By Gary M. Verigin, DDS, CTN
Originally published in Biosis (Issue #7)
For Halloween 1973, I had a bumper sticker made to hand out to trick-or-treaters. It said, “Eat Sugar and White Flour – Support Your Local Dentist and Physician.” With it, we gave the kids a choice of treats: a pencil, a toothbrush or candy. What do you think was their favorite?
The inspiration for the sticker was a book I had bought earlier that year, after hearing a lecture by Emanuel Cheraskin, MD, DMD, Chair of the Department of Oral Medicine at the University of Alabama – Birmingham. His book was Predictive Medicine: A Study in Strategy, and I was especially struck by this passage from the dust jacket flap:
A true health program should have as its thesis the anticipation and prevention of disease rather than mere identification and treatment. At the present time no such formal program exists anywhere in the world….
Predictive medicine may be described as the clinical discipline designed to anticipate disease in man, to foretell illness before it erupts in a classical form. In addition predictive medicine is concerned with primary prevention of disease – prevention of occurrence. The strategy of such a program is here outlined.
The book itself was prefaced by a quote from Sir William Osler: “Your only insurance against tomorrow is what you do today!” Those words had a profound impact on me.
Cheraskin’s book truly changed my life, my family’s life and the direction of our dental practice. In 1973, we were still filling teeth with mercury, though we and our patients knew the material was poison. But even back then, insurance companies were the “mothering teat” of most dental practices. Patients would only do what their insurance companies allowed. That meant mercury fillings.
Yes, we fell into that trap.
But after reading Cheraskin, I made a commitment to creating what he said didn’t exist as a formal program anywhere in the world. We would make it a way of life in our dental practice. And ever since, we have been refining our practice, bringing in the new and ever searching for a higher state of being through integrated, biological dentistry.
This is the backdrop for telling you more about a situation we see nearly every day in our office: recurrent tooth decay.
The conventional approach to treating dental caries (cavities) is to remove and replace the diseased tooth tissue with a filling material (mercury, silver, gold, porcelain, ceramic or composite). No attempt is made to cure the disease. The patient subject to this Western school dentistry often returns only months later needing more fillings due to recurrence of caries.
In contrast, our integrated, biological approach involves active and aggressive caries-management and prevention. It also promotes understanding of the science behind what’s really going on. After all, you can’t win the war if you don’t know your enemy.
I think most patients would agree that when they visit us for their preventive maintenance visits – some offices call it a “recall,” a word I detest – they may think of them more as lighthearted interrogations about how they daily control the dental biofilm commonly called “plaque.” And yet, despite our best efforts at motivation and education, the average adult client in our practice has anywhere from 11 to 18 decayed, missing or permanently filled teeth.
It is universally recognized that decay and caries are multifactorial, with specific bacteria residing in intraoral plaques. With the advent of new and more sophisticated microscopy, such as the confocal scanning laser, we now understand more about the nature of dental biofilms.
A biofilm is a well-organized colony of differing microorganisms living in a cooperative community. If you were to place some flowers in a vase for a few days and then remove them, you would find a sticky, slimy surface adhering to the inside of the vase. This is a classic example of a biofilm. The more it’s allowed to stagnate, the more biofilm develops.
Strictly speaking, you don’t remove biofilm from your teeth. You disturb it using one or more dental cleaning tools: toothpaste, brushes, floss, Perio-Aids, oral irrigators and so on. But within just a few minutes of being disturbed, the biofilm begins to form again.
When dental scientists view biofilm through confocal scanning lasers, they see that the microbes living and reproducing in the biofilm are not distributed evenly. Rather, they are grouped in microcolonies, each surrounded by a sticky matrix. Within this matrix are channels through which fluids and waste products pass. They also allow the exchange of endotoxins, exotoxins and enzymes – byproducts produced by the microbes – along with other metabolites and oxygen.
More, these microcolonies may have differing ecological niches. The pH, redox potential, oxygen potential and resistivity can differ greatly even between neighboring colonies. The colonies, meantime, are always in communication with each other. There is a constant flurry of activity among them. “Speaking” to each other through the exchange of chemical and electrical signals, the colonies produce even more harmful enzymes – ones that will digest whatever structures they are adhering to.
Those structures include your teeth.
Whenever you eat or drink any fermentable carbohydrate – such as sugars or refined starches – the microbes in the biofilm literally eat up the acids that are created as the carbohydrate breaks down. And if the biofilm has colonized for a few days, the reactions are even more violent. Within 20 minutes of ingesting fermentable carbohydrates, acidity is increased, drastically lowering the pH and restoring the conditions that allow the biofilm to thrive.
This process repeats with every bite or sip of fermentable carbohydrate.
With healthy teeth, the process occurs on the enamel. But if one’s gums have receded, exposing some of the roots of one or more teeth, the biofilm will attach to the exposed root, as well. The root is not covered with enamel, though. It is shielded by a thin layer of cementum, which is eventually eroded by brushing. At this point, the dentin below is exposed.
Dentin is somewhat porous. Within, dentinal tubules radiate from the dental pulpal complex, each tubule containing a protein process. You can think of these structures as small drinking straws, each with a length of spaghetti running through. And all told, there are miles of these tubules within each tooth. One dental scientist who measured the length of all tubules within a single incisor reported a total of about three miles!
Dentinal fluid slowly circulates through the straw-like tubules, moving from the inside towards the root surface. This movement is controlled by hormones, and it’s estimated that the fluid circulates about 10 times a day. But when biofilm is left on the teeth and you eat fermentable foods, hormones reverse the flow. The fluid moves inward, taking with it microbes of the biofilm, introducing them to the pulpal complex. The increased acidity, in turn, demineralizes both the enamel and dentin. After 3500 to 5000 circulation cycles, the structures of the teeth soften. Decay sets in, migrating to the interior depths of the teeth, pushing through much like a mushroom cap first bursting through moist earth.
The more acid-producing and acid-loving microorganisms you have in your biofilm, and the more frequent your intake of fermentable carbohydrate, the more decay. We see it time and again. And if the biofilm isn’t thoroughly stirred up a few times a day, the decay process is even more destructive.
We like to help inquiring clients assess their dietary habits. Balancing the biological terrain further helps digestion and the use of the ingested food. It also helps ensure a healthy salivary flow and improve its buffering capacity. Indeed, those whose terrains are less disordered – as measured through our BTA testing – seem to be better protected from the ravages of tooth decay than people with less favorable diets. As an added overall body benefit, these patients take many fewer prescription medications and have a better quality of life and greater comfort with their mental outlooks.
The condition and functioning of the teeth and periodontum are not of self-contained important; their state of health implicates all the rest of the body. – Sperber