Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
2 Jun

How to Take Care of Your Teeth (Hint: There’s More to It Than Brushing)

brushingteeth2I get a lot of questions about dental hygiene and health, and for good reason. Dental records of our paleolithic ancestors show a fairly low incidence of caries when compared to modern teeth. Exceptions exist, but the general trends suggest that Grok had better teeth than the average contemporary human. Of course, when cavities struck back then, they hit hard and got really ugly, because there were no dentists, drills, or x-rays to fix the problem, but most never got to that point. Also, the adoption of agriculture is generally associated with the emergence of poor dental health, so much so that many researchers use the appearance of dental caries in a population as strong evidence for the presence of farming. Maize/corn is particularly bad, as is wheat, but the same relationship may not hold true for rice agriculture in Asian records.

Okay – let’s take a look at a couple common questions I get about dental health:

Mark, this morning as a dental assistant was making my head buzz and my gums hurt with some sort of ultrasonic tooth cleaner, I thought, “what can Grok teach us about tooth care?” Something tells me Grok did not brush his teeth–did he do anything to take care of himself in that way? And if he survived just fine, what does that tell us about “conventional wisdom” that says we should adopt a routine, and buy a medicine cabinet full of stuff to take care of our teeth? I certainly don’t mean to convey that tooth care is bad–but rather am just thinking about what we can learn from the past to harmonize the present.

Thanks for reading this, and thank you for your dedication to better health!

Hey Mark! I’ve recently taken an interest in making my oral regimen more Primal. I’ve read up on a lot of the more natural toothpastes and toothpaste alternatives but I’m undecided. What have you and your wife found to be the safest and most effective way to keep your cavities at bay?? Thanks!

Before resorting to anything reactive, whether it be brushing with homemade toothpaste, dousing your oral cavity with anti-bacterial mouthwash, bypassing the teeth altogether with an IV nutrient feed, or using a dental dam to chew, those seeking excellent dental health should establish a strong dietary foundation of the minerals, micronutrients, and other cofactors that play major roles in the maintenance of teeth.

The Vitamin D/A/K2 Connection

You’ve probably heard about how this holy trinity of micronutrients works together to promote proper bone and tooth mineralization, which means putting calcium and other minerals where they belong (bones, teeth) instead of where they don’t (arteries, dental calculus/plaque). Both Stephan Guyenet and Chris Masterjohn have written extensively about the synergistic interplay between the three nutritional factors, so I’ll keep this brief. Get adequate midday sun or take vitamin D supplements; eat grass-fed butter, hard cheeses, and organs (especially goose liver, apparently), or supplement with vitamin K2; get plenty of vitamin A from liver, egg yolks, and other animal products.

Grain Avoidance

I probably don’t have to tell you to avoid grains, but for any newcomers who might be reading: ditch the grains, beans, and other legumes that contain high levels of phytic acid, which is known to bind to and prevent absorption of minerals critical for dental health. Nuts also contain phytic acid, but we tend not to eat as many nuts as grains or legumes due to the caloric load. It’s a lot easier to eat two cups of whole wheat than it is to eat two cups of almonds. If you do eat nuts on a regular basis, consider soaking and/or sprouting them to reduce phytic acid content.

Nutrient Intake

It’s not enough to consume the holy mineralization trio and avoid excessive amounts of mineral-binding phytic acid; you also need the raw building blocks. That means getting plenty of minerals in your diet. Leafy greens, grass-fed meat, organs, nuts, roots, and tubers are all good Primal sources of calcium, phosphorous, magnesium, and other vital micronutrients – vital for general and dental health – so eat plenty of them.

Hate the Toothbrush? Use a Chewstick.

There are numerous examples of traditional cultures using chewing sticks from trees with medicinal or antimicrobial properties, like the neem in India, the miswak/arak in Africa, the Mid East, and Asia, or the tea tree, which I mentioned in a previous post. Here’s an example of a Masai “toothbrush” – it’s a whittled-down branch from a (perhaps medicinal) tree with the end frayed and the fibers splayed out to permit interdental entry. If you don’t have access to a miswak, neem, or tea tree, you can find chew sticks online quite easily. Toothpicks or floss will also work pretty well as a physical deterrent, albeit without any medicinal qualities.

There isn’t a ton of head-to-head research on the subject, but one study from 2003 found that miswak chewing sticks removed more plaque and resulted in better gingival health than toothbrushes. The caveat is that chew stick users had to be instructed in the proper use of the implements, whereas toothbrushes are fairly straightforward (not to mention most of us have grown up using them, so we’re well-versed in toothbrushing). It’s notable that chew sticks do not require toothpaste, and they appear to be just as, if not more, effective than toothbrushes. Longer history of use, too. You just have to know how to use it. Miswak appears to be the most studied, so you’ll probably want to use that variety.

Toothpaste

toothpaste

If you’re gonna use a toothbrush, do you need the paste? If so, is Crest/Colgate/insert-mainstream-paste-here good, or should you go with an herbal/alternative/insert-paste-available-at-Whole-Foods-here instead?

Toothpaste use increases abrasion during brushing, while water alone produces less abrasive force. Interestingly, the same study revealed that softer toothbrushes actually cause as much abrasion (and sometimes more) than stiffer toothbrushes. While increased abrasive forces seem like they’d reduce more plaque, that doesn’t seem to be the case. A recent study found that the brushing is the important part, not the paste. In fact, brushing without paste was more effective at removing plaque than brushing with paste.

An herbal toothpaste made from herbs and plants traditionally used to treat oral disease in India was superior to a placebo toothpaste in the treatment of gingival bleeding and oral hygiene. Another study compared herbal toothpastes to conventional fluoride-containing toothpastes in the treatment of established gingivitis and found that both were equally effective.

In another study, a baking soda toothpaste beat an antimicrobial non-baking soda toothpaste in plaque removal and tooth maintenance. Most studies, in fact, show that baking soda is more effective at plaque removal than toothpastes without baking soda. It’s pretty common among older folks to just use straight baking soda to brush, and this seems to be an effective tactic.

If you’ve got all the nutritional and environmental cofactors under control, I don’t think obsessive dental hygiene beyond daily brushing (remember, even if the bristly toothbrush is a recent invention, cleaning our teeth with sticks or picking at them with fingernails is tradition), some toothpicking/flossing, regular dental visits, and/or maybe some chew sticking is necessary. It doesn’t even seem like toothpaste is necessary for good oral health. That said, I do use it – perhaps because I’ve just become conditioned to, or maybe because I need the artificially fresh feeling it provides – but I also don’t feel the pressing need to brush on schedule. I just don’t develop a ton of plaque if I go a bit longer than normal without brushing, nor do I get bad breath. And as anyone who’s been married for more than ten years will tell you, the wife will definitely let you know if things go awry in that area. If you want a cheap toothpaste that isn’t overly sweet, baking soda should do the trick.

How do you folks take care of your teeth? Do you do anything special? Do you have a favorite toothbrush, paste (or paste recipe), or chewing stick? Let us know about it in the comment section!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Hello there!

    I am studying Dental Hygiene by the University of Bergen, Norway and have to say that I was rather surprised from your article! Some statements strongly contradit information I get on the university or read on reputeble websites as Colgate.com and many authorized dentist’s websites! I couldn’t agree on your statement that toothpaste use increases abrasion during brushing, because toothpastes itself contain abrasives but that doesn’t cause the abrasion on your gums or enamel, it is the force you apply! Moreover, the toothpaste containing fluoride makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage can even be seen.
    I’d really like to see a link to the study that shows softer toothbrushes cause as much abrasion (and sometimes more) as stiffer toothbrushes.
    We are daily reccommending soft-bristled brushes to our patients, or a milder brushing techinique with the brush they like using. The direct use of baking soda alone, however, is something we wouldn’t reccomend a person who wants to keep his teeth healthy for life.
    Brushing with a Flouride toothpaste along with regular flossing will save you from many tooth health troubles. Of course a healthy food in addition, would only be an advantage.

    Emanuela wrote on June 4th, 2011
    • I think Europe is just now being bombarded by the american big business and pharmacies. So these bastiches finally made it into the european medical establishments…interesting.

      Fluoride was banned in Europe for decades…chlorine solution for chicken is also banned but that’ll change soon, too. Europe also had banned meat glue…but has lifted the ban a few years ago and is now using it liberally!

      If you’d like to know more about the so called ‘Fluoride’ that you’re promoting in toothpastes check out this video please:

      http://www.youtube.com/watch?feature=player_embedded&v=C7wvjypxGW0

      An example that Fluoride isn’t needed and that diet alone manages the actual health of teeth and bones has also been proven by Weston A. Price.(Nutrition and Physical Degeneration)
      My husband doesn’t eat primal. He eats a diet high in sugar and fruit. He takes in no Vitamin A, has a Vitamin D deficiency, and cooks with palm oil rather than butter which would offer him K2. He therefor takes in 0 amounts of K2. He uses a toothpaste prescribed by his dentist that’s 1% fluoride. He brushes and flosses daily. He had a check up about 6 months ago and was cavity free after fixing 2 small cavities. It’s been 6 months and he already has another large cavity…now on his front incissor…and his tooth has split down the middle.

      I’ve been wearing braces for a year (and have another 1-2 years to go). I’m on a primal diet, taking in High Vitamin Butter Oil and Cod Liver Oil. ( A, D3, E and K2)
      I never brush my teeth, I use some jewish soap that’s made out of coconuts on my teeth and I only blot, I barely floss, mostly only when I go for a cavity check up every 3 months to not be embarassed.
      I have 0 cavities, 0 gum disease and actually since going on the primal diet have healed 4 soft spots on my teeth.

      If this isn’t proof enough I don’t know what is.

      Katzenberg wrote on June 5th, 2011
    • I’m sorry but if Colgate.com is your go to reputable website you’re not really *learning* anything. Repeating would be a better description. Think of it this way, why would Colgate put any information on it’s website that would convince people NOT to use their products? Why would they sponsor studies that are designed in a way that might yield results unfavorable to the sale of their products? Why would they fund dental schools that teach anything other than the standard use of products they sell? You are still a student so you haven’t had the benefit of having patients who do the opposite of what you are taught who are in better health than many of your patients who do as they are told. Give it an honest decade or two and see what information experience yields.

      Health is first and foremost to dental health. Health is first created with diet and lifestyle.

      Sarah wrote on June 6th, 2011
  2. I have never had a cavity, but if I don’t floss I get a ton up plaque build up for some reason. So I floss everyday and brush with a natural toothpaste 1-2 times a day.

    Gary Deagle wrote on June 4th, 2011
  3. Personally for me,

    Flossing makes a world of difference for my dental hygiene besides the usual brushing and mouth rinsing. Your research findings are pretty interesting although I’m don’t quite trust the findings that baking soda is better than toothpaste.

    Angelica wrote on June 5th, 2011
  4. Great guide as a lot of these things I never even thought of especially some of the vitamin information for health gums and teeth.

    Jaysee wrote on June 5th, 2011
  5. I use 3/4 tube of tooth paste. I add two tablespoon of H2O2, for germs; I had oil of oregano for healthy gums. the I add two tsps of Baking powder to de-acidify the mouth and turn it from acidic, germ homes, to…alkaline. Germs don’t like oxigenated areas, but the like acidic where they can grow and cause carries.

    Put all this mixture in a small wide mouth glass bottle, and also add some turmeric, 1/2 capful: Warning: if misused, it (turmeric) will stain your clothes (washes out) and some of our counter top, so brush with head over bowl and keep water running. There is no stain in your pretty mouth; fresh, sweet and oh….so good tasting, and no visits to the dentist, unless, of course you use toothpaste with fluoride the you’re guaranteed carries for life. When finished, you must us a metal tongue scraper for fresh breath and healthy body, all day.

    Sean wrote on June 5th, 2011
  6. A few months ago when I had a wisdom tooth removed I was brushing my teeth with just water and sea salt and it made my teeth squeaky clean, literally, the brush made squeaky noises.

    Steve wrote on June 6th, 2011
  7. My teeth went to hell on a high protein diet. Since reducing protein my oral health has improved. I suspect excess protein was leeching minerals from my body, or just creating an acidic environment.

    I am convinced that protein at any level above the bare minimum does more harm than good.

    It’s rice and potatoes for me.

    soahc wrote on June 6th, 2011
    • Protein is usually muscle meat. Muscle meat is higher in phosphate than Calcium.
      For every mg of phosphate you consume the amount of calcium has to be drawn from bone and teeth to process the phosphorus (cavity, soft spots).
      You end up with excess calculus on your teeth because of this imbalance.
      Calcium needs to be higher in the diet than phosphorus…a ratio of about 10:4.

      That is why a high protein diet caused you problems.
      Not because it’s acidic. Protein in its raw state is only slightly acidic and the phosphorus available in the muscle meat would counter this. But because you cook your proteins the acid level is extremely high. The phosphorus isn’t enough so more has to be drawn out of bone and teeth. On top of it the imbalance of the extra phosphorus in the meat creates extra calcium being drawn out of bone and teeth…

      Balance your meals and you won’t have this problem.
      Rice (without bran) and potatoes are okay as long as you have sufficient A, D, E and K2 + ALL minerals in your diet.

      Oysters, egg yolks, bone broth, bone marrow, organ meats and RAW milks from animal source…are all things that build strong teeth and bones, together with vegetables make the best balanced diet for a healthy mouth.

      Primal Palate wrote on June 17th, 2011
  8. I wonder if Mark needs that fresh feeling because being in kestosis gives you bad breath. Im not hating im just curious. I know that bad breath feelin from kestosis

    Adrian wrote on June 6th, 2011
  9. Floss in the shower! It helps with the mess :) A recommendation from my dentist.

    Erica wrote on June 7th, 2011
  10. I find the baking soda practice unpalatable, however. It’s WAY too abrasive for me, leaving me with the sensation that I’ve gotten a friction burn or something in my mouth.

    Benjamin wrote on June 8th, 2011
  11. Mark, I would like to hear your thoughts on xylitol. Here is my toothsoap recipe that uses xylitol to add a sweet flavor to the paste & works as a cleaner – two in one! It is very simple & similar taste to store bought pastes.

    http://slowsimpleliving.blogspot.com/2011/06/homemade-toothpaste.html

    I have used baking soda in the past, but it is very abrasive.

    Carol Bahr wrote on June 13th, 2011
  12. Dont use toothpaste in the morning, cause it makes me belch..

    Only use ist very sparse in the evening.

    alex wrote on June 14th, 2011
  13. What do people think of obtaining calcium from eggshells, which is mentioned in a few places on the web?

    Take some empty shells and wash out any remaining white, although leave the membrane.

    Sterilise in boiling water for a few minutes

    Allow to dry

    Crush up and then grind in e.g. a food processor or a coffee grinder

    Take a teaspoon of the powder and add it to the juice of a freshly squeezed lemon

    Leave for something like six hours.

    The result should be (well mostly) calcium citrate, which should in theory provide bioavailable calcium.

    Take with a Magnesium (e.g. citrate) supplement (unless your diet is otherwise rich in magnesium, which is fairly hard to achieve, I gather).

    Also with vitamin D (sunlight or supplement).

    I’ve read this more in the context of countering osteoporosis than helping teeth, but hopefully, it should do both.

    People have described the taste of the resulting calcium citrate as “pleasant”. I personally would not go that far (only just started), and I get it down by adding it to food, or to a mixture of warm water and coconut oil. I usually seem to have plenty of powdery residue, which I swallow down with liquid somehow, but I wonder how bioavailable that is … presumably it is still calcium carbonate.

    Perhaps I’m not using enough lemon juice.

    Mike Ellwood wrote on July 6th, 2011
    • Never tried it but once I’m home from travels (in September) I’m giving it a go!! I’ll let you know. Stops wasting the shells. :-D

      James wrote on July 9th, 2011
      • Maybe you could do what a chef I once worked with did and add the eggshells to you bone broth. I put a ziplock baggie in the freezer and put eggshells and all kinds of table scraps in as they accumulate and later add them to my bone broth mix before boiling. I put a sweet potato skin in with my last broth and it was the best tasting one I’ve made so far!

        Matt wrote on October 6th, 2011
  14. I ditched fluoride toothpaste a few years ago and went onto non fluoride toothpastes and then baking soda and next toothsoap.

    I bought the expensive toothsoap at first, but now have switched to just use a bar of kiss my face soap which is a hell of a lot cheaper and seems q similar.

    I had good teeth as a child and teenager, no fillings despite a poor diet, then in my early 20s i started experiencing problems with cavity formation and what felt like enamel being eaten away when I ate certain foods.

    Now I’ve ditched the grains and legumes, although still eating some nuts, taking vitamin D, eating a more primal diet, things have improved in the last few months but not completely.

    Scott wrote on January 4th, 2012
  15. what should i do to strengthen the enamel?i am using colgate toothpaste and brush twice a day.i think my teeth become sensitive though more whiter .i drink green tea and it reduce bad breath and clean rhe mouth.

    nangakarihtoo wrote on March 23rd, 2012
  16. For those who are in Canada you can buy them at Well.ca and they have free shipping. http://well.ca/products/thursday-plantation-tea-tree_30173.html

    Lisa wrote on May 9th, 2012
  17. Hey everyone just use Eco Dent toothpowder. It neutralizes acids in your saliva whitens teeth no SLS or flouride no sugars or sweetners and floss also. But if you people haven’t tried tooth powder do it you’ll never switch back to paste

    kyle eropkin wrote on May 27th, 2012
    • I checked it and it does have SLS

      Annie wrote on June 13th, 2012
      • which formula contains SLS?

        Wenona wrote on December 4th, 2013
  18. Hello, I just had to comment here. I am a Weston Price member raising 3 boys, and trying to feed them properly. I will consider it my biggest accomplishment if all 3 end up with enough room for their wisdom teeth. That is my goal!

    Elizabeth McInerney wrote on June 22nd, 2012
  19. Well, for the serious reader, there’s a book by Dr. Robert O Nara called Money by the mouthful. He explains the dentists bias (lipid hypotheses anyone?) against some therapies that are excellent for oral hygiene. Caries, cavities, gum problems are all caused by bacteria that come from the external world into the mouth. People touch all kind of things and then put their hands in their mouths. This is where the bad bacteria come in from. The bacteria then start residing in the pocket of space between the gums and the teeth, right at the neck/root of the teeth. The real problems start when the bacteria start eating away at the roots of the teeth. Caries and cavities are only symptoms of this problem. Conventional Widsom says that if you clean your mouth of food particles, you have effectively cut off the food for bacteria to feed on. This sounds right but isnt. (high carb, low fat theory anyone?) The solution is really logical. Go straight for the bacteria. They have these devices called oral irrigators (viajet pro, water pik) that flush out the bacteria living in the space between the teeth and the gums. A regular routine is extremely effective at eliminating these bacteria. For those who are more cosmetically inclined, Dr. O Nara suggests using a tooth polisher to further remove any bacteria and get that glossy white look.

    Srinivas Kari wrote on June 23rd, 2012
  20. I believe as far as chewsticks (siwak) go, arak is best, then olive, the maybe walnut. I’ve actually been feeling more fuzzy on primal, so i broke out my siwak

    Summer wrote on June 29th, 2012
  21. I’ve been oil-pulling for over a year now. First thing in the morning swish around 1-2 Tbsp of oil (sesame, olive, or coconut). Spit it out, rinse, and brush.

    That’s it. Whiter teeth and eliminated my plaque. Awesome.

    Greyson wrote on July 25th, 2012
  22. Been doing Paleo for over a year; and the results are stunning. Loads of time spent at the dentist over the past 30 years because of a high carb starchy diet. No longer. Being told in the 70′s not to eat eggs; what else was there to eat? So I downed cereals and pasta and bagels and juices…. Cavity city. Oh and after starting Paleo; I said goodbye to my IBS as well. The bad science we were given in the 70′s is truly mind boggling. They couldn’t even get basic nutrition right. Stunning indictment of the medical world. Glad to see the good solid science done by Marks blog

    Screw Ancel Keys wrote on January 14th, 2013
  23. I recently got 10% off the Sonicare HealthyWhite toothbrush by using the code OralCare at dentist.net… It works!

    elaina millar wrote on February 21st, 2013
  24. Baking soda can be too abrasive, especially around fillings and implants.

    John wrote on June 23rd, 2013
  25. I have toiletbreath. Is that caused by a diet with alot of grains?

    Toiletbreath wrote on September 4th, 2013
  26. I just stumbled upon this article and I think it’s awesome! I love Uncle Harry’s Tooth Powder and I would encourage anyone to check it out. I never thought of us as primal before but i’m loving this passionate oral-health debate.

    We strictly avoid fluoride, sweeteners, preservatives, any miracle synthetic additive, baking soda, and foaming agents such as Sodium Lauryl Sulfate. Uncle Harry’s Natural Toothpowder contains natural mustard seed powder, sundried sea salt, calcium carbonate or natural chalk, and a bouquet of natural aromatherapy essential oils such as thyme, eucalyptus, clove, and peppermint. This mixture creates a very powerful synergetic potion that cleans the teeth and eliminates harmful bacterial build-up in the mouth.

    Please let us know if you have any questions and check out our new website!!
    Uncleharrys.com

    Sarah wrote on October 10th, 2013
  27. Hi,
    Very interesting post. I brush twice a day and floss almost every day.

    Carolina wrote on November 3rd, 2013
  28. Specifically with younger children that have learned to spit were primarily concerned with safety and seek the “seal of approval” of the American Dental Association on the label. As far as fluoride vs non-fluoride as long has it has the AMA label our vote is for fluoride! – TB

    Our team of Pediatric Dentists actually just covered the topic of toothpaste geared towards children. You can check it out here:

    http://www.childrensdentalvillage.net/blog/best-toothpaste-for-teeth-cleaning-recommended-by-pediatric-dentists/

    Timmothy wrote on November 11th, 2013
  29. I just brushed with (and tried for the first time) activated charcoal, leaving it on for 3 minutes after. Spit all of it out that I could, then brushed with magnesium oil (terribly nasty taste and it stings a bit) but my teeth feel very smooth. On the plus side, the old toothpaste that was kind of built up on my toothbrush got broken down and rinsed down the drain (I’m thinking from the magnesium oil) lol. I do still have some little spots of charcoal along my gums, but I doubt leaving it there to go on its own will cause any harm.

    Wenona wrote on December 4th, 2013
    • magnesium oil is also supposed to be anti-inflammatory. I do remember noticing after the first time using it a year or so ago to brush my teeth, that my gums seemed less inflamed.

      Wenona wrote on December 4th, 2013

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