Note

I have nothing against tongue-scraping. However, I intentionally do not sell products on this site because I don't want to unintentionally skew my thinking in order to make money, which is human nature. I will post more on the matter next week, but back to the subject at hand. I maintain every aspect of my site at my own time and at my own monetary expense. This approach is exactly the way I want it because my day job pays the bills. Disseminating unvarnished (or as close as I can get) information is my way of paying it forward and is reward enough. This post highlights the pitfalls of monetizing information.

Meet Dr. Jones

A new patient of mine told me I sounded exactly like a famous functional dentist online, and he sent me a link to a long interview he gave on his views. I was very impressed with his knowledge base and approach to oral and systemic health because we overlap around 98% in our approach to oral and systemic health. I will call him Dr. Jones to protect his identity because the majority of his message does vast amounts of good. Unfortunately, he thinks that the oral nitric oxide pathway is disrupted by oral hygiene, thus meaningfully increasing blood pressure in those who get their teeth cleaned and potentially diminishing their health. I believe the rise in blood pressure is insignificant and transient, which the literature supports. We differ in that Dr. Jones believes the effect is significant and lasting. However, at the end of his interview, he recommends buying his tongue-scraper because it will lower blood pressure, and he is making money by arguing against his initial claim that removing plaque raises blood pressure. However, his claims stretch beyond what the current scientific literature supports. He says one thing at the beginning and then refutes his claim later. I believe he is getting his information from a study or two about tongue-scraping. However, he does not cite any specific study in his interview. I will. The conclusions of the studies I found are definitely insignificant. I wrote about one of them in a previous post, which you can read here.

The Nitric Oxide Connection

Nitric oxide is indeed crucial for cardiovascular health, playing a key role in vasodilation and blood pressure regulation. The oral microbiome, particularly bacteria on the tongue, does convert dietary nitrate into nitrite, which can then become NO. However, the relationship between tongue scraping and nitric oxide, or NO production is where Dr. Jone's narrative diverges from scientific consensus.

The Literature

Most medical literature is close to garbage, but the current research does not support the assertion that removing plaque from the tongue significantly alters NO levels in a way that has any meaningful impact on blood pressure. Studies, including those cited in my previous post on nitric oxide, indicate that the bacteria responsible for NO production are primarily located in the deep fissures of the tongue, areas not effectively reached by scraping. Also, the study that claims tongue-scraping to be beneficial resulted in a 3-day 3.5 mm/Hg lowering and then a slight increase above normal at seven days. Additionally, the group that did not scrape benefited during the trial and achieved lower blood pressure, verifying that bacterial removal can raise blood pressure, although also insignificantly. Lastly, four of the authors have huge conflicts of interest. One is a Founder and Shareholder of HumanN, a dietary supplement and functional nitric oxide nutrition company, a shareholder and consultant for SAJE Pharma, and he receives royalties on nitric oxide-related patents from the University of Texas. Another is the President and Founder of Diversigen, a microbiome analysis service. Yet one more is Chief Scientific Officer at MicrobiomeDX, a microbiome analysis service. The last one is the Managing Editor at SynBioBeta, whose aim is to partner with dynamic organizations and strengthen partnerships between academia, industry, and investors.

Sales Hyperbole

Here is a list of hyperbolic claims he makes while urging tongue-scraping. (I smell tons of BS here):

You're going to have bad breath, [and] it's going to affect your social life
It's going to [sic} affect many things [sic], everything from erections, and that's for women as well
Blood [sic], cardiovascular health [sic] longevity of organs, blood flow to the peripheral [sic] blood supplies in the body, eye health, [sic] brain health, [sic] immune function; when the next covid comes [to] make sure your nox levels are high it's amazing what that happens [sic] it helps lung Health as well
It's the Fountain of Youth
Absolutely, you [have] to scrape your tongue. That is one of the best ways to get the nitric up

Potential Harm

Frequent or aggressive tongue scraping might disrupt the beneficial oral microbiome without the purported benefits, which could lead to other oral health issues, as the balance of oral bacteria is delicate.

Commercial Interest

It's worth noting that Dr. Jones sells a tongue scraper on his website. While this does not necessarily invalidate his advice, his hyperbolic reply in his video interview raises questions about the objectivity of his recommendations.

Palatal Rugae

The bumps on our palates are called rugae. Little is known about their function; however, if the correct tongue posture is employed where the tongue touches the palate when the mouth is closed, they serve to create friction between the tongue and the palate, thus acting as natural scrapers.

Functional Dentists Directory

On top of the tongue-scraping, Dr. Jone's initiative to maintain a directory of functional dentists is commendable, aiming to connect patients with professionals who share his holistic approach to oral health. However, the fee of nearly $500 per year for dentists to be listed raises ethical questions about accessibility and the potential for bias in favor of those who can afford to pay. He claimed to have around 250 dentists listed, which nets him close to $120,000 per year. I would like to have my name on the list, but not for that fee. The people who already adhere to Dr. Jones' message are the ones who are likely to want to find a functional dentist. Hence, he is not charging a fee to help his readers; he is decreasing their likelihood of getting real help close to where they live. So, he may be hurting them at his own monetary gain—incidentally, Dr. Jones no longer practices.

A Better Approach

While most aspects of Dr. Jone's advice, like reducing the use of chemical-laden oral care products, are sound, it's crucial to approach health recommendations with a critical eye, especially when they involve products linked to the advisor:

Evidence-Based Practice: Oral health should be guided by practices supported by robust scientific evidence. Diet plays a more significant role in NO production, with foods like leafy greens more effective in boosting NO than any mechanical intervention like scraping. Dr. Jones agrees.
Oral Health Routine: An effective oral health routine should avoid disrupting the oral microbiome unnecessarily. Instead of scraping, consider gentle brushing, flossing, and maintaining a diet that supports the natural flora of the mouth. Dr. Jones agrees.
Transparency: Health professionals should provide recommendations free from commercial influence, ensuring that the advice given benefits patient health rather than product sales. Dr. Jones’ tongue scrapers may have resulted in intellectual blinders.

In conclusion, while Dr. Jone's enthusiasm for natural oral health practices is laudable, his specific claim regarding tongue scraping needs to be met with skepticism. Health advice should always be supported by solid evidence, and when it comes to our mouths, the science should speak louder than the sales pitch. As always, eat a whole-food diet devoid of processed carbohydrates and vegetable oils, and include animal-based foods with their inherent fats for optimal oral and systemic health.

Sources:

Pignatelli P, Fabietti G, Ricci A, Piattelli A, Curia MC. How Periodontal Disease and Presence of Nitric Oxide Reducing Oral Bacteria Can Affect Blood Pressure. Int J Mol Sci. 2020 Oct 13;21(20):7538. doi: 10.3390/ijms21207538. PMID: 33066082; PMCID: PMC7589924.
Tribble GD, Angelov N, Weltman R, Wang BY, Eswaran SV, Gay IC, Parthasarathy K, Dao DV, Richardson KN, Ismail NM, Sharina IG, Hyde ER, Ajami NJ, Petrosino JF, Bryan NS. Frequency of Tongue Cleaning Impacts the Human Tongue Microbiome Composition and Enterosalivary Circulation of Nitrate. Front Cell Infect Microbiol. 2019 Mar 1;9:39. doi: 10.3389/fcimb.2019.00039. PMID: 30881924; PMCID: PMC6406172.
Saadeh M, Ghafari JG, Haddad RV, Ayoub F. Association among geometric configurations of palatal rugae. J Forensic Odontostomatol. 2017 Jul 1;35(1):33-41. PMID: 29381483; PMCID: PMC6035754.

When Monetary Gains Bend Scientific Facts: The Case of Tongue Scraping