The Truth About Kids, Cavities, and Fluoride

This year Portland, Oregon made national headlines when the majority of voters rejected a measure to add fluoride to the city’s public water system. The debate was heated, and as a whole, the final decision was criticized by many as ill-informed and not in the best interests of our children. As a dentist, it may surprise you to know that I do not believe Portland was wrong in their decision, but my reasons have little to do with the fluoride itself.

Certainly, I am fully aware of the dental benefits that topical fluoride can provide to children and adults under the right circumstances. The scientific evidence is clear that fluoride does contribute to stronger enamel development and thus helps prevent cavities. In our modern society, however, tooth decay simply does not happen because we lack fluoride. It happens because of what we eat and how we take care of our teeth. Fluoride can be a helpful aid in the battle against decay, but it is not the cause or the ultimate solution to the problem.

Tooth decay is caused by pathogenic bacteria that live in our mouths. Everyone has this bacteria and there is no way to remove it completely without also removing beneficial forms of bacteria that live in the mouth as well. Preventing the development of tooth decay is all about controlling the numbers of these pathogenic bacteria through diet and home care (brushing and flossing).

The bacteria responsible for tooth decay thrive on sugar, refined flour, and acid. Diets high in sugar, high-fructose corn syrup, white flour, and acid are the quickest way to multiply the number of pathogenic bacterial colonies in the mouth. Sugar-sweetened beverages are especially attractive to these bacteria because they often contain high amounts of both sugar and acid.

The most common chronic condition in Oregon children is tooth decay. In 2011, the Oregon Public Health Division reported that in Oregon, more than 177 million gallons of sugar sweetened beverages are consumed each year (read report here). That amounts to approximately one gallon per week for every man, woman, and child in the state. The same report quoted a survey of Oregon mothers indicating that about half of the 2 year olds in Oregon drink sugar-sweetened beverages at least once per week.

What troubles me most about these statistics is that they do not include all the other food sources of sugar and acid in a child’s diet that also contribute to tooth decay (and childhood obesity). Fruit juice, for example, may not be sweetened with sugar but can still have the same effects on the teeth and the body. Fructose is a naturally occurring form of sugar found in all fruit and bacteria feed on it just as easily – especially when all the fiber of the fruit itself is removed during the juicing process. And certainly, when a child is drinking a sugary beverage, the likelihood that he or she is also eating a meal or treat that is high in sugar, acid and/or refined white flour is fairly high.

In the battle against tooth decay, every little bit counts, and when tooth decay in children reaches epidemic proportions, water fluoridation as a stop-gap is an option we all need to consider. But consider this as well: If a child’s diet is filled with sugars, highly-refined flours, and acid, fluoridated water is simply not enough. And if that same child also does not brush and floss his or her teeth – or they do not know how to do it correctly – then nothing (including fluoridated water) will be able to prevent tooth decay from developing.

Information is perhaps the most powerful tool there is in preventive medicine. In my continuing effort to provide relevant information on how to care for your teeth and prevent decay no matter where you live or what kind of water you drink, I have created several informational resources that I hope you will take the time to review for your own health and the health of your children.

Kids and Cavities
How to Brush and Floss Your Teeth
A Parent’s Guide to Oral Health for Kids and Teens
Drinks That Eat Teeth
A Guide to Added Sweeteners

As always, I encourage you to read and learn as much as you can from as many reputable sources as possible in order to make the best decisions possible for yourself and your family.

Martha (Signature)

Sugar Has No Place in Your Diet

It’s not popular to say that sugar and refined carbohydrates should be eliminated from everyone’s diet. So many of our holiday and cultural traditions revolve around sugar, and for many people a sugary treat is often used as a reward or a temporary escape from stress. But the hard truth is that sugar and refined carbohydrates have absolutely no nutritive value. Even the USDA has removed sweets & refined sugar from its dietary recommendations because fruits, vegetables, whole grains, and lean proteins contain all the necessary nutrients a body needs to thrive – no added sugar necessary. In fact, the days when we could consider a sweet tooth as an innocent indulgence are over. More and more scientific evidence is building to suggest that even slightly elevated levels of blood sugar still within the normal range can have drastic consequences for our health.

As a dentist, I’ve been advocating for low- and no-sugar diets my entire career. Tooth decay has obviously been my primary concern, but as we all know, everything in the body is connected. If simple carbs and refined sugar create an environment in the mouth where pathogenic bacteria can thrive, what is happening in the rest of the body when that sugar enters the bloodstream as an excess of glucose? Obesity, insulin resistance, diabetes, cardiovascular disease, behavioral issues, and even cancer and mental deterioration have all been linked to high blood sugar in recent years.

In the January 2013 issue of Alternatives For the Health Conscious Individual, Dr. David Williams reviews several blood sugar studies performed in the last decade. The most compelling of these suggest that subjects demonstrating even slightly elevated blood sugar levels still considered within the “normal” range are showing drastic increases in the incidences of cancer and Alzheimer’s as compared to similar subjects with lower overall blood sugar levels.

We’ve all begun to understand the disastrous effects that high blood sugar can have on the endocrine system in the form of type II diabetes, and the cause-effect relationship is very clear in that case. It is not at all clear that elevated blood sugar levels cause cancer, but we do know that even slightly elevated levels don’t help. And there is growing evidence to suggest a strong enough relationship between Alzheimer’s and blood sugar that many researchers are starting to refer to Alzheimer’s as type III diabetes.

But diets high in sugar and refined carbohydrates don’t just contribute to blood sugar disorders and the risk factors that go with them – they also have another very serious complication: weight gain. Carrying additional weight, especially in the midsection of the body, is a tremendous strain on the cardiovascular system as well as the joints and muscles. Overweight individuals automatically carry a higher risk factor for insulin resistance, diabetes, heart disease, high blood pressure, and even depression. HBO recently released an excellent series on weight and diet that is available for free online here. If you have not yet watched this important series on obesity in America, I strongly urge you to do so for your own health and the health of your family.

All of this information is simply too important to ignore. Every one of us needs to understand and make use of it in order to make the healthiest changes to the way we eat and to the way we feed our children. To help you get started, I have compiled a resource article on the subject entitled Sugar and Your Body. It is my hope that this article will provide you with a solid base of information and serve as a stepping stone to other valuable resources that will help you feed your body in the most healing and nutritive ways possible.

Martha (Signature)

the food headache

As a dentist, it’s my job to pay attention to what my patients are eating and how diet might be affecting the health of their teeth and gums. But the way our bodies interact with food is more complicated than that. When we eat and drink food that nourishes us, the body responds by feeling energized and alert. But when we eat food that contains little nutritive value or hinders the healthy function of key systems in some way, the body communicates in the best way it knows how – with discomfort or pain.

Indigestion, heart burn, food poisoning, and other gastric symptoms can all be quite uncomfortable, and it’s easy to relate those reactions directly to food. But the digestive system isn’t the only system in the body that will react when the wrong food or not enough food is present in the system. In many cases, head pain will precede or even replace gastric pain or discomfort as the body’s initial reaction to certain foods.

In my work with TMJ disorders and other forms of chronic pain over the years, I have come to understand that headaches are almost always multifactorial. The position of the teeth and how that relates to joint and muscle function may play a role in triggering head pain, but for most of my patients, other factors are almost always involved. And food, or the lack of it, is often a major contributing factor to the development or escalation of head pain.

We all have different sensitivity thresholds when it comes to imbalances in our bodies. For people who suffer from chronic pain, however, this threshold is often extremely narrow. A slight shift in environmental or dietary conditions can tip the balance for these individuals and trigger a multi-day pain cycle. If you know that you are already extremely sensitive to sound, light, temperature, smell, or other environmental triggers, it would not be unusual to discover that your body may also be sensitive to dietary influences.

This month in The Headache Series, we’re discussing exactly how certain dietary choices can contribute to head pain, and how you can begin the process of identifying your individual sensitivities. Sometimes the answer isn’t in a single food source, but in a combination. Identifying a food trigger does take some effort, and for people with complex dietary triggers or nutritional deficiencies, the help of a good naturopath may be essential to the process. But if eliminating a large portion of your head pain might be as simple as eliminating that afternoon cup of coffee or choosing something more nutritionally balanced than a sugar-laden pastry for breakfast, wouldn’t that be worth looking into?

I hope you’ll take the time to read through The Headache Series: Food Triggers, and explore how a few simple dietary changes could not only make the difference in alleviating a large portion of your head pain, but could also help you feel more energized and alert each and every day.

Martha (Signature)

Dangerous Energy

I hope that by now, we are all becoming increasingly aware of the dangers of highly-caffeinated energy drinks – especially when they are used by children and young adults. Since Red Bull was first introduced to the American market 15 years ago, extreme energy drinks have become a staple on grocery store shelves, on bar menus, and most unfortunately on the athletic field. When my son was still in high school, I watched many of his friends consume energy drinks as meal replacements – especially at breakfast time. But energy drinks are not the same as sports drinks or meal replacement shakes.

While Gatorade and other electrolyte replacement beverages are designed for hydration after intense physical exertion, and meal replacement shakes contain protein and other vital nutrients, energy drinks have no nutritive value whatsoever. The sugar and caffeine may keep you going for a little while, but they won’t help a growing body build muscle and bone. And on the athletic field it’s important to recognize that energy drinks do not contain electrolytes at all, and can be dangerously dehydrating when used as a replacement for a sports drink. Consuming extreme energy beverages like Monster or Amp before, during, or after strenuous physical activity can not only lead to increased dehydration, they can also contribute to the development of potentially fatal heat illnesses and cardiac arrhythmia in some young athletes.

In December of 2011, fourteen year-old Anais Fournier died from caffeine toxicity after drinking 48 ounces of Monster Energy Drink within a 24 hour period. The two cans contained over 480 milligrams of caffeine combined – more than five times the maximum daily allowance for a child her age, and the equivalent of about 5-6 cups of regular coffee. Anais had been previously diagnosed with a mitral valve prolapse, but all medical professionals agree that her condition alone would not have led to her death without the excess of caffeine in her system.

Death from caffeine toxicity is quite rare. Depending on a person’s weight, the average lethal dose ranges anywhere from 5 to 10 grams in a 24 hour period. For the average person, this translates into drinking at least 42 cups of coffee in one sitting. That’s pretty hard to do. But for people like Anais, who was young and already had a heart condition, the lethal dose was just 0.48 grams. And while the number of actual deaths based solely on energy-drink consumption alone is still quite low, there is a marked increase of caffeine overdose especially in young people in the last several years. In fact, the U.S. Substance Abuse and Mental Health Services Association reports that between 2005 and 2009 (the most recent data available as of this writing) ER visits related to the use of non-alcohol energy drinks increased ten-fold from 1,128 in 2005 to 13,114 in 2009. 77% of these cases were reported in young people ages 18 to 39.

Those are a lot of scary statistics – hopefully enough to convince you that energy drinks are not worth the risk. But we are also learning even more about how energy drinks can damage the body in slower, less obvious ways.

A recent study published in the May/June 2012 issue of the AGD Journal, General Dentistry, compared the effects of sports and energy drinks on the loss of tooth enamel. Both kinds of beverages tend to be highly acidic and damaging to the teeth, but the two have never been compared so rigorously before. The results were startling. All the sports and energy drinks tested well below a pH level of 5.5 – the reading at which enamel dissolution begins in most people – but there was a significant difference in what is called titratable acidity.

Titratable acidity is different than pH in that it measures how much buffering material is required to bring the acidic substance back to a neutral pH level of 7.0. Two beverages may have the same pH, but depending on their ingredients, the titratable acidity of each beverage can be quite different. This study revealed that while all the popular sports and energy beverages tested had similar pH levels, the energy drinks all had a titratable acidity level 2 to 3.5 times higher than the sports drinks tested. Enamel loss was consequently recorded at 2 to 3 times greater with the consumption of energy drinks as compared to sports drinks with the same level of exposure.

Loss of tooth enamel may seem like a small thing when compared to some of the other possible side-effects of consuming too many energy drinks, but tooth enamel is not replaceable. Your body cannot remake it. Regular exposure to highly-acidic drinks like these can erode your enamel to the point where the teeth can no longer be protected without very expensive and invasive reconstructive procedures. And even though those replacement procedures are available, the truth is that the best teeth to have for the rest of your life are the ones you were born with.

This month, I’ve added a new resource article exploring specifically how pH works in the mouth and how you can protect your teeth from this kind of acid erosion in The Acid Test. I believe that the more we all inform ourselves on how our dietary choices can effect our health and longevity, the better. I hope that you will take a look.

Martha (Signature)

water is all you need

I’m still surprised and concerned by the number of people who tell me that they don’t drink water. As a dentist, I regularly see the damage that highly sweetened and acidic beverages can do to the teeth. But I also see how excess sugar, acid, and chemical additives can take their toll on the overall health of the body.

No matter what an advertisement may tell you about the added vitamins, minerals, or electrolytes in a particular softdrink, the truth is that your body will almost always be better off with plain water. In fact, the benefits of the nutritional additives in most softdrinks are often nullified by the work your body has to do to process the extra sugar, acid, and chemical flavorings used to make that drink taste good. Sodas, juices, and energy drinks are simply not necessary to health or hydration in any way. But water is.

This month, in The Headache Series, we’re exploring the importance of hydration and how drinking enough plain, unflavored water every day can play a significant role in helping many people who suffer from chronic mild headaches. I do hope that you will take a look, and perhaps learn something new about your body. But before you do, why not get a glass of water to sip on while you read?

Martha (Signature)