Sugar: Not Just About the Cavities

Sugar and inflammation are tightly linked.

Many years ago, when my son was very young, I asked a pediatrician how much juice to feed him. At that time, I was under the impression that young people needed juice for energy and vitamin C. The pediatrician looked at me and asked, “Why would you give your son dessert to drink?”

Of course, because of further research and changes in the way our culture views food, we now know she was exactly right. Juice is really glorified sugar water. And the evidence of negative health effects is mounting against sugar.

The Alarming Effects of Sugar

Sugar can have serious health consequences for your teeth and entire body.I have read many articles about sugar consumption from sources like the AMA, the American Heart Association, the NIH, Environmental Nutrition, and the CDC. Although the exact numbers vary, sugar consumption in this country ranges from 100-150 lbs per person per year. I know that our consumption has been going down a bit, but clearly not far enough. Have you ever carried around a 10-lb bag of sugar for very long? 100 pounds is astounding to me.

It is widely accepted that sweets have been linked to tooth decay. But if tooth decay is present in your mouth, some other type of “decay” is happening in your body.

How Sugar and Inflammation Are Linked

Inflammation has become a catchword in conversation. I’d encourage you not to ignore it even though it’s thrown around casually in many health discussions. Sugar feeds inflammation. Long-term chronic inflammation is at the root (no dental pun intended) of all our chronic diseases. I will write more on that in future blogs.

For example, an article from the Journal of the American Medical Association in March of 2014 studied a population of more that 31,000 adults. The study concluded that those who consumed 17-21% of calories as added sugar had 38% greater chance of dying from heart disease. The risk nearly triples when it is 25% of calories in the diet.

Other studies connect excessive consumption to cancer and even Alzheimer’s disease. In his most recent book, “The Case Against Sugar,” American science writer Gary Taubes links the explosion of sugar consumption in the US to our climbing rate of diabetes. Sadly, we may not even know how many other illnesses are caused by excessive levels of this carbohydrate in our modern diets.

One thing is clear: On the whole, we’re eating an excessive amount of sweets. The American Heart Association recommends that women consume no more than 6 teaspoons a day of added sugars. This is a teeny amount. Generally, women eat 22 teaspoons per day.

Resolve to Cut Sugar Out of Your Diet

Many of us don’t truly know how much of the sweet stuff we are consuming. We may even think we are consuming healthy sweeteners like brown rice syrup (which may also contain arsenic!), but the reality is that the body treats all sweeteners the same. If we want to improve our health, we need to cut way back.

My brother visited a few years ago and we had this discussion. He was happily eating his bran cereal (with sugar), juice, and sometimes toast for breakfast. He was astounded after adding up the sugars in this “healthy” breakfast. And he suffered almost daily headaches. His joints hurt. He took a nap during lunch at work. He also dreamed about eating cake, etc., at night.

Sweeteners are sneaky and addicting. They are in our salad dressings, lunch meat, coffee drinks from Starbucks, breads, and more. Avoiding candy bars alone isn’t enough to protect against harmful effects.

It’s a new year. As we make resolutions about how to improve our lives, I encourage you to look at sugar. You will improve your own health as well as that of your family if you just don’t have it around.



“The Case Against Sugar” by Gary Taubes

AMA. JAMA 2014; 311(12): 1191

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Silver Fillings Are More Expensive Than You Think

It’s hard to find many people over the age of 30 in the United States who have not had at least one silver filling in their lifetime. In fact, it’s really only been in the last 35 years that comparable alternative materials have been developed for fillings in the back teeth. Our back teeth can take a beating over a lifetime. Average chewing forces alone in the molars can exert about 70 pounds per square inch, but for people who clench and grind regularly this force can increase by 6 to 10 times as much, or more. Obviously, any material used to restore the back teeth needs to be strong and durable.

For many years, the argument for silver fillings has been based on their strength, durability, ease of placement, and cost. Silver fillings are the least expensive filling material available on the market and require the least amount of preparation work on the tooth in order to place them. Yes, silver fillings contain metals and mercury, but proponents believe that the risks of mercury exposure or metal sensitivity are low. Certainly, dental insurance companies would prefer to only pay for silver fillings rather than more expensive metal- and mercury-free alternatives. And for the low-income population without insurance or additional resources, proponents believe a silver filling is better than no filling at all.

There is some truth to that statement. However, the ease and inexpense of the initial placement of a silver filling is not the only cost associated with that filling over a lifetime. The truth is that no filling material will last forever, but silver fillings by their very nature can set up more long-term damage in the teeth than other alternative materials now available. Even if we set aside all the valid concerns about metals and mercury, silver fillings just aren’t the best materials on the market anymore.

Silver fillings are not bonded to the teeth, which means that the margins are not actually sealed. That unsealed microscopic channel between the edge of the silver filling and the tooth makes it nearly impossible to protect the margins, even with exquisite home care. Inadequate or irregular home care will definitely leave these unsealed margins extremely vulnerable to recurrent decay, causing the filling to need replacement with larger and larger silver filings over time. But that’s not the only weakness that a silver filling can present.

Silver fillings also expand and contract in relation to temperature changes in the mouth at a very different rate than the healthy tooth surrounding them. Over time, as we eat hot and cold foods, these differing expansion rates can set up fracture lines in the tooth enamel that leave the tooth even more vulnerable to recurrent decay and breakage. No filling material on the market can exactly match the expansion and contraction rate of enamel yet, but silver fillings are the most likely to set up these kinds of expansion fractures in the shortest period of time.

So if the mercury content, unsealed margins, and the expansion/contraction rate of silver fillings are all of concern, why are silver fillings still in use? The answers are simple: it’s cheaper and easier than newer, better materials. Cheaper and easier may make sense in the short term, but the more we learn about silver fillings and the long-term consequences for the health of our teeth, our bodies, and our environment, those silver fillings may be far more expensive over time than we realize.

In my practice, I have not placed a silver filling in any patient in more than 20 years. I would not place a silver filling in my own mouth, in my children, or in my grandchildren. I do agree that when the only option is a silver filling or no filling, then the silver filling is the better choice. But I do not agree that silver fillings are cheaper in any way other than the initial cost of placement. We can do better across the board and especially by our low-income population, and it is my sincere hope that by keeping the conversation open and continuing to make as much information available as possible, that someday we will.

To learn more about silver fillings and all the other options available in dental filling materials, please visit my newest resource article, A Comparison of Dental Filling Materials.

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Exercise, Nutrition, and Your Teeth

Exercise and a healthy diet are the cornerstones of a healthy lifestyle. But being healthy is about much more than simply looking slim and fit. Many very athletic adults and teenagers believe that their boosted metabolisms allow them to eat pretty much anything they want to so long as they continue to look slim and fit. But the consequences of a poorly constructed diet on the internal systems of your body, on your teeth, and even on your athletic performance, are the same regardless of how much you weigh or how healthy you may appear on the outside.

A diet filled with excessive amounts of highly refined sugar and grains, as well as foods and beverages that are high in acid, can have equally negative effects on the teeth and bodies of extremely active people as they do on sedentary individuals over time. And when it comes specifically to the teeth, very active individuals may actually be at a higher risk of tooth decay when consuming sugary or acidic foods and beverages during workouts in order to stay fueled and hydrated.

A quick burst of energy from a gel, sports beverage, or even a candy bar, may be exactly what you need to push you through the last leg of your athletic performance or training session, but that quick energy generally comes from a highly-concentrated combination of simple sugars and caffeine. Citric acid, and other acidic flavor enhancers, are often in the mix as well. Sugar and acid in the mouth create the perfect environment for cavity-causing bacteria to multiply and thrive. And introducing these elements into the mouth during intense exercise, when the saliva flow is often compromised, leaves your teeth even more vulnerable to these bacteria and accelerated tooth decay.

Certainly, there are many preventive measures that we can all take before, during, and after exercise to help protect our teeth and our bodies from the negative effects of the concentrated forms of sugar and acid we might consume during a workout. Our newest resource article, entitled Oral Health for Athletes, outlines several adjustments you can make the way you care for you teeth and fuel your body during a workout or race in order to better protect your teeth from accelerated decay.

For everyone, regardless of your level of athleticism, the first and best preventive measure you can take in protecting the health of your teeth and your body is to eat a well-balanced diet low in sugar and refined carbohydrates, and filled with plenty of whole fruits and vegetables, lean sources of protein, some whole grains, and moderate amounts of healthy fats. A strong metabolism should never be an excuse to regularly offer your body inferior sources of nutrition. No matter how athletic any of us may aspire to be, we should all be practicing healthy dietary choices every day and teaching our children that eating well isn’t just about protecting our health today or fueling an athletic performance next week – it’s about building and maintaining a healthy foundation for a vibrant and active lifestyle for years to come.

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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.

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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.

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