Cavities and Braces

The other day, I got a message from a friend of a friend, asking me for some insight into the dental health of her two daughters. Since the questions were about topics that are such common challenges for parents, I felt it would be beneficial to take the time to write a detailed response on these topics, and share it as a blog post so that others can benefit from these insights as well. As a biological dentist, I strive to help patients identify the root cause of their dental issues, and give them the tools and knowledge needed to make positive changes in their lives.

This was the message:

“Hi Julian, this is Monica, Emily’s friend from Toronto. I wanted to ask you about my girls’ (14 and 12) teeth. I am particularly concerned about the younger one now. The older one has had full braces for 2 years now. The orthodontist is insisting the younger one needs them as well. I am wondering if it is necessary and frankly I am concerned about the treatment. She also struggles with cavities despite the fact that we don’t eat junk food and I limit sugar. 

Thank you so much for your help.”

Here is my response:

Thanks for reaching out to me. I will do my best to provide you with as much helpful information as possible. There will be a lot to digest here so just take it slow and let me know if you have any follow up questions.

 

First, let’s address the cavities, aka dental caries or tooth decay. 

Tooth decay is the most prevalent chronic disease in the world!

It is truly an epidemic, and, it is 100% preventable. We will talk about this more in a minute.

In my professional opinion, you should never just take a dentist’s word for it that you or your child has a cavity and it needs to be treated. The dentist should be able to show you the cavity they are talking about, either on an x-ray (which can be confirmed by other dentists), or even better, with an intraoral photograph as shown above (keep in mind that some cavities are only visible with X-rays). This way, if you are unsure, you have the ability to request the photograph or x-ray, and seek a second opinion.  

 

I’ll quickly start by saying, yes it’s important to avoid processed and refined sugars, as well as acidic beverages, as these can certainly destroy teeth. It is also good to avoid things like crackers (goldfish) and dried fruits as these things get stuck in the teeth. Fresh breads and fresh fruits aren’t really a problem, and it is important to get the kids in the habit of rinsing their mouths out really well with water after they eat. Proper tooth brushing is also important, and for kids with braces I would recommend a waterpik to clean food out from under the brackets and between all the teeth. The message here is that it is important to get the crap off of your teeth! 

 

The other factor to be aware of is:

Saliva

Saliva is our body’s natural cleaning and buffering solution that helps keep our teeth healthy. Saliva maintains the equilibrium in our mouths. Every time we eat, we take our oral environment out of balance, usually to a more acidic state, and it takes time for balance to be reached once again. However, if we are constantly snacking throughout the day (even if the snacks are healthy), our oral environment is constantly out of balance, which can lead to problems with dental decay. Therefore, my best recommendation for families is to have organized meal and snack times throughout the day, and for the rest of the time the kitchen is closed! Don’t forget the important habit of rinsing with water after any food.

Other factors that influence healthy salivary flow are:

 

1) Hydration – naturally, optimal hydration will encourage optimal salivary flow. I recommend adding electrolytes (such as Nuun, or LMNT) to water for improved hydration.

 

2) Medications – We frequently see this problem in dentistry. Patients who are taking multiple different medications will often experience dry mouth, or xerostomia, as a side effect. This reduction in salivary flow can have disastrous consequences for the teeth. This is where we see the highest prevalence of dental decay, and it illustrates just how crucial healthy salivary flow is to the health of the teeth. Patient’s in this situation need to take extra precautions to try to stave off dental decay, such as using products like Biotene that help stimulate salivary flow. 

 

3) Diet – Diets that are high in carbohydrates, particularly from grains, tend to alter the pH of the saliva, and will also lower the salivary flow. These would be breads, pastas, rice, and other grains, as well as white potatoes. Alcohol will also have similar effects. You can do this experiment yourself. Eat a big bowl of pasta for dinner, wipe up the extra sauce with a nice piece of bread (my favourite), maybe have a few glasses of wine as well, and try to notice if your mouth feels really dry through that night as you are trying to sleep. I’m not saying that you need to cut these things out completely, but just that they should not be the dominant food on the dinner plate. See the Food Design Pyramid below for more on this.

Now onto the not so obvious stuff:

 

I want you to remember this as you go through all this material:

A healthy body is immune to tooth decay!

This isn’t taught in dental school, and so you’ve probably never heard this from a dentist. It is very similar to the core tenant of Naturopathic medicine, that: “The body has the innate ability to heal itself.”  I first heard this from Dr. Larry Palevsky.

 

Okay so what does this mean? It means that if the nutritional and mineral needs of the body are being met, and if the oral environment is treated properly, the teeth will not decay. You see, teeth are storage reserves of minerals in the body. Unfortunately, our agricultural practices over the last century have depleted the minerals in our soils, so our food does not have the mineral content that it should, including organic food.

See the following charts, which I pulled from an excellent presentation given by Dr. August Dunning entitled: Habitat Crisis which can be viewed here.

The first chart illustrates the degradion of mineral content in soil over time, and the second illustrates how much more of a given food we need to eat in order to acquire the essential minerals and nutrients that we need. Minerals are the spark plugs of life. Check out the work of Dr. Leland Stillman here to learn more about essential minerals.

Side note: this is also part of the reason why obesity is so prevalent in our society today, where it once was quite uncommon (see photo of a 1970’s beach scene). We now need to eat higher quantities of food in order to meet our metabolic needs. We are starving in the face of plenty.

When the body is mineral deficient, one thing it will do is leetch minerals from the teeth (and bones later in life) to meet its metabolic needs. This is why we commonly see pregnant women or new moms, with no history of dental decay, come in and suddenly have several cavities. Their body is taking minerals from their reserves in their teeth to grow a healthy baby.

 

Here are 3 ways that I recommend getting more minerals in to yours and your kids diets:

Mineral Shilajit – https://cymbiotika.com/products/shilajit-normal-jar (we make a tea with this or you can just add it to food)

Celtic Sea Salt – https://www.healthyplanetcanada.com/celtic-sea-salt-fine-ground-bag-454g.html (Use lots of this in your food and you can also add it to your drinks)

Actimar Marine Plasma (Canada) or Quinton (USA) – https://www.shopactimar.com/en/product/actimar-hypertonic-pure-marine-plasma-1000-ml-economy-size-bottle (Keep in fridge, get a dropper and add this to your drinking water, about 10mL per L of water) https://waterandwellness.com/collections/quinton/products/original-quinton-hypertonic-30-amps

 

Click here to learn more about Quinton Marine Plasma.

Okay next is nutrition. The most comprehensive work on this topic was done 100 years ago by a dentist named Weston Price. You may have heard of the Weston Price Foundation, they are a great organization and have community chapters all over North America and if you have one near you I recommend hooking up with them.  Weston Price concluded in his work that communities of people who had remained on their traditional agrarian diets, as opposed to switching to a modernized, industrialized, grain and flour heavy diet, grew larger jaws, had straight teeth, and did not have dental decay. Their diets were high in animal foods and saturated fats, like pasture raised meats, particularly organ meats, fish, eggs, and high quality dairy (hard to get nowadays). Particularly, it is the fat soluble Vitamins, A, D, E, and K, that are extremely important in healthy dental development. Vitamin D3 and K2 are particularly important in this. It is probably worth supplementing these two Vitamins and it should help with the cavity problems.

 

Here is a nice food design pyramid put together by one of the leaders in Biological Dentistry, Dr. Dominik Nischwitz:

He also has a great instagram account which I highly recommend following, here are a few good posts he made related to these topics.

Please note: it is important to take Vitamin D3 with cofactors K2 and also magnesium to avoid potential toxic affects of Vitamin D. Target blood level for 25-hydroxy Vitamin D is 150-200 nmol/L.

 

Dr. James DiNicolantonio also shares some great information on these topics on his Instagram account:

If you’re into this stuff and want to go into it in detail, there is a beautiful book called – Nourishing Traditions by Sally Fallon, that compiles the work of Weston Price into a cookbook of these traditional foods. If you want the condensed, short version, there is a dentist named Steven Lin from Australia who has done a great job bringing this knowledge to everyday people. I highly recommend you read his book – The Dental Diet by Steven Lin – this will give you a lot of clarity about your kids dental health and get you guys on track to solve this issue with the cavities.

Here are a few podcasts with Steven Lin:

Here are some sources of good quality meats, ideally you want to look for terms like pasture raised, grass fed, rotationally grazed, regenerative agriculture.

Best is to buy directly from farmers who are raising meat the right way, such as my friend Chris in Creemore at hogwildfarmingcompany.com, growingbrokefarm.ca, or wildmeadowsfarm.ca.

You can also find good stuff in butcher shops in Toronto now such as Rowe Farms, or in Durham at healthymeats.ca, or at grazeandgatherfood.ca.

If you link up with the nearest Weston Price Foundation local chapter, they will surely have some good connections for food. https://secure.westonaprice.org/cvweb_weston/cgi-bin/utilities.dll/openpage?wrp=chapter_dir.htm

The best way to get organ meats in to your kids is to get the meat grinder attachment for the kitchenaid standing mixer if you have one, and you make homemade burgers with ground beef, ground pork, and grind up some beef liver or chicken hearts to mix in with it all and then make burgers, meat balls, meat sauce, etc.

Okay now let’s talk about braces. Kids ultimately end up needing braces because their jaws are too small for their teeth, and so the teeth end up being crowded and do not fit in the jaw. This is also the reason why most people end up needing their wisdom teeth extracted. The best approach is to do all the right things early on to encourage jaw growth, which will avert the need for braces, as Weston Price so eloquently demonstrated.

These are the reasons why almost all kids these days end up needing braces:

1) Nutritional deficiency of the mother of the fat soluble vitamins A, D, E, and K that we discussed before and during pregnancy, and subsequently nutritional deficiency of the growing child.

 

2) No breastfeeding or babies not breast fed long enough (18 months is good).  – the physical stimulation from breastfeeding induces healthy growth of the upper and lower jaw, it also promotes healthy nasal breathing. Tongue ties can be a major barrier to breast feeding and so it is important to correct this if a problem. My brother is also a dentist and he helps families with this using an Yrbium Laser to release the tongue ties. You can find him here. https://durhamtonguetielaserclinic.ca/procedures-tongue-tie-release-durham/

 

3) Soft diet – our modern diet is very soft and doesn’t require much effort to chew. Think of how your jaw feels if you chew some tough beef jerky or some tough bread for while, sore right? This physical stimulation stimulates the growth of the jaws and facial structure. See the work of Mike Mew for more on this topic, such as this interview (https://youtu.be/JYpPu-NrYSI?si=ZaQVocphLqNF1s98) or this presentation (https://youtu.be/TY3bIMRKil8?si=0qW0AcuZfBsaLauR).

 

4) Postural issues such as mouth breathing. When we are not speaking or eating, our mouths should be closed, jaws relaxed (lips together, teeth apart), and tongue resting up on our palate. This facilitates healthy nose breathing and the tongue posture influences the proper growth of our jaws through our growing years. As I mentioned this is also what breastfeeding helps to facilitate as well. There is a great book on this topic called Breath – by James Nestor.

Okay so as for the specific needs of your kids right now with respect to the braces. It’s really hard for me to say what is the right approach for them. I do not specialize in this area, and I am still taking courses, learning, and networking with other dentists to figure out how to best help people in various situations.  I have been to some of Dr. Ben Miraglia’s lectures on this topic, and if it were my children I would do everything I could to avoid extraction orthodontics and I would bring them to see him in New York. https://bgmdental.com/about-the-doctors/dr-ben-miraglia/. What I like about his approach is that he works to expand and grow the jaws, rather than just making room and straightening the teeth. There are other great practitioners in the Toronto area who employ these techniques, such as Dr. Janice Goodman (https://dentistryintoronto.com) or Dr. Emily Trahatos (https://www.orthodonticsondanforth.com/meet-dr-emily-trohatos).

My specific area of focus within Biological Dentistry is dental implant surgery and the treatment of oral infection. Examples of oral infection are diseased teeth such as infected root canal treated teeth, and dental cavitations from previous unhealed tooth extractions.  I also focus on the removal of metals for patients who do not tolerate them well, and the replacement and restoration of teeth with biologically compatible, metal free materials such zirconia or other ceramics. If you or anyone else ever needs help in these areas I would be happy to be of service.

Lastly, here are some Instagram accounts that I highly recommend following that will reinforce and reiterate everything I’ve shared here:

@drjamesdinic

@drdome1

@drstevenlin

@askthedentist

@biological_dentist

@blodgettdentalcare

I hope that you find this information helpful.

 

Sincerely,

 

Dr. J