Beyond the drill – Reversing tooth decay

An Australian study reveals the unthinkable: tooth decay is reversible. Celeste McGovern investigates how to reverse cavities and avoid a drill-and-fill solution.

In a little known study in the 1920s, researchers at the Department of Pediatrics and Dentistry at the State University of Iowa treating children for diabetes discovered something untoward. Twenty-eight of the children, who’d had a number of dental cavities, saw their extensive active tooth decay come to a halt after they were put on a diabetic diet and treated with insulin. Low in sugar, the diet also included two pints of milk each day, cream, butter, eggs, cod liver oil, vegetables and fruit.1

Intrigued by these findings, the same researchers tried the diet on children in the hospital’s orthopaedic ward. The group were fed the same low-sugar, high-dairy plus cod liver oil diabetic diet, but not insulin. Again, all of their dental caries were halted, as evidenced by the “stony hardness” of the dentine (‘dentin’ in the US) compared with its initially decaying state. The researchers noted “no advance in the destructive process”.

Next, the researchers instructed the mothers of a group of preschool children with cavities to make sure the children got a teaspoon of cod liver oil, a quart of whole milk, an ounce of butter, a glass of orange or tomato juice and two or more servings of vegetables and fruit every day. Otherwise, they could eat whatever they wanted.Some children ate sweets, some were on high-carbohydrate diets and some on low-carbohydrate, high-fat diets. In some cases, they didn’t even use a toothbrush. Yet all of the children’s tooth decay arrested within 10 weeks.2

This study and the idea behind it—that dental cavities can be reversed—has been largely forgotten by the dental profession, whose approach to dental decay is to brandish a drill. In the UK, dentists drill and fit about 12 million metal amalgam fillings each year, to say nothing of the white fillings offered to small children and those willing to pay extra to avoid mercury. According to a British Dental Health Foundation survey, dental decay is the most common disease of UK children. More than four-fifths of the entire UK population has at least one filling; the average adult has seven.

But recently, the possibility of reversing tooth decay was resurrected after a team of Australian dental researchers published the results of their explosive seven-year study and follow-up: up to half of all tooth decay was reversible with the appropriate care, they concluded.

The researchers had split 902 patients from 22 private dental clinics into two groups: those having conventional “restorative” treatment (drilling and filling); and those following a routine of preventative oral care, including high-fluoride varnishes, attention to brushing, and restriction of snacks and sugary drinks. At the end of the study, those patients following the conservative route were between 30 and nearly 50 per cent less likely to need drilling and filling.3

Unnecessary treatment

As Associate Professor Wendell Evans of the University of Sydney, the study’s lead author, concluded, fillings are “unnecessary” and “not required in many cases of dental decay”. In his view, his team’s research signals nothing less than “the need for a major shift in the way tooth decay is managed by dentists”.

In the current paradigm, when a semi-annual checkup at the dentist reveals early tooth decay, it is generally a fait accompli that drilling around the affected spot and filling the hole will follow. Even if patients don’t feel pain now, they are told that if they don’t deal with the decay immediately, it will progress rapidly, damaging the tooth enamel first, then invading the dentine (the layer just under the enamel) to finally make its way to the innervated pulp, where it will cause lots of pain and the need for a root canal procedure or even eventually extraction of the tooth.

A little pain now or a lot of pain later is the deal—and to not treat at all may well be considered negligent. The idea of healing or reversing cavities is rarely discussed—it’s as if teeth are inert rocks in our mouths rather than living tissues. What’s done can’t be undone.

But the University of Sydney study notes that, as far back as the 1960s, dental decay was described as a “dynamic” disease with various states of “arrest, progression and remineralization.”4 Teeth are in a constant state of demineralization and remineralization, like skin being continually sloughed off and replaced—all without our needing to do a thing.

Watch and wait

The average tooth decay takes four to eight years to progress from the outer enamel layer to the inner layer, according to the Australian dentists. “That is plenty of time for the decay to be detected and treated before it becomes a cavity and requires a filling.”

What’s more, according to Evans, “50 years of research studies have shown that decay is not always progressive and develops more slowly than was previously believed”. One recent study, for example, of 8,084 tooth surfaces from 543 “caries-active adults with substantial fluoride exposure” discovered that half the early lesions found were reversed within 33 months, with only 8 per cent progressing to cavities.5

The study concluded that drilling and filling is often unnecessary and “brings into question the ethics of continuing this practice”.

This is a radical accusation coming from within mainstream dentistry. While ‘overtreatment’ is a well-known topic inside the profession, it is considered to apply only to “gross” situations, Evans told WDDTY. “Many dentists would claim that our approach is unprofessional and bordering on malpractice.”

But Evans is not alone. David Albert, an associate professor of dentistry at Columbia University, told the website Colgate Professional in 2014 that early fillings of caries is not always a good thing, as it usually leads to a domino effect of drilling and filling.

“For some individuals at high risk for dental decay, it’s good to find decay early and treat it early. But if you’re in a low-risk group for dental decay, the treatment of choice is to apply fluorides in the dental office and at home to repair the tooth. In other words, don’t drill.

“If I saw 100 patients [who had early decay and no cavities] and decided to wait six months before treating them, it would be the right decision for 95 of them,” he added. “I think we do more harm by over-treating because there will always be complications of treatment.”

Fillings can crack, break or fall out, for example, and the space between the filling and the tooth is a hot spot for further decay that could lead to root canal treatment or tooth loss.

Drilling weakens the tooth and may also threaten neighboring teeth. A 2015 study from the University of Oslo found that, of 750 tooth surfaces in contact with new dental composite fillings, 61 per cent developed tooth decay within five years. The type of filling used made no difference to the increased risk of tooth decay.6

Not to mention that the material used for the fillings themselves may be hazardous. Amalgam fillings are at least 50 per cent mercury—a metal for which there are more than 10,000 published reports of toxicity. Mercury is a well-established neurotoxin, associated with diseases ranging from Alzheimer’s to cancer and multiple sclerosis. Countries like Sweden, Norway and Denmark have even banned amalgam fillings altogether.

But the white composite resin fillings that are replacing them may contain hormone disruptors like bisphenol A (BPA). This component of plastics has been linked to infertility, altered brain development, cancer and cardiovascular disease.

Particularly in the case of children’s painless cavities, the ‘wait-and-see’ approach seems to be gaining favor. In 2009, more than 50 practicing dentists met at the University of Manchester to discuss the treatment of painless cavities in baby teeth and agreed that it seemed to only expose children to needless pain and suffering for teeth that would be lost by age 11 in any case. The NHS Health Technology Assessment Program is currently running a trial throughout the UK to compare treatment options in such cases.7

For some critics outside of the dental profession, the suggestion that dental practices are not supported by evidence is hardly a revelation. Drilling and filling is driven not by research evidence, but by dentistry’s third pillar—billing—according to Ramiel Nagel, author of the book Cure Tooth Decay (Golden Child Publishing, 2009). In the UK, dentistry is a £7 billion industry—a fraction of the £90.4 billion of the US dental industry, but still enormous.

“There isn’t much incentive in the system for curing and preventing cavities,” says Nagel.

Nagel started to look at tooth decay several years ago, when his young daughter’s teeth began crumbling, and he himself had four cavities. Preferring natural remedies to fluoride, and loath to subject a toddler to the dentist’s drill, he began to investigate other options.

He came across the works of dentist Weston Price who, in 1915, was the first research director of the National Dental Association (now the American Dental Association). In the 1930s, Price set out to study indigenous peoples across the globe to learn why their teeth and general health were now deteriorating rapidly.

His 1939 book, Nutrition and Physical Degeneration, is still popular today. It contains many remarkable photographs of the robust health and teeth of people on traditional diets, and those of people with rotten mouths and lots of degenerative diseases with the rapidly spreading modern diet of sugar and processed flour.

Modern dentistry acknowledges that increased sugar consumption is a key ingredient in dental caries because it promotes the growth of the Streptococcus variety of bacteria which produce acid that gradually eats away at teeth. Genetic factors are also increasingly implicated in the process as well.8

But even dental textbooks continue to acknowledge that the mechanism for reducing caries is still not “fully explained” by either the use of fluoride or restricting sugar intakes.9

Price recognized the perils of sugar, but he also noted that the various cavity-free indigenous peoples around the world, though they had widely different diets, all had one thing in common: a high level of fat-soluble vitamins (especially A, D, E and K).

“Dr Price found that modern people suffer from tooth decay because modern diets are severely lacking in fat-soluble vitamins,” says Nagel. “To cure cavities, they simply need to add these vitamins back into their diets.”

In his Cleveland, Ohio, clinic, Price successfully reversed many cavities, both in the enamel and the deeper layers of dentine, without using fluoride, but
just his nutrient-dense protocol.

Pre-World War II studies

Price’s nutritional approach to preventing or reversing dental caries is also supported by other early research besides the Iowa study of diabetic children. Lady May Mellanby, a British dentist who studied thousands of children in pre-World War II London, was also convinced that diet is essential. In an early experiment in children, she observed that a high-cereal diet (and especially oatmeal) was associated with the greatest tooth decay.10

This result prompted her to investigate a cereal-free diet rich in vitamin D and calcium. This diet was given to 22 children who had a number of cavities for an average of 26 weeks. The results showed that the diet worked better than any other in preventing further decay and healing those teeth with cavities.10

Miraculous turnarounds

Ramiel Nagel put these and other findings to the test, and healed his daughter’s and his own cavities. He claims to have been contacted by many people who’ve also reversed their caries or their children’s too.

Mielle Chenier-Cowan Rose is one of them. Before her daughter Clara Rose was two years old, her teeth were in trouble. One of them was brown and mushy to the touch, and her other teeth were obviously decaying too. Her dentist recommended immediate surgery.

Mielle found Nagel’s book on the internet and implemented every recommendation immediately. “Literally, in five days that one tooth had a miraculous turnaround,” she says. “It was hard and had lightened. It had been brown. I just couldn’t believe it.”

That was five years ago and today, Clara Rose, now seven, has lost a few of her baby teeth naturally, but all of her dental checkups have been positive. Mielle says they’ve reintroduced some of Nagel’s prohibited foods, such as high-phytic-acid beans and nuts and a few grains occasionally, but she is no longer ‘casually vegetarian’, a factor she believes contributed to her daughter’s tooth decay.

Judene Benoit is a practising Canadian dentist and author of How to Stop Cavities: A Natural Approach to Prevention and Remineralization (self-published, 2015). “Absolutely remineralizing your teeth and cavities requires much more work and effort than having a filling,” she says. “And remineralizing your teeth and cavities naturally [that is, without fluoride] requires even more work and effort.”

Benoit says that choosing not to have fillings can be risky and should always be overseen by a dentist to ensure that the tooth is healing and the cavity is not progressing. But be aware: some cavities must be treated. Benoit has developed a chart to help determine how likely it is to be able to reverse dental caries in a given case (see box, right).

Nevertheless, everyone can benefit from remineralizing their teeth, whether they have cavities or not, she insists. Benoit hears stories of other unintended benefits in children with her approach: it cleared up allergies and acne, improved energy, normalized weight, improved school performance, led to better sleep and made rashes disappear.

All this is more evidence of what Weston Price intuitively understood:
the mouth is a unique window into the state of your health.

Price’s protocol

Dr Weston Price was the first research director of the National Dental Association (now the American Dental Association)

¼ tsp fermented cod liver oil + ¼ tsp high-vitamin butter oil (from the milk of grass-fed cattle)

Suggested daily dose: 1–1½ tsp/day (taken in two to three doses)

Foods to avoid:

White-flour products

Skimmed-milk products

Sugar and other sweeteners

Foods to include:

2 cups or more of raw grass-fed milk daily

Bone and vegetable broths

Bone marrow

Beef and fish stews

Seafood

Organ meats

Fine cuts of red meat

Tomato or orange juice (rich in vitamin C and antioxidants)

Lots of green vegetables

Cooked fruit

Some whole grains (although Nagel advises against grains like oatmeal, which are high in phytic acid, which can deplete critical minerals)

Benoit’s Remineralizing Likeliness Chart

Remineralizing teeth, while possible, is still a challenge that requires significant changes to diet that may impact lifestyle. Dentist Judene Benoit has seen patients cry for joy when they’ve hardened a cavity and staved off the drill, but also some who’ve worked hard, yet decay has progressed. She devised the following chart to assess the odds of a tooth remineralizing before it needs drilling and filling, but she urges people not to self-assess themselves, as it’s a skill that requires extensive training and isn’t always obvious: sinister-looking cavities can be harmless, and harmless-looking ones can be a potential disaster. A dentist can help assess the risks of waiting to treat while attempting to remineralize based on the location and extent of the decay, and how fast it is progressing.

The chart assesses your tooth by adding up the points: easiest to remineralize = 2 points; challenging = 3–6 points; highly unlikely = 7+ points. Minus 2 means subtract two points from the total score, and a zero point is neutral. But Benoit maintains that whatever the odds of remineralizing an existing cavity, changing the conditions in the mouth to prevent future cavities is always a good idea.

Healing your cavities naturally

Besides increasing nutrient-dense foods and cutting out grains, especially oatmeal, from your diet, here are a few other cavity-healing remedies to try.

Coconut oil ‘pulling’

Many people recommend taking a tablespoon or so of coconut oil and swishing it around the mouth, pushing and pulling it between the teeth. It’s an ancient Ayurvedic technique that is claimed to have a detoxifying effect, but some think it may remove plaque associated with dental caries too. A recommended oil-pull should last 15 to 20 minutes, and the swishing-about seems to also have a tooth-whitening effect.

In 2015, a group of 60 teenagers with plaque-induced gingivitis were asked to swish coconut oil each morning for 30 days in addition to brushing their teeth. After seven days, plaque and gingivitis markers began to noticeably decrease significantly and continued to drop throughout the rest of the trial.1

Grape seed extract (instead of fluoride varnish)

Many dentists like to treat cavities with a fluoride varnish, but this has been linked to neurotoxicity in adults and, at low levels, impaired brain development in children.2

Alternatively, grape seed extract, inexpensively available in liquid or powder form, has been demonstrated to be even more effective at remineralizing human teeth in the lab than fluoride,3 or two other remineralizing agents commonly used in toothpaste.4

Cinnamon and clove oil

Applying clove oil to a sore tooth is an old traditional remedy that, in a 2011 study, significantly inhibited the growth of Streptococcus mutans, the bacteria associated with cavity formation.5 In another study, cinnamon oil beat clove oil at combatting cavity-causing mouth bacteria.6

Try adding a few drops of cinnamon or clove oil to a homemade baking soda (bicarbonate of soda) mouthwash:

1 cup (250 mL) tap water

¼ tsp (1 mL) baking soda

Stir the baking soda in the water until it dissolves, then pour the mouthwash into a bottle and close the lid. This mouthwash can only be used for 24 hours; after that, throw it away and make a fresh batch.

Altering your oral pH

The acidity of our mouths is changing all the time—when we’re sleeping, after we eat or drink, when we mouth-breathe, if we’re dehydrated, when we’re stressed, even when we’re hungry. Tooth cavity formation requires acidic conditions, as acid dissolves enamel and dentine.

Dentist Judene Benoit recommends that patients start testing their pH throughout the day—several times at first, to get an idea of what conditions are contributing to oral acidity. pH strips are not expensive and come with a colour-coded chart to show where your mouth saliva is on the scale between acid and alkaline (this runs from 0 to 14). You simply spit into a cup or let saliva pool in your mouth, dip the test strip into the saliva and immediately compare it against the colour chart to get a reading. (Don’t wait or you’ll get a false reading.)

A pH of 7 is neutral, neither acid nor alkaline—and where you want to be. A number higher than 7 is alkaline, and a number lower than 7 is acidic. A saliva pH of 5.5 is the ‘critical pH’ for cavity formation, Benoit says. “If you or your child see a pH score of 5.5, you should treat it like a mini-emergency and take action to raise mouth pH immediately.”

But higher acidic numbers like 6.5 aren’t ideal either. Your mouth should be neutral or very slightly alkaline. If you find your mouth is acidic after drinking numerous cups of coffee all day, stop sipping it all day! If it’s mildly acidic after eating, take the following steps to alkalinize it:

1) Consume green drinks, smoothies and vegetables containing Chlorella algae, eat a salad, or add a few drops of liquid Chlorella to water.

2) Swish Milk of Magnesia like a mouthwash and spit it out.

3) Mix 1 tsp of sea salt and 1 tsp of baking soda in a cup of water, swish it like a mouthwash, then spit it out.

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