Volume 11, Letter 30
July 13th, 2021
Dental Care - Why is it so important?
We have intermittently discussed dental care over the last 11 years with regard to oral health as well as systemic health. There was an excellent podcast between Dr. Peter Attia and Dr. Patricia Corby two weeks ago looking at all things oral health. I am going to distill the 2 hour podcast down into a manageable read in this newsletter.
Dr. Corby is an oral health researcher from Penn Dental Medicine in Pennsylvania.
The tooth is a highly innervated and vascular structure despite being an apparent bone visually. It contains the hardest substance in the human body on it's surface called enamel. The enamel overlies the dentin which is a cushion that has nerves allowing for sensation. Below the dentin is the pulp which contains the vasculature and more nerves for cellular and cell signal activity. The pulp is the zone of odontoblasts that grow more dentin over time as well as being the zone of immune activity to protect the teeth from infection and disease. The tooth is cemented and ligamentously held into the jaw bone for stability and strength as the jaw muscles allow for functional chewing and grinding of nourishment. Image.
Teeth offer the primary function of grinding and tearing food which opens up the food's cellular structure to enzymatic degradation via saliva and later stomach acid and finally digestive pancreatic enzymes in the intestines. These processes unlock the nutrients for absorption and utilization.
The oral cavity in general plays an important role as the first location for our exposure to the outside world of food and bacteria. A child's oral cavity develops it's own bacterial microbiome over time after being initially inoculated by mom during the delivery process. The saliva of the mouth provides a medium for bacterial growth and maintenance. We are in a constant process of saliva production and swallowing which is our normal steady state. We have many different types of bacteria and they serve different functions symbiotically within us. As long as we maintain a healthy ecosystem for them by eating natural fiber filled whole foods, drinking water and avoiding medications or other activities that promote a dry mouth or the wrong microbes, we will be rewarded with health.
Oral hygiene is the other key piece of the puzzle for a healthy ecosystem of the oropharynx. To that end, Dr. Corby performed a study comparing flossing to not flossing in twins with the same pathogens and pre-gingivitis that adults with periodontal disease have and found that the group that does not floss has more dysbiosis(harmful bacteria) and gingival bleeding/inflammation. "After the 2-week study period, putative periodontal pathogens and cariogenic bacteria were overabundant in the group that did not floss compared to the group that performed flossing. Those included Treponema denticola, Porphyromonas gingivalis, Tannerella forsythia (previously T. forsythensis), Prevotella intermedia, Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), and Streptococcus mutans. Microbial species that are not consistent with the development of periodontal disease or dental caries were overabundant in the group that did floss compared to the non-flossing group." (Corby et. al. 2008)
Preventing periodontitis, inflammation of the area around the tooth, is a key piece of the heart and systemic health prevention strategy. Mild inflammation from periodontal irritation begins a process of loosening the periodontal ligament and gum tightness to the teeth. When the periodontal space around the tooth increases in size or pockets form, then bacteria have the ability to grow in these spaces leading to immune responses that we see as increased inflammation including redness and tissue loss. The tissue loss leads to more parts of the tooth including the base to suffer exposure to acid and other irritants. Eventually, we have cavities and tooth loss.
If you perform quality oral hygiene on yourself and your children, where then do things breakdown? The biggest contributor to poor oral health is excessive exposure to all forms of sugar as sugar is broken down by oral bacteria into an acid that can damage the enamel over time. Once the enamel is damaged then the dentin and finally the pulp are exposed to the acid which rapidly degrades the tooth and promotes gingivitis.
Human teeth are highly innervated almost like fingers. They work as sensory processing devices which are beneficial to protect the teeth against damage as a damaged tooth/teeth leads to decreased oral nourishment intake over time which evolutionarily would have led to starvation. Thus, a supremely hard tooth is highly advantageous to human and animal health in general.
The to do and not to do for oral health:
1) Try not to extract any teeth at any age as the tooth has a very specific job of holding space in the jaw bone which is its evolutionary job other than mastication
2) Brush your teeth, tongue and oral mucosa to vibrate or mechanically move bacterial biofilms off of the surface of tissue and into the salivary fluid for spitting out or washed out with water. Multiple times a day and especially at night
3) Floss in between all teeth after meals or at least before bedtime to remove excess food that the oral bacteria use as fuel for acid production
4) Do not use mouth rinses daily as they can kill off your good bacteria put you at risk for an opportunistic bacteria to gain a foot hold in the oral microbiome
5) Eat lots of fibrous vegetables and fruits as the process of eating mechanically removes biofilms on the tooth surface
6)Use flouride based tooth paste over the age of 1 year old especially when living in a house with well water. Young children under 5 years old should use a rice grain sized amount on the tooth brush to control the volume of fluoride
7) If you have dry mouth issues, chewing xylitol based gums can help keep saliva active and also protect the teeth by the active ingredient altering the microflora of the oral cavity. Xylitol is a 5 carbon polyol sugar that promotes oral flora that prevent cavities in humans. (Nayak et. al. 2014)
8) Control inflammation with diet and supplementation. The Mediterranean diet or an anti inflammatory diet are great places to start by loading the system with natural food based chemicals that promote inflammatory resolution and do not promote inflammation in general. Proresolving lipid mediators found in omega 3 fatty acids from fish oil have beneficial effects systemically for controlling an over inflammatory immune response as seen in periodontitis. (VanDyke T. 2011)