I want to give some background before I get into the meat of this post. If you are not interested in the background, skip to the section called Rebuilding a Better Foundation.

When I started out as a dentist, I believed that if people would simply avoid sugar, brush twice daily, floss once a day, come in every six months for their cleaning and check-up, and use fluoride, they would be fine. I was wrong. I had good company; many dentists believe that the problems our patients suffer are their fault. There is much more to understand, and it has been omitted from dental education curriculums, leaving dentists and their patients bewildered. This post will explain why this is so, why it happened, and what we can do to solve the problem.

The Long and Winding Road

The road to becoming a dentist is long, demanding, and time-consuming. Becoming a dentist was an early goal for me; it started in high school. I was attracted to its preventive aspects, which are much more integral than those of most of the other medical fields. The process starts early because one must achieve and maintain high grades for consideration. The preparatory education ends after four years of college. Once candidates are accepted to dental school, they are bombarded with a tremendous academic load for four years. As a Columbia University Dental student, we were combined with the medical school. We had to take all of the courses the medical students were required to attend. Additionally, our clinical training began early, meaning we had a greater course load than the medical students initially. We had no additional time to investigate the context and integrity of the information we received.

Hit the Ground Running

After school, one to two-year residencies are the norm. I became a fellow instead, but it was similar to a residency. The pay was meager. We then either start up an office de novo, join an existing practice with the goal of purchasing it later, or purchase one immediately. The costs for college, dental school, purchasing, or setting up a practice are immense. Building a practice takes time, so the early money is low compared to the amount of debt owed. I could not afford my debt early on. Many young dentists have to consolidate their debt over longer periods to avoid default. I was fortunate that I was married, and my wife worked to bring in additional money to keep us above water.

Welcome to the Machine

Add on trying to start a family and purchase a home to the rigors of starting a practice. The result of all of this is a practitioner who has no time to do independent research or question our knowledge base. We almost have no choice but to believe what we were taught, employ it with vigor, and work long hours to make ends meet. Luckily, most dentists ultimately do well, which is one of the reasons many of us chose dentistry in the first place.

The Inadequate Foundation of Dentistry:

The following foundations do not explain the continued presence of decay, crowded teeth, gum disease, and impacted wisdom teeth when strictly followed

Tooth decay is caused by sugar

We are taught that tooth decay is caused by sugar, which is true. Our professors leave out all other processed carbohydrates, which, when introduced over ten thousand years ago, coincided with an explosion of tooth decay and gum disease, which were rare previously. During the first three million years of human existence, which we call the Paleolithic era, we were hunter-gatherers and consumed little to no grains as a whole. The first farmers lived during what we call the Neolithic era. We still employed stone tools, but the advent of agriculture defined the border between the eras. The first farmers were eating grains like wheat and barley. They were not eating sugar cane and sugar beets, yet rampant decay, gum disease, and tooth loss became widespread.

Brushing and Flossing

I believe in brushing and flossing. Plaque and tartar are unpleasant and, with modern diets, cause disease. We were taught to brush twice and floss once per day. I have treated hundreds of thousands of patients who brush and floss as they are told and continue to have numerous dental problems. They end up with fillings, gum treatments, root canals, crowns, extractions, dentures, and implants despite their best efforts. Naive dentists, like I was initially, don't articulate our thoughts but erroneously believe our patients must be lying. If we believe they are telling the truth about their brushing and flossing habits, we think they are lying about their sugar consumption.

Fluoride

I have covered fluoride before. The topic is too broad to discuss in detail here. Click for more information on topical and systemic fluoride for that. We are taught that children should be drinking fluoridated water. If the water does not contain fluoride, we are told to prescribe fluoride tablets. We are also taught that fluoride should be in our toothpaste. Lastly, we are encouraged to provide fluoride treatments when our patients have their teeth cleaned. We are not told that fluoride is 100% not needed for any bodily process. Since paleolithic people consumed no fluoride and had no tooth decay, an alternate model exists where humans can be decay-free without it. We are not taught this in dental school. More on this later.

Dental Cleanings

We were taught that our patients should have a minimum of two cleanings per year because plaque causes tooth decay and gum disease. Patients should have an additional cleaning or two if they are prone to gum disease. I agree with this premise as a whole. Problems other than tooth decay and gum disease should be routinely screened for. Additionally, plaque is unsightly and malodorous. It turns solid and can build up, being quite noticeable and disgusting. Lastly, with almost the entirety of civilization eating processed grains, decay and periodontitis are likely, whereas plaque was not pathogenic prior to humans consuming processed carbohydrates.

The problem is that plaque grows back within 24 hours. Hence, regular, meticulous brushing and flossing can control unsightly, odorous, and potentially disease-causing plaque. Remember, plaque only causes problems when processed carbohydrates are included in the diet. The burden of care lies with the patient, not the dentist and hygienist. We spend two hours each year cleaning our patients' teeth, so the rest of the 8,758 hours of the year, it is up to our patients to care for themselves.

Small Jaws are Evolutions Fault

All Paleolithic peoples had large jaws, straight teeth, and enough room for all 32 teeth. We were led to believe that small jaws are the cause of our crooked teeth and lack of room for wisdom teeth and that it is due to our continuing evolution towards smaller jaws. But our small jaws are too new for classic evolution to explain. Not enough generations have passed for such a rapid decline in jaw size.

Furthermore, pediatric dentists are encouraged to wait until the child is approaching adolescence for correction by orthodontists. As a result, orthodontists are not fully correcting our small jaws to accommodate all 32 teeth. They make the teeth as straight as possible. Sometimes, teeth are removed because of our inadequate jaws. Wisdom teeth are almost universally removed due to lack of room. The bottom line is that since the majority of orthodontists do not adequately correct our jaw size, we almost all have jaws that are too small, which can lead to medical problems, TMJ issues, tooth wear, and more. Large jaws are easy to grow on our own. I will explain how later.

Rebuilding a Better Dental Foundation

Naming and Blaming Processed Grains and Other Carbohydrates for Tooth Decay and Gum Disease is Priority Number One

Teeth are physically strong but not chemically strong. Seven is neutral on the PH scale, and teeth dissolve when it drops to 5.5. All grains must be processed for us to eat them. They are inedible when we don't. Additionally, we can now concentrate dietary carbohydrates from most plants. Potato starch, tapioca flour, and table sugar from cane and beets are examples. The germs in our mouth ferment these processed carbohydrates, creating acid and lowering the PH below 5.5, which leads to the minerals in our teeth dissolving. The result is tooth decay.

As I previously stated, tooth decay and gum disease were not present in any significant amounts prior to human consumption of grains initially and processed carbohydrates eventually. Although brushing and flossing were not required for Paleolithic people to avoid cavities and gingivitis, and they are not required for those of us who don't eat processed carbs, I still recommend them due to the unpleasant nature of plaque and tartar.

Fluoride Use in Perspective

Those of us who do not eat processed carbohydrates have absolutely no need for fluoride because their elimination means we won't suffer from tooth decay. It may come as a surprise to many, but toothpaste and rinses containing fluoride come with warnings about their poisonous nature, so caution should always be exercised when considering their use. The benefits of fluoride need only to be considered vis-a-vis a diet containing processed carbohydrates. Lastly, fluoride can help with tooth sensitivity.

Understanding Optimal Jaw growth Patterns and Size

My average patient has the jaw development of an eight-year-old. You heard that correctly; when I measure the transverse distance between their upper first molars, they come in at around 35mm, which is expected for eight-year-olds. Normal development is 45mm for adults, which means most of us are deficient in our jaw growth by 1/3. The ramifications are dire, apnea being one of the worst conditions associated with improper facial growth.

Most rapid jaw growth in humans happens prior to age 10. The more force we place on our jaws by eating the coarse, unprocessed foods similar to the food our ancestors ate, the better the growth. Especially today, with ultra-processed foods, we barely place the proper forces needed to stimulate proper jaw growth. Sadly, we believe that although babies are born with the ability to nurse, all bets are off when they are ready to chew and swallow. This is a misguided notion. We should introduce chewy foods early. Instead, we feed mush on a spoon, delaying jaw growth.

Tongue Posture and Breastfeeding

Keeping our mouths closed and our tongues placed firmly on the palate also helps promote good facial development. For this reason, allergies and chronic nasal congestion can have devastating effects on facial growth and shape. Breastfeeding is also very critical because the forces placed while suckling are required for proper growth. Also, mother's milk is the perfect food for developing babies. Lastly, pacifiers and finger sucking can result in adverse jaw growth and development.

Conclusion: Ancestral Versus Modern Approaches

Our ancestors did not need to brush or floss to remain decay-free, have straight teeth, and room for their wisdom teeth. Of course, they did not use fluoride. Additionally, they were universally breastfed and ate a coarse diet devoid of grains and processed carbohydrates. To repeat, they rarely had tooth decay, gum disease, crooked teeth, or impacted wisdom teeth. Native Americans knew about proper tongue posture, and we can assume this may have been universal in most of our Paleolithic ancestors because they had such beautifully healthy mouths. We can choose this option (Option 1) to mimic our ancestors and achieve the same results, although, as I said before, we should brush and floss, and visit the dentist every six months.

Alternatively, we can skip breastfeeding and give our children soft, modern foods which will result in small jaws with crooked teeth, tooth decay, gum disease, impacted wisdom teeth, and potential breathing and swallowing issues. To combat decay and gum disease, we brush and floss away the problematic food and apply and consume fluorides. When decay arises, which is expected in over 90% of us, we can have fillings, crowns, root canals, extractions, dentures, and implants. Our small jaws almost universally require orthodontic treatment and wisdom tooth removal. I will call this option 2.

Option 1 seems the obvious choice to me, but I am in a very small minority. Additionally, we must not forget the destructive nature of processed food has on our teeth, so that when we swallow it, it continues its course of destruction, leading to obesity, diabetes, and heart disease.

I believe it is unethical for me to profit from my patients because they do not understand that processed carbohydrates are risky for their health. I always enlighten my new patients to the ideas presented in this post. Alas, most people, despite this information, still choose option 2, securing my financial future and that of their other doctors. We continue to eat more processed foods as time goes by and our lifespans are shortening despite more medical interventions. I find this tragic. This 18-year study shows how bad our processed food consumption was getting in 2018. Since the lockdowns, it has been much worse. This trend needs to be reversed. Do you need to be as strict as I am? No, but giving up wheat would be a huge first step in reclaiming your health and enjoying life more while living longer. The choice is up to you.

Improving The Foundation for the Practice of Dentistry