientific which measures hair, urine, and blood mercury levels to determine your mercury burden. I suggest everyone remove their mercury filings correctly if they have any because you are not improving your health leaving them your mouth. If you have your mercury amalgams removed and replaced I recommend that you look into finding a good biological dentist that uses many parts of the SMART (Safe Mercury Amalgam Removal Technique) protocol to help remove your amalgams and use natural porcelain. I do not recommend the use of composite resin fillings because many are made from the xenoestrogen bisphenol-A. I also do not recommend gold and silver fillings because of the increased galvanic effect of having metal in the mouth which can trigger chronic low-grade inflammation in the oral cavity. In addition, when it is time to chelate mercury I recommend you research Dr. Andrew Hall Cutler and follow his protocol for mercury detoxification. Finally, I do not support the supplementation of R-lipoic acid (the proper use of alpha lipoic acid is recommended if you are following the Cutler protocol) and glutathione for mitochondrial health if you believe you are mercury burdened because of the issues associated with improper mercury chelation and using these supplements.

Root Canals

Now if putting permanent non-ceramic fillings in your mouth is idiotic, “decontaminating,” “sealing,” and leaving a hollowed out tooth in your mouth is worse. Welcome to the insanity that is known as a root canal.

At the center of your teeth is a hollow area that contains soft tissue called pulp. The soft tissue is comprised of nerves, blood vessels, connective tissue, and odontoblasts which are cells that form dentin, the substance between tooth enamel and the root. Your pulp’s functions are to form dentin through odontoblasts, keeps the inside of your teeth supplied with moisture and nutrients, and make teeth able to send impulse sensitives to the brain of temperature, pressure, or trauma. There are many canals, inside each root of the tooth, that run from the pulp chamber at the center of the tooth that connects to jaw bone that contains blood vessels and nerves. The canals can be very complex and can form cul-de-sacs, fins, and lateral canals. Finally, the root contains a multitude of tiny dentinal tubules (six to eight miles worth per tooth) that extend from the pulp-to the cementum-dentin junction of the tooth.²¹

Why does a root canal need to be performed? Root canals are recommended by the ADA and your dentist when you are suffering from unhealthy pulp symptoms. Symptoms of a tooth that has unhealthy pulp include pain, tooth blackening, nearby gum swelling, specific sensitivity of the troubled tooth to temperature changes within the mouth, nearby gum tenderness, gum abscesses usually near the tooth that is unhealthy, and fever. Infection of the tooth pulp is called pulpitis, and if severe enough the pulp tissue can die and become necrotic. Sometimes differing degrees of pulpitis can be reduced from practicing excellent oral hygiene, and the tooth can return to being healthy. However, necrotic pulp tissue can be painless from nerve damage, cause oral abscesses, swelling, jaw bone inflammation and loss, night sweats, and fever can still occur from infection and immune reactions to dead tissue within the tooth. If a root canal is not performed or the tooth is not extracted, and antimicrobial agents are not given when the tooth is either necrotic or severe infected, the infection can become severe and enter the bloodstream from the vascular jaw bone causing sepsis. Sepsis simply put is blood infection, and can cause severe immune reactions and toxicity that produce organ damage and failure, cardiovascular issues, and cerebrovascular issues if not treated. If the swelling is severe enough, depending on the location of the abscessed tooth a condition called Ludwig’s angina may occur. Ludwig’s angina is a type of severe cellulitis involving the floor of the mouth which can compromise the airway and cut off breathing which is a medical emergency. As you can see it is crucial to treat an abscessed or necrotic tooth as soon as possible.^{22 23 24 25 26}

When you visit the dentist, and you have oral health concerns, most of the time the first service they will perform is an X-ray to determine the integrity of your oral cavity. If a root canal needs to be performed the dentist will then use local anesthesia to numb the gum tissue around the compromised tooth and place a rubber dam around the tooth to keep the area dry and away from saliva. An access hole is then drilled into the tooth so the dentist can perform the root canal procedure. The pulp, along with bacteria and related debris, is then removed from the tooth. The root canal process is accomplished using root canal files which are a series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water, chlorhexidine, ethylenediaminetetraacetic acid, MTAD (a mixture of the antibiotic tetracycline, citric acid, and a detergent) or diluted sodium hypochlorite is used periodically to flush away the tooth and debride the pulp chamber and root canals. Once the tooth is thoroughly cleaned, it needs to be sealed. If there is an infection, your dentist may way to seal the tooth and put medicated dressing inside the tooth to “treat” it. If the tooth does not appear to be infected the dentist might decide to seal the tooth in one procedure. If root canal therapy is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep contaminants out between appointments. During the sealing procedure, the tooth interior is filled with a sealer paste, and a rubber compound called gutta-percha is placed into the tooth’s root canal. A filling is placed to fill the exterior access hole created at the beginning of the root canal. The final step in a root canal procedure may involve further restoration of the tooth including a crown or a crown and post that needs to be placed on the tooth to protect it and restore functionality.^{27 28 29 30}

There are many issues that I have with using root canals to “restore” the functionality of a dead tooth. A tooth that is infected in most cases it is unlikely that you will be able to completely treat the infection and debride the inside of the tooth well enough during a root canal procedure. Most of the time microbial colonies (bacteria, archaea, parasites including Entamoeba dentalis, and yeast like Candida can infect root canal space) are left in the root canal space even after it is sealed because it is not entirely debrided to sterility in the first place. Common bacterial dysbiotic colonies found in root canal spaces and tubules include Actinomyces, Bacillus, Campylobacter, Citrobacter, Enterococcus fecalis, Eubacterium, Helicobacter pylori, Klebsiella, Lactobacillus, Peptostreptoccus, Pseudomonas, Porphyromonas, Prevotella, Propionibacterium, Staphylococcus, Streptococcus, Veillonella. If you test positive for elevated levels of these bacteria in your stool tests (GI Effects test for example), then you might have oral dysbiosis. Not all root canals are even debrided with antimicrobial agents, especially those that do not appear to be infected from the X-ray or visual inspection, and the dentist believes the pulp is inflamed for some other reason. Not all teeth that have pulp inflammation occur from dysbiosis or infection, but the majority of them are. Our teeth are a living structure, they have a blood supply and a nerve supply, removing those and sealing the dead tooth can allow dysbiosis to occur that wasn’t even there previously because of both the sealing process is not 100% sterile and because of the dentinal tubules that I mentioned early as well. The sealing process does not seal the multitude of dentinal tubules where various colonies of microorganisms can survive the root canal process and chronically infect the tooth. When you remove the blood supply to the tooth the body’s immune system is not able to combat any dysbiosis within the tooth, which can lead to chronic oral dysbiosis, chronic digestive issues, Th1, Th2, or Th17 dominance, mental health issues, cognitive issues, arthritis, systemic inflammation, cancer, oral cavity abscesses, cavitations in the jaw bone, and if severe enough manifestation of sepsis. Finally, for more information on the risks associated with root canals I recommend you view the documentary on Netflix, Root Cause.^{31 32 33 34 35 36 37 38 39}

Your unhealthy tooth might be able to be saved if it is not severely infected or traumatized. I recommend you follow the advice of Ramiel Nagel in his excellent book Cure Tooth Decay and follow the recommendations of the Weston A. Price foundation first to see if you can save your tooth. I do not recommend root canal’s, however, if you have to have a root canal performed, follow these recommendations. The use of ozone to debride the tooth combined with the use of MTAD for “sterilization” is your best chance to prevent dysbiosis. I also recommend the tooth is treated with medicated dressing for one week before sealed. After the procedure follow the recommendations in Cure Tooth Decay for proper oral health. So what can be done instead of having a root canal? I believe in most cases if the tooth is deceased to the point where your only choice is a root canal it should be removed. The gum and jaw tissue underneath the tooth during the procedure should be debrided with ozone if needed a bio-identical ceramic implant should be used to replace the tooth, and after the procedure follow the recommendations in Cure Tooth Decay for proper oral health. Try to find a well rated biological dentist in your area if you need a tooth removed, implanted, or a root canal removed. The biological dentist might use a thermography (to see if there is adequate blood flow to the oral cavity), CAVITAT scan, or a panoramic x-ray (small exposure to radiation) to diagnose your oral health issues. Finally, you may need oral jaw surgery or ozone injections into the jaw tissue to debride the tissue and repair any cavitations that can occur from root canals or diseased teeth.

Using Oral Health Products That Contain Fluoride

I shake my head when most mainstream health articles come across my news feed. Facebook friends share them occasionally and most of the time, the articles and the studies most of these articles reference are flawed. Very few people read the articles, let alone the studies. Most people read the headlines and from that reinforce or form their beliefs. An article was shared on my Facebook recently with the link text, “Oral Care has “no impact” without fluoride, report finds”. Most people will just read the link text and conclude that fluoride toothpaste is the only way for proper oral health. However, if you click on the actual article, the headline is “Experts question benefits of fluoride-free toothpaste.” There is a big difference between those two headlines. The first headline states that oral care without fluoride has no impact. The second heading in the article states that “experts” question the benefits of fluoride-free toothpaste but does not make any statement that fluoride-free oral care products do not make an impact on cavity prevention in the headline (it is mention in the sub-header). I should stop writing right now. There is bias in the reporting just based on the headings, but I would be no better than the mainstream news. We are going to break down the Associated Press article and the study to see if it is conclusive that fluoride-free toothpaste is useless for oral health.⁴⁰

Associated Press Article, “Experts Question Benefits of Fluoride-Free Toothpaste” and The Truth About Fluoride

“Dental health experts worry that more people are using toothpaste that skips the most important ingredient — fluoride — and leaves them at a greater risk of cavities.”⁴¹

Who are these dental health experts? Oh, we are going to find out, and it is going be a wild ride. But first, what about fluoride, is it good for oral health?

Fluoride is a mineral added to some municipal water supplies in specific amounts (0.7-1.2 parts per million on average), to improve our dental health. The most common form of fluoride added to our supply in the United States is fluorosilicic acid, which is a byproduct of fertilizer production. The more-expensive form, sodium fluoride, is found in toothpaste and used in dentistry. It is interesting how they use a manufacturing byproduct to “improve” the quality of the public supply and reserve the pricier medical grade sodium fluoride for oral care products and dentist offices.^{42 43}

Daily fluoride ingestion is hard to quantify, with concentrations varying widely from the unfiltered water we consume, our dental health products, some of the prescription medicine we take, and even the food we eat. Oral-B Glide dental floss for example has recently been reported to contain the toxic fluorine compounds perfluoroalkyl and polyfluoroalkyl (PFAS). Much of our food is grown using fluoridated water, and depending on the food, it might have naturally occurring fluoride like tea leaves (which accumulates calcium fluoride—supposedly less of a problem). In 2015, the Department of Health and Human Services recommended a 0.7 mg/liter limit on fluoride in drinking water—way below the FDA maximum of 4 mg/liter—out of concern for excess fluoride consumption. That is a considerable spread in recommended amounts for something added to the supply as a medication to “improve” oral health. All differing regulations in place, the average municipality supply has ended up with around 1–2 mg/liter.^{44 45 46 47 48}

An estimated 40% of Americans suffer from dental fluorosis, ranging from mild to severe, which can lead to dental damage. Dental fluorosis is hypomineralization of the teeth that comes from ingesting excessive amounts of fluoride. Dental fluorosis changes the enamel, it causes discoloration, pitting, damage to the enamel, and even CAVITIES. Excessive fluoride ions in maturing enamel alter the rate at which enamel matrix proteins are enzymatically broken down leading to issues with enamel structure. Excessive fluoride ions also might also reduce the rate at which the subsequent breakdown products are removed. Finally, excessive fluoride ions may also indirectly alter the action of the enzyme protease by decreasing the availability of free calcium ions in the mineralization environment. Because of the excess of ingested fluoride our teeth and bones are unable to remodel and remineralize leaving them appropriately weakened. Excessive fluoride consumption can do more than cause dental fluorosis. It can weaken our bones, weaken our teeth, calcify the pineal gland, and disrupt thyroid function by interfering with its uptake and use of iodine.^{49 50 51 52 53}

We can easily prevent dental caries without fluoride, by merely brushing with a xylitol-containing essential oil toothpaste, consuming less refined sugar, avoiding low pH drinks like soda and energy drinks, and oil pulling. Our teeth need adequate amounts of calcium, magnesium, phosphorus, boron, potassium, vitamin D, and vitamin K2 for proper health from diet or supplementation. But I guess instead of living healthier lives we should have a chemical mandated by the government to be added to our water and food supply so that we can be lazy. We should have that same government fail to regularly monitor the average American’s daily consumption of fluoride or consider how it might be affecting their health, right? Finally, I guess the media also known as the 4th column should reinforce standard beliefs for the “good” of the people.^{54 55 56}

One of the so-called “dental care experts” is a dentist who is the oral care directory for Procter & Gamble who produces Crest, one of the bestselling brands of fluoride toothpaste in the world. Dentist J. Leslie Winston, oral care director for Crest-toothpaste maker Procter & Gamble, said the review “serves as an important reminder.” “Despite a large body of scientific evidence, there are growing numbers of consumers who believe that all toothpastes are the same and that as long as you clean your teeth effectively with a toothbrush or other device which cleans in-between the teeth, you can prevent decay,” he said in a statement. It appears to me that Winston feels threatened that people are buying less Crest, and the AP article talks references his fear. “The market share for fluoride-free toothpaste is closely held company data. Industry sources estimate it at no more than 5 percent of all toothpaste sold, but with projected growth of over 5 percent annually. On Monday, Tom’s of Maine antiplaque and whitening toothpaste, which is fluoride-free, was listed as the second-best selling toothpaste on Amazon’s online buying platform.”⁵⁷

The article quotes Paul Jessen that he states that Tom’s toothpaste does not promise to help fight cavities. “Paul Jessen, a brand manager at Tom’s of Maine, said “the products that don’t contain fluoride that we offer do not promise that benefit” to fight cavities. He said his company’s customers generally understand this.” Well, yeah, he cannot make the statement that Tom’s fluoride free toothpaste or any brand of fluoride free toothpaste can fight cavities because the Food and Drug Administration has not ruled that fluoride free toothpaste reduces cavitation formation. Remember, just because the FDA has not ordered that fluoride free toothpaste fights cavities do not mean that it does not work, our government is not omniscient. Most of Europe uses xylitol containing toothpaste over fluoridated toothpaste, and they do not have a severe epidemic of dental caries.⁵⁸

The article also quotes Gerald Curatola a dentist who founded Revitin, a company that produces a fluoride free probiotic toothpaste. “Gerald Curatola, the dentist who founded Revitin and now serves as chief science officer, called the review “misleading.” He said that the latest science suggests that a healthy mix of oral bacteria is key to dental health. “I don’t think fluoride makes a difference at all,” he said. However, referring to his company’s decay-fighting claim, he added: “After this call, I’m probably going to remove that from the website, because I don’t think that should be on there, because I didn’t know that was on there.” I agree with Dr. Curatola, but I could see where some people would argue his quote and logic is biased because of the toothpaste his company sells. However, I think it is a shame that he cannot claim his toothpaste fights decay because it does not contain fluoride. Revitin appears to fight decay by providing probiotic bacteria for the oral cavity, CoQ10/vitamin C/silica to reduce gum inflammation, and vitamin K2 to help prevent cavity formation. However, there is no xylitol used in Revitin, because it would reduce the chances of colonization of the probiotic bacteria used in the toothpaste.⁵⁹

The article concludes:⁶⁰

“The review also cited a 2009 analysis of studies involving 60,000 people that found fluoride rinse prevents cavities about as well as fluoride toothpaste.

In 2016, The Associated Press reported on the poor scientific evidence for the benefits of flossing. As a result, the federal government removed its long-standing flossing recommendation from Dietary Guidelines for Americans.

The review raises questions about how cavities form. Cavities have long been thought to develop in a poorly cleaned mouth when acids left by food start to wear away tooth enamel. The idea is that clean teeth do not decay. This review, though, argues for an alternate model: cavities grow in tiny crevices in the enamel that can’t easily be reached with a toothbrush or dental floss alone.

Despite the clear benefit of fluoride, some studies have also challenged the belief that fluoridated drinking water stops dental decay as well as fluoride toothpaste or rinses. In any event, it makes sense to combine fluoridated water and dental products for amplified protection, said Niederman, the NYU dentist.

Some dentists also said the most effective way to prevent cavities is simply to reduce sugars in the diet.”

So what is the information that can be gathered from the study and is it legit?

The Study, “Personal oral hygiene and dental caries: A systematic review of randomised controlled trials“

Ever scrapped off that white film of your teeth if you have not been able to brush in a while. The white film is biofilm. We brush our teeth to break up bacterial biofilm colonies and prevent them from producing acids that degraded our demineralize and degrade our enamel which forms cavities. Cariogenic bacteria that produce acids prefer simple carbohydrates for survival. Cariogenic bacteria preferring simple carbohydrates are why we are indoctrinated after birth that eating large amounts of sugar, usually in the form of candy will “rot your teeth.” Cariogenic bacteria prefer simple carbohydrates because they do not have time to ferment complex carbohydrates that we ingest like other bacteria further in your digestive tract. Food does not stay long enough in our oral cavity to be fermented before it is swallowed. Depending on the depth of a cavity in a tooth cariogenic bacteria are eventually able to colonize the dentin and the pulp of a tooth causing an infection. Once a tooth is infected, it may need to be removed, or the infection can spread to other parts of the body through the bloodstream including the heart. The above information on the formation of cavities is known as the oral hygiene hypothesis.⁶¹

The new study “Personal oral hygiene and dental caries: A systematic review of randomised controlled trials,” puts forth information to prove a newer hypothesis for the formation of cavities, known as the dental defect hypothesis. “The dental defect hypothesis posits that dental caries starts in microscopic cracks or crevices in teeth, and not on defect-free or sound enamel. The biofilm within the dental defects is also thought to become cariogenic in the presence of dietary carbohydrates. However, the biofilm cannot be removed with a toothbrush or interproximal cleaning devices; hence, oral hygiene is believed to be ineffective. Under this alternative hypothesis, prevention of dental caries must focus on preventing the formation of dental defects during odontogenesis, by repairing the defects from the pulpal side, or by sealing or surgically eliminating surface defects in the enamel. Historically, the motto of the proponents for the dental defect hypothesis was that “sound teeth do not decay”.⁶²

I believe that the dental defect hypothesis is a refined version of the oral hygiene hypothesis. It might be possible that teeth that are healthy and strong without any defects would not succumb to dental carries if the person ate a healthy diet (Perfect Health Diet for example), ingested or supplemented adequate amounts of calcium, magnesium, phosphorus, boron, potassium, vitamin D, vitamin K2, and avoided consuming very low pH sugary beverages like soda. That being said I still believe that brushing is important for oral health, to reduce biofilm formation even on healthy teeth, but I do find the dental defect hypothesis to be fascinating. Where I disagree with the rest of the study is that instead of suggesting ways to make sure the body has enough of the correct vitamins and minerals to make healthy teeth or changes in diets (which in Figure 1 they briefly list on a diagram) the study instead focuses on the need and importance for fluoride in preventing caries.^{63 64 65}

The study is a meta-study, which means it is a study that analyzes other studies that have been done and reaches a conclusion based on the information. “A total of 984 unique citations from 3 sources were identified. Thirteen references of interest were identified for full-text review, which included 12 published articles and one abstract for which we obtained the NIH grant report. After full-text review, three randomized trials were included. Four non-randomized trials were retained for the purpose of sensitivity analyses” So, out of 984 records, 13 full-text articles were assessed for eligibility and out of those six were excluded, leaving 7 full-text articles. Out of those articles “three randomised trials on 743 participants (children) were identified” and were what were used to justify the results of the meta-study. For big academia a study based off of 743 participants is a small sample size, even the author of the study admits that in the AP article. “Even without fluoride, dentists say there’s some value in brushing. Philippe Hujoel, the dentist and University of Washington professor who led the dental review, said oral hygiene without fluoride might produce real cavity-fighting effects too small to detect in a study, or adults might conceivably benefit where the children in the studies did not, and tooth brushing did reduce swollen gums in Hujoel’s review. Brushing the teeth may also dislodge stuck food and help patients recover from oral surgery.” Finally, the meta-study did not analyze the referenced studies for bias “Meta-regression or statistical assessment of publication bias was not performed due to the limited number of trials and minimal variability in terms of duration or quality of the randomised trials.”⁶⁶

The first study that is referenced is also a meta-study “Mechanical and chemical plaque control in the simultaneous management of gingivitis and caries: a systematic review“, the study did look for biases in the studies (data reference point inconsistency, but not funding to my knowledge) that were referenced and there was a conflict of interest and source of funding statement, so I applaud them for fact checking and honesty. My main issue with this meta-study is like the current meta-study I am writing about, the meta-study uses the next two studies as trusted references to show evidence that fluoride use is the main way to improve oral health. The other two studies that are referenced in the study for the statistics have major flaws. The second study that was referenced is “Effects of supervised daily dental plaque removal by children after 3 years“. For one, this study was performed between 1979-1980. It is rare that I will reference earlier studies (thirty years or more) in my work because research and theories constantly change. There is no consideration of biases listed in the study, conflict of interest statement, or source of funding statement in the study. The ingredients of the fluoride-free toothpaste used in the study are unknown or if xylitol was even used in the study. In addition, the study had big potential conflicts of interest with the National Caries Program and the NIDR (National Institute of Dental Research) being acknowledged in the study for helping with the study and one of the authors of the study being involved with the NIDR. The NIDR funded studies that advocated how to protect teeth from excessive sugar consumption instead of promoting the hypothesis that excessive sugar consumption can cause health issues including dental carries. For more information on the NIDR and how they were sponsored by sugar manufacturers, read this great blog article and study. Finally, the third “study” “Effect of Supervised Deplaquing on Dental Carries, Gingivitis, and Plaque,” contains an abstract of what appears to be a presentation? If anyone can find the actual presentation or study, I would love to analyze it. The presentation was funded by the NIDR (NIDR Contract N01-DE-32424) and is listed at the bottom of the abstract.^{67 68}

Interestingly the study does mention in conclusion the importance of vitamin D in the prevention of dental caries. “According to the dental defect hypothesis, the dramatic decline of caries in wealthier countries that occurred in the second half of the 20th century is attributed to the widespread use of dietary vitamin D supplements to overcome epidemics of pediatric malnutrition” “The dental defect hypothesis is also consistent with the effectiveness of vitamin D” Vitamin D, among other important vitamins and minerals can lead to healthy teeth that are resistant to developing dental caries. I believe vitamin D should be endogenously produced if possible through proper sunlight exposure. I find it interesting nonetheless that even the study admits it is crucial for the health of our teeth.⁶⁹

The study concludes “This review does not question whether clinicians should provide advice on the potential benefits of oral hygiene for preventing dental caries. There is still substance to the arguments that small therapeutic effects of personal oral hygiene remained undetected in statistically underpowered trials, that findings in healthy paediatric populations with no exposed cementum do not extrapolate to adults with exposed cementum or decreased saliva flow, or that adults with other systemic diseases or disorders may benefit from personal oral hygiene in terms of dental caries prevention. Indeed, oral hygiene can be a pleasant and cost-effective way to deliver fluoride, reduce gingivitis, remove food impactions, or to help patients in their recovery from oral surgical procedures. The dangers in the unqualified promotion of oral hygiene for dental caries prevention are that it may lead individuals to select fluoride-free toothpastes, to sacrifice effective fluoride exposure for interproximal cleaning without fluoride, or to forego effective therapeutics such as fluoride rinses. Such beliefs which reduce fluoride exposure increase dental caries risk and are most dangerous when used as a justification to promote sugar consumption, and to perpetuate the myth that sugar is safe to eat as long as one brushes their teeth.” I do have some issues with the studies conclusion. First, I rarely have seen anyone advocating that habitual sugar consumption is safe for your health as long as one brushes their teeth, except for sugar manufactures that funded the NIDR for that exact purpose. The study bases its conclusions on two studies that had a strong relationship with the NIDR. I find it biased that the most important and first listed part of proper oral hygiene is that it is a “cost effective fluoride delivery system“. Using that logic why not consume public fluoridated water, because obtaining fluoridated from public water fountains is free? There was no critical examination of fluoride in the study, let alone any mention of the known issues fluoride use even incorrectly by their standards like dental fluorosis. Finally, there are no disclosure or mention conflicts of interest or sources of funding in this study.⁷⁰

Conclusion

As I wrote in Fix Your Gut “The most overlooked body part of digestion is the mouth.” Many people do not realize that their digestion starts in the mouth. We masticate our food thoroughly, so our stomach does not have to work as hard. We produce saliva to moisturize our food, and our saliva contains small amounts of digestive enzymes like amylase to help break down carbohydrates. The health of cavity is also overlooked and because of that many of us are suffering from many chronic health conditions. The following is a link to some oral care products I use and recommend including toothpaste and mouthwash. I also recommend that people follow the oral health advice published by the Weston A. Price Foundation and the information provided in the excellent books of Ramiel Nagel. I recommend brushing at least once or twice daily with a xylitol-containing essential oil toothpaste, avoid or consume less refined sugar, avoid low pH sugary drinks like soda and energy drinks, using correctly a water flosser with non-fluoridated filtered water, using a copper tongue scraper, and oil pulling for ten to twenty minutes once daily. Adequate amounts of calcium, magnesium, phosphorus, boron, potassium, vitamin D, and vitamin K2 are essential for proper teeth health from diet or supplementation. Finally, if everyone followed the recommendations in this blog instead of placing toxic amalgams in their mouth, getting root canals, and using unnecessary fluoride toothpaste our overall health would be better.