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Dental Health And The Paleo Diet: Gingival Sulcus Depth, Periodontal Disease, Systemic Inflammation, and Some N=1 Data

I recently visited the dentist for my regular six-month cleaning and checkup.

One mysterious practice you might recall from your own checkup is your hygenist probing around your gums with a pick, while calling out a bunch of numbers that someone else dutifully records in a computer.

This isn’t some mysterious rite of Dental Magick: they’re measuring the depth of each gingival sulcus—the space between your tooth and your gums. Ideally, in a healthy mouth with healthy gums, this space is approximately 2mm deep, a depth easily reachable and cleanable by regular brushing.

However, most people do not have a healthy mouth with healthy gums. Somewhere between 30 and 50% of the US population has mild periodontitis (inflammation of the gums), with approximately 10% having severe periodontitis.

Plaque and Periodontitis: A Vicious Cycle

The usual cause of periodontitis is dental plaque (a bacterial biofilm), which accumulates in the gingival sulcus. The resulting inflammation causes the sulcus to deepen, beginning a vicious cycle: more plaque = more inflammation = deeper gingival sulcus = more plaque.

A depth of 4mm or more almost always indicates a degree of permanent damage and chronic infection, and is termed a periodontal pocket. Since pockets deeper than 3mm are generally too deep to clean by brushing one’s teeth at home, they tend to become deeper and worse over time, leading to chronic periodontitis—and a depth of 7mm creates a strong risk of tooth loss.

Periodontitis Causes Constant, Low-Grade Inflammation

Even if the pockets never reach this depth, the continual low-grade oral infection of periodontitis (known colloquially as “gum disease”) causes systemic inflammation. We know this is a causal relationship, not just a correlation, because successful treatment of patients with severe periodontitis results in lower CRP and IL-6 levels:

J Clin Periodontol. 2004 May;31(5):402-11.
Periodontitis and atherogenesis: causal association or simple coincidence?
D’Aiuto F, Parkar M, Andreou G, Brett PM, Ready D, Tonetti MS.

“A median decrease in serum CRP of 0.5 mg/l (95% CI 0.4-0.7 mg/l) was observed 6 months after completion of periodontal therapy in this population.”

Also see:

J Periodontal Res. 2004 Aug;39(4):236-41.
Periodontal disease and C-reactive protein-associated cardiovascular risk.
D’Aiuto F, Ready D, Tonetti MS.

Given this, the strong association of periodontitis (“gum disease”) with deaths from coronary heart disease (= CHD, = “atherosclerosis”, = the blockage of the coronary arteries due to arterial plaque) should not be surprising.

J Periodontol. 2007 Dec;78(12):2289-302.
Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis.
Mustapha IZ, Debrey S, Oladubu M, Ugarte R.

RESULTS: Periodontal disease with elevated markers of systemic bacterial exposure was associated strongly with CHD compared to subjects without PD, with a summary odds ratio of 1.75 (95% confidence interval (CI): 1.32 to 2.34; P <0.001). This group was not associated with CVD events or with stroke but was associated with a significant increase in mean CIMT (0.03 mm; 95% CI: 0.02 to 0.04).

In further support, periodontitis is associated with lower HDL, higher LDL, and increased non-fasting blood glucose:

J Clin Periodontol. 2007 Nov;34(11):931-7. Epub 2007 Sep 17.
Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case-control study.
Nibali L, D’Aiuto F, Griffiths G, Patel K, Suvan J, Tonetti MS.

Summary: Our Story So Far

  • Dental plaque is a bacterial biofilm that accumulates on our teeth.
  • Plaque causes tooth decay—because of the acids the plaque bacteria produce when they ferment sugars in our mouth.
  • A gingival sulcus (the space between tooth and gum) deeper than 3mm allows plaque to accumulate unmolested by regular brushing. Its ideal depth is 2mm.
  • Plaque accumulation is usually a vicious cycle: more plaque = more inflammation = deeper gingival sulcus = more plaque.
  • A sufficiently deep sulcus is known as a periodontal pocket, which usually leads to periodontitis (“gum disease”), and sometimes tooth loss.
  • Periodontitis causes systemic inflammation. It is associated with increased risk of heart disease, and with several bad metabolic markers.

Result: we would like all the measurements our dental hygenist calls out to be 2s (signifying a depth of 2mm), with perhaps a few 3s.

A Paleo Diet And My Own Gum Health: Some N=1 Data

I’ve cautioned about extrapolating based on personal experience (“N=1″) before, so I’ll preface this with “correlation is not causation, etc.” However, my warning applies primarily to proving the negative: just because something doesn’t make us feel bad or kill us within a few months doesn’t mean it’s either harmless or good for us!

If we take objective measurements and/or a consistent record of our observations, though, and are careful to evaluate possible confounders (was it that I started eating liver and pastured eggs, or that I got a new job and am sleeping better now that I don’t have to worry about making rent?), it’s often reasonable to correlate improvements with changes we’ve made.

To that end, here is some fascinating data I was able to obtain from my dentist’s office. I think the data is reasonably solid: my measurements were all taken by the same hygienist in the same office, I’ve used the same Sonicare toothbrush and kept the same program of indifferent dental hygiene, and my diet hasn’t changed radically.

Links updated 10/13!

Note that there are several different types of Sonicare toothbrushes: the type I linked above works best, is easiest to clean, and its battery lasts the longest. And if you need two, here’s a two-pack at a discount.

Also note that I was already eating a strongly anti-inflammatory diet previous to “going Paleo”: I had independently found the original research on n-3/n-6 ratio, and had long since removed all seed oils from my diet (I was rendering my own beef tallow back in 2007!) The major dietary changes were going gluten-free, grain-free, and legume-free (except for occasional white rice), and dramatically decreasing my carbohydrate intake—mostly as a consequence of no longer eating bread or pasta.

I went Paleo between the first and second measurements. Therefore, the first set of measurements (#1 on the far left) is my pre-Paleo baseline.

Each tooth is measured six times: at the center and each edge, both front and back. Thus, there are 28x2x3 = 168 such measurements if your wisdom teeth have been removed, 192 if you still have them. For those interested in the raw data, here’s a scan:

Note that there are no 4mm pockets at all after the third set of measurements.

Result: starting from a reasonably healthy mouth and an already strongly anti-inflammatory baseline diet, my oral health has improved dramatically—to the point that my dentist told me “Your teeth are great! Whatever you’re doing, keep doing it.”

I have also experienced subjective improvements. My teeth are much less sensitive than before: I used to dread the approach of the electric tooth scaler at each cleaning (it was painful to the point that I would white-knuckle the armrests) but now it doesn’t bother me at all. They’re far less sensitive to cold as well, and less prone to bleeding when I neglect to floss for days or weeks.

In short, while I can’t rule out coincidence, it certainly appears that my excellent dental health is strongly correlated with eating like a predator.

Live in freedom, live in beauty.

JS

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63 comments

Permalink: Dental Health And The Paleo Diet: Gingival Sulcus Depth, Periodontal Disease, Systemic Inflammation, and Some N=1 Data
  • The High Fat Hep C D

    Pretty much all my teeth crumbled away after years on a high-carb diet with gluten and sugar (and, to be fair, taking drugs), and I had frequent abscesses. Eventually some years ago I had all my top teeth out and all the bottom except for 7 at the front. About then I switched to paleo – grain free, low fructose, lots of animal food and fat.
    Even though my remaining teeth are full of big cavities, they have not broken, chipped, become infected or acquired any new holes since I changed my diet (and, to be fair, gave up drugs). At this rate, they may last as long as I do.
    I wish I’d known about this sooner!

  • Donald Savchuk

    Keep sending these articles, Awesome! Since on Paleo 3 months:
    Weight 221-200
    Cholesterol 209-163
    HDL 51-56
    LDL 140-100
    BP 140/80 117/72
    HR 72-58
    I feel incredible, younger, and tons of energy!

  • Marilyn

    Interesting! What kind of toothpaste do you use? I haven’t had a filling in 20 years. I credit our straight-from-the-ground hard water that I’ve been enjoying since moving here. But if I use any products with sorbitol — which is most toothpastes and flavored mouthwashes — I can kick up a gum problem in a couple of locations. Apparently, bacteria can adapt to using sorbitol.

  • Birgit

    “Whatever you’re doing, keep doing it.”
    My dentist used exactly the same words during my last check up :-).

    He also said:
    “It’s very rare that we see this. Well, never, really.”
    (6mm deep pockets filling in and gums re-attaching.)

    Considering where I lived at the time, I dare say it’s simply very rare that they see people who don’t eat refined, sweetened junk.

  • Lauren

    Yeah, I used to be baffled that gingivitis and miscarriage are positively correlated. The bast I could figure was lifestyle factors independantly impacting both. But the systemic inflammation thing it the kicker; your body isn’t going to let you risk something like gestation with rot in the floor joists.
    I’ve had a pocket behind one tooth for a year that never gets better or worse. I tried oil pulling (inconsistently – didn’t like it) but abandoned the Sonicare plan due to costs where I am, but I may revisit that idea when I’m next in NAm because my HDL reading is kicking my ass.

  • icitizen

    I resisted oil pulling, until I read where using unrefined virgin organic coconut oil was helpful for gum health and deterring dental caries. I also am a daily user of therapeutic essential oils. I combined the two and found I was oil pulling faithfully every morning for a couple of months. My mind/body wanted and looked forward to it. After “swishing” for 20 mins each morning (is not as long as you think), I did an after rinse with warm green tea.
    I don’t have the hard data that Stanton does, but I noticed a
    definite improved feeling in my gums. Also, one tooth’s sensitivity, that never healed properly from a root planing procedure, is so much more improved. I have mixed feelings about dentistry. I will maintain the integrity of my teeth and oral environment through other successful organic choices.

  • Meesha

    I’m in the middle of reading Nutrition and Physical Degeneration by Weston Price. It’s a very good read and supports your N=1 experiment.

  • js290

    JS, I have the same experience as you. Before altering my diet, I was having receding gums and eventually my dentist told me to go to a periodontist for deep cleaning. Since changing the way I eat, I have stopped going to the periodontist, and my dentist doesn’t mention anything about gum problems any more. My only dental problem these days is chipping my teeth, but that’s probably due to my overly aggressive chewing.

  • Dan

    I have had very similar results. Paleo 2 years and 8 months now. No bleeding gums ever at my dental visits. I never floss, only Sonicare and toothpicks once in a while. My dentist was happy too.

  • Timothy

    Excellent! I can throw my own N=1 into the mix. On a strict paleo diet, I’ve also seen pockets reduced from 5 to 3 over the course of six months.

    My somewhat guilty confession: I am a daily flosser, and I drink tons of water and have salivary glands the size of walnuts, but I do not brush my teeth more than a couple times a month. Toothpaste just tastes wrong to me. Still I get the plaudits from the hygienist: “You’re doing very well, keep it up.”

    If only they knew I was a toothbrushing heretic…

  • Tcraig09

    I’ve been on the paleo diet for a few months now, not for anything serious but just to become more energized and healthy in general. While trying out this new diet It never occurred to me the positive effects it would have on my teeth and gum health. The tissue around my teeth is a much healthier pink and whenever I flush or brush, I don’t see one bit of blood, nothing. I am actually still getting used to it! This diet definitely has it’s benefits. To anyone just trying it out, make sure to have a good list of paleo recipes. It helps in the long run.

  • Jesse

    Thanks for sharing. Your assertion about what causes decay:

    “Plaque causes tooth decay—because of the acids the plaque bacteria produce when they ferment sugars in our mouth”

    May not be accurate. I did a lot of reading on it in 2012 when my cats started losing teeth. The alternative view is complex and I won’t detail it here but it is related to pH, primarily upset by high BG, and de-mineralization of the teeth due to nutrient deficiency. I.e. the bacteria are doing the body a favor, it is symbiotic. Hey bacteria, I need those minerals, I stopped sending nutrients in there a while ago, I will make the perfect environment for you to prosper by breaking down my teeth for me.

    Best,
    Jesse

  • Chuck

    My hygienist has said the same things to both me and my wife for the past 2 years. She makes these unprompted “Wow you are really looking good” remarks about my teeth and gums and has asked what changes we made.

    This has been a consistent thing ever since we started a lower carb Paleo diet about 2 years ago.

  • Ray Medina

    I want to also say that my dental health improved when I gave up eating gluten. I had to get my teeth cleaned every four months because of plaque buildup in spite of using a Sonicare toothbrush and daily flossing. Once I went gluten-free, the plaque disappeared and my teeth and gums have never looked better.

  • Cyclops

    Not sure where I read this but I think the normal flow through the teeth is from the inside to the outside..until you start eating sugar, which reverses it. Then all the bacteria and pathogens in the saliva are drawn into the core of the tooth creating cavities and infection..inflamation etc..it goes on to link heart disease with poor dental health. So don't be shy on the toothbrush or a stranger to your hygenist. Best way to keep things healthy is yet again to eat real food and not sugary foodlike substances.

  • George:

    I wish I'd discovered Paleo sooner, too.

    Donald:

    That's excellent progress!  Glad to hear of it.

    Marilyn:

    I've used the Tom's strawberry-flavored kids toothpaste, mainly because I don't like mint.  The ingredients don't mention sorbitol.

    Birgit:

    I don't have my older data, but I know I used to have several 5mm pockets.  Apparently it is possible, despite the claims that gums only get worse over time, for gums to reattach and heal — given a strongly anti-inflammatory, gluten-free diet and several years.

    Since my previous diet was very clean and strongly anti-inflammatory, I have to credit going gluten-free, and an overall decrease in carbohydrates, for the improvements.

    Lauren:

    Absolutely.  The study that shows a reduction in CRP after resolution of periodontitis is key: it shows a causal relationship, not just a correlation.

    The Sonicares are worth it IMO.  Note that Costco has the best price on brush refills, but Amazon appears to have the best price on the brush itself.  (Again, I recommend the ProResults version.  The battery lasts the longest, and the brush heads don't have crevices that get clogged with disgusting residue.)

    icitizen:

    Coconut oil is antibacterial and antiviral, so I can see why it helps.  I find it quicker just to brush my teeth, though!

    Meesha:

    I was very close to a WAPF diet before I switched to Paleo — and while I accumulated no cavities on that diet (my cavities date back to my vegetarian or guilty low-meat omnivore days) my dental health improved dramatically after the switch.

    js290:

    Apparently mouth bacteria feed on simple sugars…so if you're eating a lot of simple sugars, or eating a lot of starches that are well-digested by salivary amylase, you're giving your plaque much more to eat.  Our bodies clearly have some ability to fight plaque accumulation (Paleolithic humans had neither toothbrushes nor toothpaste), but a modern diet (and most agricultural diets, modern or no) appears to overwhelm it.

    Dan:

    It's almost like this stuff works!

    Timothy:

    As I said to js290, Paleolithic humans had neither toothbrushes nor toothpaste, and their teeth were excellent…so clearly there's something about the modern diet that makes regular brushing necessary.

    Tcraig09:

    It's hard to explain to people that there's a whole level of health beyond “I feel fine.”

    Jesse:

    It's clear that plaque feeding on sugar isn't the sole cause of tooth decay, because otherwise pure carnivores would never get cavities…but the fact that the plaque biofilm feeds on simple sugars is well-established and not controversial.

    Chuck:

    Hopefully we can continue to educate our healthcare providers!

    Ray Medina:

    Absolutely!  I don't know exactly how gluten contributes to gum disease: whether it's simply a systemic inflammation issue, or whether there's some direct effect in the mouth itself.

     

    Thanks, everyone!  Keep forwarding this article around, as it's important.  People balk at spending a few extra dollars on good-quality food — but when balanced against the cost of dental work, it suddenly starts looking like a much better deal.

    JS

  • eddie watts

    this very much backs the idea explored in good calories bad calories that poor dental health is followed roughly 10-20 years later by poor health in heart disease/cardiovascular disease and cancer development too.

    i imagine this was covered by other writers too, weston a price springs to mind, but i first read it there.

    i cannot remember where, but i do recall reading a theory that the body may “allow” a cancer to develop as a means to deal with excess blood sugar as a final ditch effort before going full blown diabetes.
    this would mean the body does not die so fast in the short term, due to the toxic glucose being consumed by the cancerous cell(s) protecting the rest of the organism.

    of course the longterm implications are pretty poor, but the body tends to focus on short term (keep alive long enough to procreate) rather than long term (live to be 100) anyway.

  • Tom Passin

    I’ve had a similar experience. After I retired and moved to New Mexico in 2008, I had no dentist. After about 2 years I drastically reduced the amount of starch I was eating, which used to be a lot. My goal was to reduce or eliminate my acid reflux, and that succeeded. I noticed that the amount of gunk coating my teeth reduced a lot.

    I have had periodontal disease most of my adult life,m and have lost about 5 teeth to it. Before I moved, I had pocketing measurements with lots of 4s and 5s, many 6s and 7s, and one bleck hole – too deep to measure.

    I have been using a sonicare toothbrush for a long time. About 2 years ago I read that some people have found that glycerin in the toothpaste causes problems since it keeps stuff stuck to the teeth. i tried sqitching to Ivory soap for brushing (not as bad as you’d think) since it seems to be low in glycerin, and finally using a toothpaste that does not list glycerin as an ingredient, unlike most of them.

    The other change I made was to stop flossing. I noticed that after flossing I often developed gum infections – incipient abcesses – that would have to be controlled with antibiotics. I changed to using little “proxy brushes”, and that problem has gone away. i also take a lot more vitamin C, and when I do get signs of a gum infection, I push more – the infection then goes away in days without antibiotics.

    This year, after 4 years without seeing a dentist, I got a through dental exam and cleaning. No cavities, and my pocketing was less than before. The dentist of course advised getting cleanings at least 3 times a year to “stay on top of things”. My thinning is that if after 4 years my mouth was better off than ever before, why should I even consider getting regular cleaning?

  • Againstthegrain

    I really liked the very clean feeling I got with a Sonicare toothbrush, but never experienced any improvement in my 3, 4, & 5 mm gum pockets when I used it, despite regular 3 x year hygienist cleanings, brushing 2-3x day, and a low starch/low sugar/GF/paleo diet. By accident on an overseas trip without my Sonicare I discovered my Sonicare toothbrush was probably the source of the nighttime tinnitus I’d been experiencing for several years, so I went back to using a manual toothbrush. I resumed and stopped using the Sonicare brush several times to test that the tinnitus was definitely caused by its use). YMMV.

    Last year while undergoing orthodontic treatment (at age 49) to broaden my narrow and slightly crowded dental arches and improve my bite (mild malocclusion was the likely cause of abfractions on some of my teeth due to force loads), I began using a sulcabrush regularly along my gumline to target areas where a regular toothbrush couldn’t easily reach with the wires and brackets in the way – wow, what a difference that little brush head made! The braces have been off for 7 months now and I continue to use the sulcabrush along the gumline – at my recent dental hygiene visit my pocket measurements were reduced (though I’m hoping there will be further improvement next visit), the pronounced gumline sensitivity during scaling was greatly reduced, and my gums no longer bleed at all when flossing (and oh, do I love to floss now that my teeth no longer feel crammed together, and I no longer am restricted to the thinne$t and $lipperie$t name-brand flo$$e$).

  • Cyclops:

    I don't know enough about tooth biology to comment.

    eddie:

    It's more data in support of the central role of systemic inflammation (as opposed to “cholesterol”, or any other measured number) in heart disease.

    That being said, I suspect high TG and low HDL generally go along with high CRP.

    Tom:

    I also use interdental brushes instead of flossing.  They're much quicker and easier to use, and I suspect that flossing just pushes a lot of the gunk deeper instead of pushing it out!

    Regular cleaning, if performed properly, certainly won't do you any harm, and may well do you a great deal of good…but 3 times a year is excessive.  Every six months is usually enough AFAIK unless your hygiene is terrible, and those of us eating clean Paleo can probably go longer.

    Againstthegrain:

    I've used a Sonicare since forever, so it's not the cause of my recent improvement.  That's interesting that you found it aggravates your tinnitus!

    I've never used a Sulcabrush, but I bet it's magical when you've got braces in the way.  As I said to Tom, I've use interdental brushes instead of flossing for many years…and it seems to be working, so I'll continue.

    JS

  • pam

    JS,

    what is the unit on the y axis?

    my teeth were not too bad to begin with; the pockets were rarely deeper than 4 mm, except few sensitive spots. there was a spot in gum that would get infection or inflammed every 2 years.

    when i first switched diet, the first thing i noticed was the improvement dental health before anything else. (didn’t have to loose weight so not much too tell).

    but i’m still left with receding gum. is there way to regrow it back? it does not give me any discomfort tho.

  • eddie watts

    JS you said “That being said, I suspect high TG and low HDL generally go along with high CRP” i assume CRP means Cancer Rate Production?

  • Mike B

    Eddie
    I believe he means C Reactive Protein.

  • neal matheson

    I had a brush with peridontal disease some years ago, I ate copious amounts of fruit working on a fruit farm along with bread etc.Dental health (which is subsidised but not free in the UK) is the main reason I am tight with my sugar intake despite pretty high sugar (honey) intakes of several Hunter gatherer groups.

    I won’t allow my daughter (2 years old) to eat any sugar as it is pretty hard to brush her teeth, I have actually been called “cruel” for this. Every one of her peers is given sweets and fruit juices. I had no sugar as a small kid and didn’t have any cavities until I discovered fizzy drinks at university.

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  • heather

    I’ve had a lifetime of dental problems (9 cavities in 5th grade) – I’ve had fillings fall out and have had fillings replaced. Cavities as a child (constant). In my thirties it was root canals and crowns (no my dental hygiene was never great but I tried). It was cracked and broken teeth which I blamed on my nighttime grinding. They couldn’t drill without breaking the tooth. It didn’t matter how much I brushed and flossed at this point. It came to a screeching halt when I went Primal. And my “dental hygiene” is actually worse now. I use my WaterPik and occasionally brush with whitening toothpaste because I’m a coffee drinker. That’s it. It was a 180 degree turn around for me.

  • heather

    Oh yes, I did go through the numbers games at the dentist. They were pretty bad. 2 weeks of faithful brushing and flossing (I HATED FLOSSING!) kept me from the deep gum cleaning. Little did I know…

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  • Marilyn

    @ Cyclops: I saw something like that, too, but can’t find it now. As I remember, the illustration was about the pH of the mouth — when the mouth is too acidic, minerals flow out of the teeth, but when the mouth is more basic, minerals flow into the teeth and the teeth can actually remineralize somewhat. A paleo diet, by reducing food for acid-generating bacteria, probably automatically adjusts the pH of the mouth.

  • Marilyn

    JS, thanks for the info on the Tom’s strawberry flavored toothpaste. Sounds good. I’ll check it out next time I’m at the health food store.

  • Elenor

    What is y’all’s take on Xylitol toothpaste (and chewing gum)? My dentist was pleased when I said I was using it. (Spry in the brand I use — they have a nice peppermint, and cinnamon, and I forget what-all else.) As I understand it, the Xylitol starves the bacteria so they can’t dig holes in your teeth.

  • usrbin

    Another interesting read on the topic can be found here:

    http://www.agd.org/publications/articles/?ArtID=9892

    The article is a bit of a long read. But it details the acid theory vs the proteolysis-chelation theory of dental caries. The articles puts forth the notion that we may have been going down the wrong path of how dental caries are formed due to a dominant (and unproven) theory. In my mind, there is also a certain parallel with dominant (and unproven) nutritional theories that drive research and policies.

  • Grafvitnir

    Being a periodontist and having eaten a paleo diet for almost three years I had to add this:

    http://www.ncbi.nlm.nih.gov/pubmed/19405829

    http://www.zora.uzh.ch/25306/2/Baumgartner_Impact

    to the reference list :)

  • pam:

    Y axis is the total pocket depth in excess of 2mm/tooth.  You can look at the chart to see the original data.

    I’m not sure that receded gums ever grow back, but I’m open to correction here.

    eddie, Mike B:

    Exactly.  CRP is C-Reactive Protein, an approximate measure of systemic inflammation.

    neal:

    That’s one reason I’m skeptical that our post-chimpanzee ancestors ate a highly frugivorous diet…as I point out in this article, their tooth enamel simply wasn’t built to withstand the acids and sugars.  And the experience of many modern raw vegans underscores this point.

    heather:

    I’m glad things have improved for you!  Thanks for sharing.

    Marilyn:

    “Health food” stores usually carry a selection of non-traditional toothpastes, many of which are sorbitol-free…particularly those intended for kids.

    Elenor:

    Apparently xylitol is non-fermentable, so plaque bacteria can'’t use it as a food source.  There are also some anti-streptococcal effects specific to xylitol: Wikipedia footnotes this book as a source (particularly see p. 204).

    usrbin:

    That’s very interesting!  I’m not really qualified to judge it, but it seems like the upshot is: simple sugars, particularly sucrose, indeed cause tooth decay, though by a different mechanism (inhibition of the hormone that controls dentinal fluid flow).

    Grafvitnir:

    That's a great reference: thank you for linking it!  

    (The second link is a PDF version of the first)

     

    I'm finally caught up.  Thanks, everyone, for sharing your experiences…and please continue to do so!

    JS

  • Marilyn

    Elenor, I just bought some Spry online. When I got it and discovered that in addition to xylitol it also has sorbitol, I tossed it. In my mouth, that would be kind of like putting water on a fire to put it out, and at the same time, putting on some gasoline. It’s a real challenge to find products that have xylitol that don’t also have a bunch of other junk. I even suspect any plain xylitol sugar that doesn’t specify “birch.” Not because I’m worried that much about corn — by the time it’s been processed into xylitol, it probably doesn’t make much difference — but from what I’ve read, most of the corn xylitol comes from China, and has been known to be laced with sorbitol, since sorbitol is much cheaper.

  • Morris

    My experience is even more dramatic. After decades of perio disease and tooth loss (pockets in range of 4-8mm) and following dentist’s instructions a sudden flare (bone loss, implants falling out) caused me to finally look into root causes. I had changed my diet to a more “heart healthy” one on my doctor’s recommendation and within 3 months sudden worsening happened. So I reversed my diet (i.e. fewer grains, legumes, meals/day) and in a couple of months there was a detectable improvement. So I kept going in that direction and backed into the “paleo” diet. Now 2 and half years later improvements continue albeit at a slow pace. Some interesting things I found: improvements in lower back & neck pain, aging biomarkers too numerous to list. The key thing is that the change came mostly from reduced production of plaque not from brushing. I floss once a week as a test for gum sensitivity. Diet change was not the only intervention. I was initially concerned about the high fat content but my total cholesterol has now declined to near normal (212ng/dc) from a high of 350.

  • Marilyn:

    I don't chew gum myself, but health food stores will usually have several different types of xylitol toothpaste.  I just got some Kiss My Face berry flavor (yes, the kids' stuff), and it's sweetened with xylitol and a touch of stevia.

    Morris:

    That's how most of us got here: “I'm eating exactly what I'm supposed to eat, why do I feel worse and worse?”  

    Your experience is consonant with the idea that periodontal inflammation is symptomatic of systemic inflammation.  I'm glad you're seeing improvements!  

    And yes, I also find that many signs of “aging” are really signs of poor diet.

    JS

  • Marilyn

    Thanks again, JS. “Kid stuff” tooth paste sweetened with xylitol and stevia sounds worth checking into! I just bought some “kid stuff” mints sweetened only with xylitol, BUT the last several ingredients are artificial coloring. Another item to cross off my list. . . .

  • dana pallessen

    your readers might like to read “cure tooth decay, by ramiel nagel. it is right in line with what you have said about tooth health as well as more exyensive in other areas. he also believes the natural way of eating is the right way.

  • pam

    ok. sorry didn’t see the caption.

    ok i’d report back if i have success growing back my gum.

    i really dont’ want to loose my teeth!

  • Tim Lundeen

    I’ve had bad tartar and plaque as long as I can remember, eating paleo didn’t really change anything. The kelp variety Ascophyllum Nodosum (avaiable as capsules from Nature’s Way, or bulk from Maine Sea Vegetables) helps a lot with tartar buildup, I take 1T/day in bone broth with a little salt.

    What’s made a tremendous difference is upping my fermented skate liver oil from 1/2-tsp/day to 2 tsp/day. This basically increases Vitamin A to about 9,000 IU and D to 4,500IU, plus additional quinones, K2, etc. I’ve also started using Mark Manhart’s Calcium-Zinc toothbrush moistened with some of his oral calcium-zinc solution to brush in the evening before bed. The combination is amazing — no plaque, no tartar buildup, my teeth feel shiny and smooth all day. So I expect to get an excellent report on my next cleaning (just to confirm), and then to just stop going to the dentist.

  • Dana:

    Having not read it, I can't comment, but I'll try to take a look someday.

    pam:

    Let us know what you find out!

    Tim:

    The biochemistry suggests that the combination of A (not just beta-carotene) and D3 is necessary to absorb calcium, and K2 is necessary to deposit it in teeth and bones instead of arteries, so that's a plausible dietary therapy.  I personally wouldn't stop getting occasional cleanings, but that's your call.

    JS

  • [...] Dental Health And The Paleo Diet: Gingival Sulcus Depth, Periodontal Disease, Systemic Inflammation,…, if you’re into slightly nerdy body hacking type stuff. [...]

  • Tim

    I undetrstand Xylotol is effective because it helps break up the bio films that are holding bacteria. It is for that reason that it is effective in breaking up plaque and is also used in sinus sprays. Professor Ayers has information about it on his Cooling Inflammation website.

  • Margaret Auld-Louie

    If people would be willing to buy their toothpaste online instead of in the store, there is a great one available from Tropical Traditions that has no bad ingredients and is only sweetened with stevia. And there is a mint-free version for those who take homeopathics (me). The ingredients of the one I use are: purified water, organic virgin coconut oil, baking soda, xanthum gum, wildcrafted myrrh powder, stevia, organic essential oils of cinnamon and clove. No SLS, which is caustic, and no glycerin, which can coat the teeth.

  • I found this a really useful read: http://thepaleohygienist.com/

    My toothpaste is now coconut oil, soda bicarbinate, xylitol and peppermint oil.

  • Tim:

    That sounds right, but I'll defer to others on the details.

    Margaret:

    Online ordering opens up a lot of options for those without a “health food” store nearby.

    Paul:

    Good find.  Thank you!

    JS

  • luc

    The brushing technique presented by Orawellness worked great for me to drastically reduce my gum disease problems: Youtube video

    This is a very simple technique (they call it the Bass brushing technique), which worked for me without using the Orawellness brush or their oil. At the moment I only get gum problems when I become too lazy to brush daily like they suggest.
    I am using olive oil with a few drops of tea tree oil. However, I really should order their oil, at least once to say thank you.

  • Grafvitnir

    This is like a retrospective study of the one I cited before :)

    http://www.nature.com/ng/journal/v45/n4/abs/ng.2536.html

    Instead of studying bacterial effects on the mouth after a dietary change on modern humans they studied fossilized mouth bacteria of humans before agriculture, after agriculture and after industrial revolution.

    [A layman's summary of the article can be found here -JS]

  • Grafvitnir:

    Fascinating!  Thank you for sharing that.  Unfortunately I can't see the full text, but the figures are available and shed some light on the conclusions.

    JS

  • Bizz

    I’ve been lucky with my dental issues over the years, but my new Paleo lifestyle should only help in that department…

  • Gregg in Maine

    JS,

    Glad to hear you’ve moved to another product from the Tom’s children’s paste. A good friend of mine recently left Tom’s after working there (most recently as head of manufacturing) for years.

    What very few people know is that Colgate bought Tom’s about six years ago, and the product has been going downhill since then. (I won’t even get into Colgate’s draconian HR tactics that are aligned with one goal – maximizing profits, and thus executive bonuses.) The last straw for me, as a customer, was learning that Colgate subjected the iconic peppermint baking soda toothpaste to consumer panels. The result was a reduction of the baking soda from 15% to 5%, which made it taste like every other peppermint toothpaste on the shelves. Why buy Tom’s and then ruin the product that made the brand what it is (was)?

    Oh, they also changed from U.S.-sourced peppermint oil to one from India.

    We’d got a great local toothpaste here in southern Maine that’s made in New Hampshire, called “The People’s Paste”; not sure where you are, but if you’re not in northern New England I doubt it’s available locally for you.

    Thanks for the great site, from someone very new to Paleo… and loving the changes I’m seeing so far.

  • Christie

    Awesome content. i found it very valauble as I am cuurently writing a kindle book on Paleo and weight loss. i have found some fascinating information, and though there's a bit hype about this caveman style of eating habit, there are risks as well as benefits. Will definitely be sharing what I learned here with [blatant spam link deleted] By the way, I also hope you done mind if I use some of the info here, of course, in my words, in my kindle book! Thank you, I have booked marked and will be back:)

  • Christie:

    It's considered polite to contribute to the discussion before engaging in blatant self-promotion.  I haven't deleted your comment, but I did delete your keyword spam link.

    (Note that WordPress defaults links in comments to nofollow, so keyword spamming the comment section won't help you anyway.)

    JS

  • Bill

    Put baking powder and sea salt in palm of your hand add drops of hydrogen peroxide. Clean / brush teeth then rinse with apple cider vinegar. This will get rid of plaque, and the bio-film you talk about. As an extra added bonus your teeth will have no stains within a week. Cheers

  • Bill:

    You're correct that ACV is bactericidal and should help clear out the plaque-causing biofilm.  However, I'm concerned about using both it and baking soda every day, as it seems that might be a bit harsh on tooth enamel.

    JS

  • Bea

    I too have experienced great improvement in my teeth. I always formed quite a bit of plaque on the backs of my teeth. I would get them cleaned and in a week I could feel it forming again . Was told it was just from the minerals in my saliva. That everyone was different. Haven’t had my teeth cleaned in several years and No Plaque! I used to have to go every 3 months. Sometimes I form a tiny amount and can just clean it myself with my own dental tool . My teeth just feel different too. Slick. I thought they were making my little toothpicks different as they were not just sliding out the other side but my gums must have filled in more or teeth actually formed more? They feel so solid. No starches and sugar for me!

  • Bea:

    This is one of the reasons I don't believe the assertions that Paleolithic people must have eaten lots of starch hold water: given their uniformly excellent teeth, and simultaneous lack of toothbrushes and toothpaste, I see no way they could have eaten a diet high in starches and sugars.

    In fact, there is a great piece of supporting evidence: the only Paleolithic fossils with substantial dental caries involve Late Paleolithic fossils also found with evidence of high-volume acorn processing — including storage vessels, so that the acorns could be eaten for longer than their harvest season.

    JS

  • Doug

    Hi J. – first time poster.

    Love the site: Will concur with the correlation about gum health and a diet devoid of grains and sugars.

    I was using the sonic a couple of years before the diet change 18 months ago. The sonic really helped but the greatest improvement came with the diet, my regular 9 month cleanings ( 2 so far so take my comment with a grain of salt) have been commented upon by the hygienist as great work, even though I stopped flossing 9 months ago as a further test.

    Eating like a predator (paleo, wheat free, whatever) has given me my life back, and I’ve converted a dozen so far based on the results they receive. I lost 45 lbs over 5 months and more importantly BP went from 145/95 to 115/75 and no more acid reflux, joint inflamation.

    Look forward to completely reading your site and book this summer. – thanks

    One quick off topic question: have you ever looked at the effect of erectile dysfunction reversal on this diet? I will correlate a 100% reversal of ED on this diet, one main reason I will never go back to the SAD. Most men suffer in silence, needlessly, and big pharma profits from it. I always thought the “‘E’ diet” book would be a great winner, yours if you want it :-) I’ll never write it.

  • Dave:

    I'm glad to hear of your success!  I know my articles are popular from the web statistics — but they're given meaning when they're applied by individual people, like yourself, to improve their lives.

    Isn't it amazing how many maladies we think of as “just part of getting older” are actually the result of an evolutionarily discordant diet?

    No, I'm not familiar with any results of Paleo on ED specifically — but many people report a substantial boost.  First, adipose tissue is anti-androgenic, so just the weight loss alone is helpful.  SFA also seems to support androgenic function vs. PUFA, and a general lack of circulating Neolithic toxins also helps.

    In general, the healthier you are, the more energy your body can devote to mate-seeking and reproduction vs. simple survival.

    Thank you for sharing your experiences.  Welcome home.

    JS

  • Time to jump back in …

    I'm getting seriously clean teeth from brushing with alum powder. I picked some up as part of my more naturalised post-shave routine and find a dab with a damp toothbrush and a good scrub very nice indeed. Very clean.

    I wonder about the long term …

  • Paul:

    Alum?  Isn't that extremely puckery?

    I've had decent results with just about anything, provided I apply it with my Sonicare and get plenty of K2-MK4 in my diet.  Neem powder is favored by those who like herbal solutions: I used it for a while and it seemed to work without the harshness of baking soda.

    JS

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