This blog entry continues my review of the book Cure Tooth Decay by Ramiel Nagel. In the last two reviews I covered topics raised in Chapter 1. This entry will address topics from chapter 2. As I write my review, I will be writing this on the premise you have read, or are reading the book along with me. I will continue to focus on pointing out both areas where I disagree with the author as well as areas I do agree with the author.
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Chapter 2 includes references to two theories, the Diet / Nutrition Theory and the Acid / Bacteria Theory. The author is very much for the Diet / Nutrition Theory, which I also support. Unfortunately, the author’s bias prevents him from recognizing the truth being the Acid / Bacteria theory and realizing that these two theories work together, rather than being mutually exclusive. As both of these are important components to the cause of cavities, I will cover both of these theories.
Diet / Nutrition Theory
In Chapter 2 the author references studies done by Dr. Price and comparisons of different people groups and changes in diets. These dietary changes are linked to differences in oral health, particularly tooth decay (cavities). These dietary changes are very important to take note of as they include key information on how to prevent cavities and improve overall health. Further, it is due to information like this that I recommend the book and chose to do a review on it. I am a firm believer that diet is the number one cause of cavities and that changes in dietary habit will have the biggest impact on preventing cavities. the downside to this is dietary changes are on of the hardest things to do, especially if you live with other people who are resistant to change.
Through Dr. Prices work, it was noted when comparing the Swiss Alps communities, while the modern Swiss where introducing sweets, they were also removing/reducing the intake of cheese and milk with cheese accounting for the biggest difference in calcium and phosphorus intake. If you image this as being a teeter-totter, with a healthy, cavity free diet on one side, and cavity causing diet on the other. As sweets are added to one side, the balance starts to shift, but only so much. If you then start taking away from the healthy food side, it shifts that much faster. So if you are struggling with cavities, it is not just a matter of reducing sweets and acid foods, you also want to replace those with healthier foods that provide the nutrients needed to strengthen the teeth.
When Dr. Price’s research is referenced, there are comments related to jaw growth and heredity. I have seen several sources of research related to the growth of the jaw and dietary habits. In general, soft foods do not work the jaw muscles and provide very little stimulation for growth. As a result, a soft food diet for a growing child can result in under development of the jaw structures. On the flip side, a diet that forces more rigorous work of the jaw structures, will stimulate more growth, as well as potentially being healthier and providing more nutrients for growth to occur.
On the flip side of diet is genetics. Genetics also take a role in overall jaw development. If the genetics are geared for a certain jaw structure or shape, a healthy diet will allow it to develop to that preset form. If you look at different ethnic groups you will see different trends in jaw structure formation. Some will have larger, more protruded jaw structures, other will only have more advanced lower jaws, etc.
Genetic or hereditary trends are very much real and in play; however, these hereditary trends can often be over played as a way of making people feel better. This has been a growing trend in our society for a long time. Eg. “you are not fat, it is just your genetics and slower metabolism”, rather than saying “you are overweight and some changes to your diet and activity routines can accelerate you metabolism and help improve your health”. People often want to spare the criticism and truth and will substitute in something that has a little truth instead. As we understand genetics more and more, we realize the impact our genetics have. However, this may have pulled us to far from reality in the sense that genetics are only one aspect, and environment, diet, routines, etc have a huge impact and can alter the genetic tendency (eg. malnutrition an result in a short person, even though their genetics are for a tall person).
Countless times I have heard people say things like, “I will end up with dentures, my family has bad teeth. My parents have dentures and I will to”. These types of comments always sadden me as this does not have to be the case. Although there are some genetic conditions that will cause severely weakened teeth that will not stand the test of time, these are rare. More often it is the dietary and oral hygiene routines being passed down that are the true cause of the damage and tooth loss. I have personally witnessed cases were people have had a history of rampant decay and have had a lot of dentistry done, and have now reached a stage in life and diet/oral hygiene where they no longer get any cavities. On the flip side, I have seen people come to Canada from another country, be cavity free when they arrive (and have never seen a dentist), and 6 months later have a mouth full of cavities strictly due to the change in diet.
Acid / Bacteria Theory
Chapter 2 also raises another important topic. Unlike the other theory for which I agree with Dr. Price and the author, this area is where I strongly disagree and so does science and real life. This is the topic of the Acid / Bacteria theory. This theory on tooth decay is very real and very well researched as well as being evident clinically all the time.
It is important to recognize that this theory does not replace the Diet / Nutrition theory, rather it works hand in hand with it. Science has helped us understand how these bacteria work, feed, and their impact on our teeth. In the overall fight to prevent tooth decay, a major focus is often put on this aspect of prevention as it is generally easier to get someone to change their cleaning habits than to do a total overall on their diet. Further, if you can not convince a person to brush their teeth, which is easy and products readily available, how can you expect to convince the person to revamp their diet with things that will be harder to come by, may cost more, and have a drastically different taste/texture than the diet they are already used to?
If this theory was completely false, as the author suggests, and diet was the only factor, decay on teeth would occur very differently than the way dentists see it every day. If decay was strictly the result of systemic changes like the author suggests, teeth would become uniformly weaker and slowly dissolve away. No one spot on a tooth would be more susceptible to a cavity than the other. But this is not what happens. I do see the occasional case which will come close to this, and more be related to nutritional deficiencies of the mother during pregnancy that affected the development of the baby teeth, leaving them soft and very weak. But this is a systemic effect affecting the development of the teeth rather than a systemic effect that slowly dissolves the teeth once they are formed.
In support of the Acid / Bacteria Theory, I reference this radiograph:
This individual has gone over 30 years without a cavity in his mouth. This would suggest overall diet and oral hygiene routines are pretty good. Despite this, a cavity developed in an isolated spot. The location of this is in a deep pocket in-between two teeth, one of which is a partially erupted, impacted wisdom tooth. This area allows food and bacteria to collect that he is unable to adequately clean due to lack of access. If the author is correct, and cavities are only caused by the Diet / Nutrition Theory, then because this individual has one cavity, he would have multiple areas of cavities over multiple surfaces of his teeth. But this is not the case. He has one cavity where food and bacteria collect. Over time, as the bacteria breaks down the food and produce acids, those acids slowly dissolve the healthy tooth structure. With enough time, the damage gets worse to the point of a full blown cavity as seen in the radiograph.
In conclusion, I would like to note, the above cavity may very well have been preventable via a different diet, but at the same time, if the wisdom tooth came in straight, allowing this individual to keep the area clean, his diet would not have contributed to the development of a cavity as evidenced by the long standing history of being cavity free in the rest of his mouth.
In conclusion, dentistry can not change our food supply, nor should it be expected to. However, there is a responsibility for dentists to guide patients towards healthier food habits, as well as dealing with the poorer quality food choices.
It is unfair to blame the American Dental Association (ADA) for all the millions of cavities. The information the ADA is being accused of hiding/withholding was published and readily available back in the 30’s, and yet society chose to continue on its terrible food trends and get worse as time went on. So dentists did what they could and focused their efforts on where they can make a difference – cleaning teeth and dealing with the bacterial component.
Although the pendulum has swung to far in favor of the Acid / Bacteria Theory, with a potential lack of focus on the Diet / Nutrition Theory, this does not remove the responsibility from the individual. It is up to each and every person to take their health into their own hands and be proactive. Ask questions, learn, and be open to change. If something is not right, find the cause and switch to a better way of doing things. If you get cavities regularly, look at both your oral hygiene routines and diet to start finding the easy things to change and go from there. Keep modifying until the problem is solved.
I (Dr. Kamal) personally have not had a cavity in almost 20 years, and do not expect to get another one for as long as I am healthy enough to take care of myself. The main areas I changed were oral hygiene routine. To help ensure this change in rate of cavities continues and lasts through the aging process I have been modifying my dietary routines/habits as they have an impact not only on my oral health, but my overall health as well. I have seen my patients make these changes to improve their health with great success, and I believe you can do it too if you want it bad enough.