This blog entry starts my review of “Cure Tooth Decay: heal and Prevent Cavities With Nutrition” by Nagel, Ramiel.

For the first blog entry I will address some conceptual thoughts on dentistry raised in Chapter 1 and then we will take it from there with future blogs working through specific items in each chapter. As chapter 1 is an intro to the entire contents of the book, Chapter 1 will take a couple blog entries to cover. Further, the keep these entries shorter, they are being written based on the reader having read the book.

I would like to start with saying I agree with many things thing Ramiel has to say, but disagree with others. Unfortunately, in my opinion, Ramiel’s bias towards main stream dentistry has clouded his judgement causing him to dismiss well documented truth’s as being wrong.

I do agree with Ramiel that teeth were designed to last and have the potential to last a life time. With adequate care, they can. And when problems arise, it is important to not only find the right treatment for the here and now, but to also find the right long term solution, which should involve figuring out and dealing with the cause of the original problem. Ramiel references individuals taking ownership and control over their situation rather than feeling preventing cavities is a hopeless cause. I often see patients who say “I have always had bad teeth and always will”. And that is often the case as there is often a lack of engagement in the knowledge and behaviours that will prevent the cycle. For those who take the time and effort to learn the cause of their poor dental health, significant change can and does occur. The past can not be unwritten, but it does not have to be repeated either.

The biggest area I find myself disagreeing with Ramiel relates to Germ Theory. On this topic Ramiel’s bias and frustration really starts to show as he rejects well documented and proven science. There is some truth to what he says, but it is twisted out of proportion. If you have ever seen a microscopic video of viruses in action you would see how a virus invades a cell (forcefully), takes over cell function to produce more virus, then kills and explodes the cell to spread and invade more cells. Bacteria tend to behave more passively and opportunistically in the sense they are more prone to cause bodily harm to people via the byproducts they produce, rather than actively attacking the body. In many cases these byproducts are there to aid in altering the environment to one more conducive to further bacterial growth. Our body has synergistic properties with many bacteria, and is harmed by the over abundant presence of others. With both viruses and bacteria, the healthier the body is, the harder it is for these organisms to get a foothold in our system and do damage. Therefore, effective treatment involves both removal of the offending organism combined with alteration of the environment that contributed to the foothold situation.

Dentistry’s war on bacteria: Ramiel lists seven stages of the war on bacteria and concludes with “but if the basic cause of tooth decay (your diet) is not addressed, your teeth continue to decay.” Ramiel’s concluding comment is correct. For a person with problems of repetitive cavities, diet needs to change. In some cases, change in oral hygiene may be enough to compensate.

Bacteria vs Diet: Ramiel references two theories of the cause of cavities along with one flawed study against bacteria, and one for bacteria, but disregards bacteria all together. From my experiences and perspective, this is just as bad as saying it is only bacteria that case the problems. It becomes evident in the future chapters that the same foods that cause problems are the same ones that have an impact on both the overall body chemistry as well as the local environment of the mouth. Something Ramiel fails to recognize is there is no perfect tooth that can withstand all acids. Different foods contain acids which work to weaken our teeth by promoting demineralization. Certain foods are more basic and packed full of minerals that help to promote remineralization of our teeth.Our teeth are in a constant state of flux as the environment with which they sit is in a constant state of flux. In the long term, if the environment stays more on the demineralization side, teeth weaken and get cavities. If the environment stays to the remineralization side, teeth get stronger. The goal of modern dentistry is to address all these factors, but will always focus primarily on those easiest to change.

I once read a study where a group of students went an extended period of time without brushing or flossing their teeth (no change in diet). During the initial phase of the study, students started getting cavities. During the second phase of the study, the students started taking care of their teeth again (no change in diet), and the cavities repaired themselves. Each student had varying degrees of this effect, but the effect was general amongst the students. If bacteria and food left in the mouth does not contribute to cavities, then these students would have had no change with their teeth during the study. Further, if bacteria did not play any part in the process, teeth would decay by evenly dissolving away, rather than having site specific areas of decay where food and bacteria collect.

Overall, food contributes to overall health and body chemistry including acidity level of the body, available minerals for repairing teeth, as well as food accumulation in the mouth. Bacteria contribute to localized environmental changes that can help promote disease. Changes in the local environment then change the habitat that encourage other similar bacteria to flourish and inhibit the growth of other bacteria which further offsets the balance. change in the environment (brushing, flossing, antimicrobials) can help get rid of harmful bacteria, and encourage habitation by beneficial bacteria. Food can introduce beneficial bacteria as well as modify both the local and systemic environment. In many cases where things are in a fine balance, changing just one or two things can make the required improvements, even if they are not the main contributors to the problem. If things are really far out of balance, it may require more changes to restore balance.

To wrap up this section of the blog, I’ll touch on one last item referenced in chapter 1 related to the above. Ramiel references data regarding increased tooth decay as people age and increase in tooth decay in children. From this he argues that brushing, flossing, etc is not working because in his opinion the majority of people are following the dentists recommendations. I would have to disagree strongly with this ideology for a few reasons. Firstly, part of the reason for increased decay with age is the lack of changing habits combined with the history of damage the teeth have experienced. A lot of people accept having a filling a year vs making the necessary life changes to prevent it. Secondly, as people age and further damage happens to teeth, degradation does accelerate, especially in cases of previous tooth loss (as teeth are lost, more stress is placed on the remaining teeth which further compounds the problem). Thirdly, as people age other health issues come into play which alter body chemistry, especially if medications are involved, and these can have an affect on the foods they eat and their ability to keep things clean.

Dentistry focuses on repairing the damage to the best of its abilities, and as feasible, work on prevention through education and various treatment options. Dentistry itself cannot cure tooth decay. The dental team can help and is an important part in the process, however, only the individual affected is ultimately in control. As for the amount of time spent providing treatment vs education for prevention, if more people valued prevention, and were willing to pay for it, dentists could spend more time getting to the heart of the problem.

To conclude, I leave you with this final thought. Smoking, alcohol, drugs, and malnutrition do contribute hugely to ones overall health, hence the saying “never look a gift horse in the mouth”.

If you have any thoughts or questions, post away on my Facebook Page, and stay tuned for the next blog entry to finish off Chapter 1.