Tuesday, January 25, 2011

Genes, Diet and Oral Health: Why Do Some People Get Cavities and Others Don't?

Genes, Diet and Oral Health: Why Do Some People Get Cavities and Others Don't?
Getting rid of candies didn't prevent me from getting caries. (Photo by exper)

As you may know, I have something of an ongoing experiment with dental health. This includes reducing cavities, preventing gingivitis and the receding of gums, and also finding safe ways of whitening teeth.

In previous updates, the main focus has been on the teeth whitening aspect. The last product I purchased was called "Plus White 5 Minute Bleach Whitening Gel". Compared to the supposedly teeth whitening toothpastes out there, this product does seem more effective.

However, in recent months, I've noticed increased sensitivity along the gumline. Specifically, the gums next to two of my upper teeth seem to be the problem. The whitening gel probably has very little to do with it, but it doesn't solve the problem either. In the short term, whitening gels can increase sensitivity, so for the time being, I've turned my focus elsewhere – to preventing caries and improving gum health.

The motivation for this post is that I've struggled with these things my whole life, and despite my various experiments with diet, I've yet to find a proper solution to the problem. When I was a kid, the common explanation was that too much candy and soda was the reason for dental cavities – despite the fact that scientists had already shown that carbohydrates in general give rise to the bacteria that cause caries. So when I got a bit older, I cut back on candy and soda, hoping it would be enough.

Unfortunately, it wasn't. Apart from the Snickers Bars and Coca-Cola I'd occasionally enjoyed that were now gone, my diet remained the same. It took me a long time to discover that all carbs are essentially sugars, that all acidic drinks make the issue worse, and that it's not just Coke and candy that are the problem. You can get cavities just as easily by eating bread and drinking apple juice. Then it was time to get rid of those too.

When I reduced my carb consumption and switched to a more paleo-like diet, my dental health improved, but it still didn't stop me from getting a new cavity every now and then. Furthermore, I knew several people who ate junk food and drank acidic sodas all the time, and yet had never had cavities. Some didn't even brush their teeth every day, let alone floss. When we were kids, my brother and I had very similar diets, and yet I was the only one to get cavities.

These things have led me to believe that genes play a more important part than most dentists would have you believe. Kind of like some people stay thin no matter how much they eat. But, just like in the case of weight loss, your genes do not necessarily determine your fate – it just means you have to know what you're doing. People who don't have the genes for staying naturally thin have to be more careful with what they eat if they want to avoid weight gain. Similarly, people who get cavities easily have to be more careful with dental health.

While keeping your teeth clean by brushing, flossing and chewing gum prevents cavities, I'm wondering whether all the cleaning really strikes the problem at the root (no pun intended). If genetics do play a role, what is it specifically about some people's genes that keeps them from getting cavities, despite their poor dental health habits?

One important factor in cavity formation is saliva. The surfaces of teeth are constantly going through a process of demineralization and remineralization. The balance depends, in part, on salivary flow and the pH of saliva, with the mineral content probably playing a role as well. I know my mouth often feels kind of dry and acidic, which can't be a good thing for remineralization. What is unclear to me is how to affect these things.

There are a million websites out there listing foods that are "acid-forming" or "alkaline-forming", but the classification seems very unscientific. Some list apples as acid-forming because apples themselves are acidic, some list them as alkaline-forming because they claim we should look at what happens after digestion. Here's a quote from one such website:

All foods are "burned" in the body -- more commonly called "digested" -- leaving an ash as the result of the "burning", or the digestion. This food ash can be neutral, acid or alkaline, depending largely on the mineral composition of the foods.

I'm not sure how scientifically valid this theory is in the first place, but I do know that even those who promote the "food ash" theory disagree on which foods leave acid or alkaline ash. One person will tell you plums are acid-forming, while others will tell you they're alkaline-forming. I doubt any of them have actually burned plums and studied the ashes.

So, expect some dental health related posts in the upcoming weeks and months, as I go through some of the papers on the subject. I'm also interested in hearing your comments, especially if you've previously suffered from cavities but managed to find a solution.

Meanwhile, for more information on dental health, see these posts:

Tea, Coffee and Cocoa: All Good for Your Teeth
Dental Health Effects of Green and Black Tea
The Role of Coenzyme Q10 in Oral Health
Whitening Teeth & Healing Gums: In Search of the Perfect Toothpaste



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22 kommenttia:

jelris January 25, 2011 at 3:08 PM  

Have you read Ramiel Nagel's Cure Tooth Decay book? According to him, the most important things for strong teeth are vitamins A, D, and K2 coupled with plenty of calcium and phosphorus to be preferably obtained from cod liver oil, raw dairy products, bone broths, and organ meats. In addition to this, have you read Elie Phillips book? It seems that the most important thing, as you mention, is to keep saliva alkaline. If you use a mouthwash, you need to make sure that it is alkaline or that you use an alkaline mouthwash after using an acidic one since an acid environment will make your teeth weaker. As to foods that are alkaline or acid, it seems there's the food's effect on the body as a whole versus on the mouth environment. In this case, what matters most would seem to be how it affects the mouth environment. For instance, limes are alkaline to the body but obviously acidic to the mouth so you would avoid eating a bunch of limes without drinking some water to re-alkalize the mouth. It is also possible that the water you drink may be slightly acidic. What's your oral health regimen? It would seem to me that oral irrigation combined with alkalizing mouthwashes and brushing with essential oils would likely be the most effective means of cleaning teeth. Anyway, I recently did a quick review of this issue at my blog and these were the conclusions I came to. Keep your mouth alkaline and eat a tooth strengthening diet.

Anna January 25, 2011 at 9:26 PM  

Have you read Stephan Guyenet's Whole Health Source blog posts on research that pertains to dental issues (decay, mineralization, malocclusion, etc.)? If not, I highly recommend the posts (& reader comments).

Sandy January 26, 2011 at 7:55 AM  

Still eating oats? You might want to reconsider if you have a problem with cavities-


http://wholehealthsource.blogspot.com/2010/12/dr-mellanbys-tooth-decay-reversal-diet.html

JLL January 26, 2011 at 3:34 PM  

Thanks for your comments. I've read Stephan's posts on the subject, yes. I get a lot of vitamin A from red palm oil, but it's not clear to me whether the animal form of vit A is better than beta-carotene in this case. I also take vitamin D and K2 supplements.

I don't really eat organ meats, but I have been considering it. Liver would be the easiest choice for me.

I don't take cod liver oil because of the lipid peroxidation issue. EPA and DHA are the most oxidation-prone fatty acids out there. The only reason I see to take it is if you're trying to balance out excess n-6 consumption -- but even then the better option would be to cut back on the n-6, in my opinion. And if the animal form of vitamin A is crucial here, I'd go for the organ meats instead.

These days I eat oats only rarely. In any case, I had cavities way before I started eating oats; I know phytic acid can be a problem but I doubt it's the main issue in my case, as my intake of grains is so low.

- JLL

Sandy January 28, 2011 at 6:51 AM  

I propose a new experiment for you to embark upon- the all meat diet ala Stefansson and Andersen.

It worked for Stefansson's gingivitis so why not give it a bash?

The cost may be a little prohibitive though I imagine.

Anonymous January 28, 2011 at 11:07 AM  

Just for reference;

I eat massive amounts of oats daily and also take phytic acid and haven't had any dental issues in over a decade.
I do use xylitol quite a bit though and have been using a cut down version of Dr. Elie system for several months now.

T.W. January 30, 2011 at 4:27 AM  

I've had a habit of not brushing my teeth since I began on a high-fat/zero-carbohydrate diet some time ago. Even now that I'm not on that diet and eating a diet high in carbohydrates, I surprisingly have still had no issues with not brushing. I've always thought this was due to my avoidance of sugars, but as you noticed, perhaps genes are making all the difference.

From what I've read it seems that a high-fat diet would help avoid whatever deterioration or aging that may result from a high-carbohydrate diet, but at the same time, why couldn't aging occur on a high-fat diet as well, albeit through different mechanisms...

T.W. January 30, 2011 at 6:52 PM  

I was really surprised to read that cavities were still possible for you on a low-carbohydrate diet that avoided sugars.

If it's at all of interest, I'll add that I have done nothing for my dental health in the last 5+ years. I haven't seen a dentist since I was a child, and I don't waste my money on a dental plan. I'm in my 20s. My diet is currently high in maltodextrin with some dextrose due to the high amount of altern/splenda I use (at least 1x 9oz bag per day). I was a heavy user of diet soda but recently stopped and replaced it with splenda + coffee now, which I find to be quite effective in curbing appetite. With all the splenda I consume, I should probably volunteer for some clininal trial...

Water Ionizers January 31, 2011 at 5:25 AM  

In addition to eating high alkaline diet, we should also drink plenty of water. But, we must know that it is better to have our water alkalized. This is what we call alkaline water. It is known to be good for our health. A basic or an alkaline diet helps maintain the body’s normal pH level. When this happens, the body functions optimally; and we are less susceptible to illnesses and diseases.

JLL January 31, 2011 at 10:54 AM  

@Water Ionizers,

That doesn't make a whole lot of sense to me. The body maintains pH in a very narrow range, regardless of what we eat.

Also, according to this "alkaline diet" hypothesis, you could eat nothing but lime for a week and it'd be great for your body, because lime is an alkaline-forming food despite its acidity. But I'm not so sure you'd feel that great, much less "alkalized", than on a regular diet.

And, if meat is acid-forming, then the idea doesn't even make sense from an evolutionary point of view. Where is the scientific evidence behind this idea?

- JLL

Aaron February 5, 2011 at 1:41 AM  

JLL, if you look through the literature on Dr. Eliie's site(which btw has a pretty good regimen), you can see that there a is a segment of the population that seems to always test in the acidic range for mouth saliva.

You can correct that by using cloysis or xylitol rinses -- which raise the ph of saliva. you have to rinse a couple of times a day with both products though.

Anonymous March 16, 2011 at 5:27 PM  

I am one of thos people who seemed to get cavities no matter waht I did and my dentist said that it could be related to the fact that I don't produce enough saliva- which interests me because I also have chronic dry eyes - its like my head is a desert- anyway since switching to Xylitol/coconut oil/calcium carbonate toothpaaste I have seen a drastic improvement in my oral health. My gums are pinker and no new cavities in the last year.
(I'm a relatively new fan of yours and not the most PC savy- I've looked and I don't see any other way- but I wanted to suggest a new experiment- Vinpocetine- I just started taking it and I don't know if I'm experiencing the placebo effect or not but I'd love to get your take on it)

JLL March 17, 2011 at 2:29 PM  

@Anonymous,

It's illegal to order vinpocetine to Finland, but if I can get my hands on some then sure, why not.

- JLL

Leila Rousseau May 9, 2011 at 11:51 PM  

Brush - floss - brush. Twice a day. Not directly after eating.

@jelris - Calcium needs to be taken with Potassium and Magnesium (Epsom Salts). The easiest way to get the Vitamin A, Potassium and Calcium part is: Natural Yoghurt and half a banana. And don't eat before bed time.

Stella P October 18, 2011 at 2:05 PM  

I am 49 years old, and haven't had any cavities since I was 18. My dentists think it may be due to my consumption of tea, especially tea from China has high levels of fluorides, that can be part of the exlanation, and genes.

Matt December 21, 2011 at 7:20 AM  

After reading your post, I would have to agree with you; I believe genes play a major factor in some peoples tendencies to get cavities easier then others. I'm currently 22 years old and all my life I've had problems with cavities. I go to the dentist every 6 months and have perfect dental hygiene. I brush and floss my teeth twice a day and still get cavities; I even apply GI paste every night before going to bed. I currently have 12 fillings in my mouth and am no means proud of it....I swear I really do value my teeth. I would question my dentist, but its hard to when he pulls up a digital image of my teeth and blatantly points out my cavities. I guess the point of me commenting on this post is, I really don't know what to do. I'm afraid that by the time I'm 30 I won't have any teeth left. After reading everybody's posts, it seems like xylitol is the next thing to try. Also I think I will attempt to cut as many carbs out of my diet as possible. I really appreciate everybody's comments and am open to any additional thoughts or suggestions to help me combat my cavity problem. Thanks!

Againstthegrain October 17, 2012 at 8:06 PM  

I have gradually shifted my view to think that genetic factors are given far too much weight when it comes to a predisposition or resistance to dental cavities.

Environmental factors are the only things we have any degree of control over, since teeth develop long before they erupt are forever subject to the life-long effects of any deficiencies or process defects during development. The best we can do is try to maintain our teeth.

I also second commenter jelris' recommendations for Nagel's and Phillips books - while Nagel's book goes into great detail the role nutrition plays in dental health, Phillip's book in particular goes into great detail on the role of oral bacterial biofilms and pH, and what can be done to disrupt/neutralize the negative effects of those.

My teenage son (age 14) has never had a cavity, but I doubt that's due to genetics. I, my husband, my son's aunts, grandparents, and great aunts and great uncles all have mouths full of fillings, root canals, and various restorations (& those with more dental work have had worse health when aged). Most of the extended family has had regular dental care throughout their lives, and at least during in my generation, fluoride treatments and fluoridated water, too.

My son also happens to be a quite lazy tooth brusher and an even lazier flosser, despite my efforts to encourage and model good habits. Due to my concerns about fluoride toxicity and lack of conviction that fluoride prevents cavities without risk, I stopped providing fluoridated toothpastes for him and ceased applications of fluoride treatments at dental visits about the time he started school, which is also when I gave him more autonomy over his brushing habits (& the hygienist reports that he always has a lot of tartar, so for some time he was going in for 3 cleanings a year, but he went back to 2 when it didn't seem to make a difference). Our So Cal municipal water supply supply has two main sources, only one of which is fluoridated (& I wish it wasn't). He is in orthotropic treatment for an overjet, narrow, underdeveloped jaw (a different type of orthodontic treatment for younger kids that guides favorable facial growth to create ample room for teeth, rather than pulling and moving teeth in teenagers as in conventional orthodontics) and it requires 24/7 wearing of a removable training appliance or retainer, even while eating (it's amazing how much this treatment has not just improved his occlusion & smile, but also enhanced his profile and overall facial balance).

With the family history of cavities and extensive dental work, his lazy oral hygiene habits coupled with no fluoride, and an orthodontic appliance in his mouth nearly 24/7 for the past 3 years, if ever there was a kid who should have a mouth full of fillings, it would be my son, at least based on the conventional wisdom.

Againstthegrain October 18, 2012 at 1:06 AM  

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2284419/pdf/brmedj03944-0030.pdf


THE IMPROVED DENTITION OF 5-YEAR-OLD
LONDON SCHOOL-CHILDREN
A COMPARISON BETWEEN 1943 AND 1929
BY
MAY MELLANBY (Nutrition Building, National InstituteforMedical Research, N.W.7)
AND HELEN COUMOULOS, D.D.S.Athens (GirtonColege,Cambridge)

JLL October 18, 2012 at 10:45 AM  

@Againstthegrain,

So what do you attribute your son's lack of cavities then?

I don't doubt that there are things one can do to improve oral health - otherwise I wouldn't be posting about it - but I do think genes play an important part. Some people just don't have to pay any attention to their teeth and diet and they still get no cavities. How else could you explain it? I also know several examples of brothers/sisters where the other gets cavities and the other doesn't, despite eating the same foods etc.

- JLL

Natural remedies for gum disease April 24, 2013 at 10:38 AM  

There's nothing quite like a foul odor coming from your mouth to ruin a first impression. More importantly, halitosis, as bad breath is termed in medical circles, can be an indication of poor oral health or more serious issues like infection.

keeeyk October 18, 2014 at 8:19 AM  

It must be some sort of gene or trait or something. Growing up, I was pretty diligent about my teeth. Brushed twice a day, attempted to floss once a week, probably did not do it that often though. I ate mostly whatever I wanted, lots of sugar, sodas, everything. I was never fat, but not thin, just average and fairly athletic, as was my brother, who is two years younger then me. We are only now in our early 20's and still live under the same roof and consume nearly identical diets -- lots of fast food, alcohol, etc. Growing up, I didn't get a cavity until 13 and since then have had a few but don't remember them, it's been a few years.
Brother in his early years had many cavities but he almost never brushed his teeth. He now does at least once a day. With age, I grew less worried about teeth brushing. I do it very hastily in the morning now and often fall asleep at night before I remember, so it is a once a day at least type of thing for me. I floss maybe once a month maybe 6 weeks and usually get some light bleeding when I finally do.... But I haven't had a cavity in years. I have no idea why. I expect one every time. My brother has not gone to the dentist in 2 years, so I am not sure, but I know before he would get one occasionally.. it was not really much of an issue, though, and he wasn't great about oral hygiene anyway.

My point is, I should get lots of cavities. It's been at least 5 years since my last, and before that I think I only had maybe 4 in my life? I don't have a clue it's been so long. But I don't worry about it because I've never had to... so there must be something genetic.

Anonymous October 7, 2015 at 11:28 PM  

I am here to tell you that it has to be genetics. I do not have any cavities as of this writing (i am 48 yrs old) I have seen a dentist for cleaning once in the last 32 years. i do not brush my teeth more that once a month (if i remember) i never floss. i drink a ridiculous amounts of Pop, some alcohol. i eat a lot of sweets, dry cereal, chips (all the things i shouldn't). the only thing other that genes that it might be is the fact that i have copious amounts of saliva at all times, i grew up on Raw milk, and drank HARD water most of my life.

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