Praise for Kiss Your Dentist Goodbye

“Truly Life-Changing”
“I vividly remember picking up the first edition of this book and reading
it cover to cover in one sitting—it was incredible and truly life-changing.
As a pediatric dentist, I frequently explain to parents that baby teeth are
critical to the proper development of adult oral health. Dental disease is
entirely preventable, and it’s vital for parents to understand that
unnecessary or invasive treatments in a child’s mouth can have long-
term consequences on their oral health. I would love to see dental
education place greater emphasis on the types of effective, non-invasive,
and preventative strategies detailed in this outstanding book.”
DR. QUINN YOST, DDS, MSD • BOARD-CERTIFIED PEDIATRIC DENTIST

“For Anyone Seeking to Improve Their Dental

Health”
“Your mouth is the first place where your food gets its chance to help
or harm your health—starting with your teeth and gums! In this
second edition of Kiss Your Dentist Goodbye, Dr. Phillips gives valuable
advice that everyone needs to know on how to optimize their oral
health. She has your back, so read this book to kiss your fear of the
dentist goodbye.”
DR. WILLIAM W. LI, MD • NEW YORK TIMES BESTSELLING AUTHOR OF EAT TO BEAT DISEASE AND EAT TO
BEAT YOUR DIET, AND PRESIDENT AND MEDICAL DIRECTOR, THE ANGIOGENESIS FOUNDATION

“A Clear and Lucid Guide”

“Dr. Ellie’s passion for healthier teeth is limitless, and this book clearly
explains the impact of an unhealthy mouth on body health. My passion
for prevention includes women’s heart health, and Dr. Ellie explains
why women’s teeth suffer in a special way as they are affected by
dramatic shifts in mouth pH and dryness over time. This informative
new second edition of Kiss Your Dentist Goodbye is a clear and lucid
guide filled with all kinds of action-based tips and protocols. Thank you,
Dr. Ellie.”
DR. AMY DONEEN, DNP, ARNP • MEDICAL DIRECTOR, THE PREVENTION CENTER FOR HEART & BRAIN
 HEALTH

“For Patients to Be Empowered”

“I interviewed Dr. Phillips as part of a story for The Times (of London)
covering flossing. Her evidence-based debunking of the myths around
flossing went completely against decades of public health education,
but Dr. Phillips was right. The research was incontrovertible, and
backed up by my own adoption of her methods. I also became acutely
aware, as this book describes, of a disconnect in the world of patient
education, and the need for patients to be empowered about their oral
health and effective strategies to use at home, between dental visits.
HELEN RUMBELOW, JOURNALIST, THE TIMES OF LONDON, UK

“So Much for Consumers to Learn”

“The message in this book is about the impact of poor oral health on
oral and general health, but it also addresses the dangerous oral health
spiral that can begin with just a few small fillings. There is so much for
consumers to learn—and easy behavior changes that everyone can use
to achieve oral health success. This book offers an in-depth picture of
the pivotal role xylitol plays in the prevention of dental disease. It is of
particular value for expectant parents if they read it before their baby is
born.”
TRISHA E. O’HEHIR, MS, RDH, PRESIDENT OF O’HEHIR UNIVERSITY, BUTEYKO BREATHING COACH

“Impressive”
“This book challenges us to consider the impact of plastics, metals,
and oral diseases on overall health. It advocates for a shift in how we
approach oral care, with deeper evaluations and higher expectations
for what dentistry should be in America. Dr. Ellie Phillips’ impressive
work is bound to start meaningful conversations we should have
started long ago.”
DR. HOWARD FARRAN, DDS, MBA, PUBLISHER, FOUNDER OF DENTALTOWN, HOST OF DENTISTRY
UNCENSORED PODCAST

“I Love This Book”

“I love this book! Dr. Ellie has tackled a difficult subject—the
 simplification of oral health—and has done the job well. As a dentist,
there is much to learn, and this new edition of her vital and invaluable
book adds many new dimensions to the topic of oral health, making it a
book for all patients—and even your dentist—to enjoy.”
DR. JOHN FOCHELLA, DMD, DENTAL SPECIALIST AND LECTURER

“Invaluable”
“This invaluable resource is a must-read for anyone looking to better
understand their dental health journey. Dr. Ellie skillfully breaks down
the key information patients need to know—not just about what a
dental visit entails, but about the empowering choices they have when
it comes to their care. Her insights into when to delay or refuse
treatments, and how to address the myriad of microbes in the mouth,
are both enlightening and practical. I’m confident that dental
professionals and their patients alike will find this book to be an
essential guide in navigating the modern dental landscape. It’s a
perfect recommendation for those seeking to take control of their oral
health in a more informed, personalized way!”
DIANE LARSON, RDH, BSDH, DIRECTOR OF CLINICAL EDUCATION AT ORALDNA LABS

“Will Shine a Light on These New Treatment

Options”
“Dr. Ellie always says it like it is—and here she is again, speaking
uncomfortable truths in this brand new edition of Kiss Your Dentist
Goodbye. In this book, Dr. Ellie has informed patients about these
possibilities for change and the techniques dentists can implement for
‘no-drill, no-fear’ dentistry in their offices. I know this book will shine a
light on these new treatment options that give patients what they want.”
DR. CHRIS KAMMER, DDS, FOUNDER OF THE AMERICAN ACADEMY FOR ORAL SYSTEMIC HEALTH

“Here Are So Many Ways People Can Help

Themselves”
“In this book, Dr. Ellie Phillips has built a bridge across the chasm of
oral health self-care knowledge that has unfortunately existed between
dental science and the public. People are suffering and dentistry needs
 to do better. As a leader in the use of medicines to treat and prevent
cavities worldwide, I spent a decade searching for drugs to stop
cavities but found the answer in nutrients from foods. People deserve
to know that cavities and gum disease are diseases, like other medical
diseases, and they can be halted with effective strategies. Here are so
many ways people can help themselves, and ways for dentists to make
treatments less invasive, easier, and more comfortable.”
JEREMY HORST KEEPER, DDS, MS, PHD PAST DIRECTOR OF CLINICAL INNOVATION, CAREQUEST AND
FOUNDER, DR. KEEPER’S DENTAL WELLNESS

“What the World Needs Right Now”

“What the world needs right now is a one stop, self-care guide that
everyone can understand. As a dental health educator and
practitioner, I thank God for Dr. Phillips and her simple and effective
mouth care system. Ellie Phillips has devoted herself to helping our
missionary team modify her system—and explore how we could
adapt it to be useful in impoverished areas of the world, where dental
care is neither available or affordable. What an inspiration she is to our
team!”
GERRY BEAUCHEMIN, LICENSED DENTAL THERAPIST, DIRECTOR, DENTAL CARE FOR ALL INTERNATIONAL,
AND INVENTOR OF “GENTLE HAND-BURS”
The information and advice contained in this book are based upon the research and the personal
and professional experiences of the author. They are not intended as a substitute for consulting
with a healthcare professional. The publisher and author are not responsible for any adverse
effects or consequences resulting from the use of any of the suggestions, preparations, or
procedures discussed in this book. All matters pertaining to your physical health should be
supervised by a healthcare professional. It is a sign of wisdom, not cowardice, to seek a second or
third opinion.
EDITOR: Anthony Pomes • TYPESETTER: Gary A. Rosenberg

Square One Publishers

115 Herricks Road • Garden City Park, NY 11040
(516) 535-2010 • (877) 900-BOOK • www.squareonepublishers.com

Library of Congress Cataloging-in-Publication Data

Names: Phillips, Ellie, author.
Title: Kiss your dentist goodbye : healthy, clean gums and teeth / Ellie, DDS Phillips.
Description: Second edition. | Garden City Park : Square One Publishers, 2025. | Includes
bibliographical references and index. | Summary: “In this book, Dr. Phillips emphasizes
explains the importance of bacterial balance for oral health, highlighting how it will never be
attained through excessive flossing, aggressive cleanings, or the indiscriminate killing of mouth
bacteria. She exposes the detrimental effects of certain dental procedures and products,
including tooth whitening, bleaching, dental sealants, and certain fluorides. By adopting her
practical do-it-yourself daily routine, you can effortlessly reduce plaque buildup, strengthen
your teeth, heal and even reverse small cavities, cure periodontal disease, and eliminate tooth
sensitivity”— Provided by publisher.
Identifiers: LCCN 2024047734 | ISBN 9780757005312 (paperback) | ISBN 9780757055317 (epub)
Subjects: LCSH: Teeth—Care and hygiene.
Classification: LCC RK61 .P535 2025 | DDC 617.6—dc23/eng/20241120
LC record available at https://lccn.loc.gov/2024047734
Copyright © 2025 by Ellie Phillips
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise, without the prior written permission of the publisher. Furthermore, no existing
portions of the copyrighted material contain herein shall be repurposed or drawn upon by
any/all present or future forms of AI (artificial intelligence) systems/applications worldwide.
To Walter Cooper, PhD, for caring to ask, listen, and encourage.
 Contents
Praise for Kiss Your Dentist Goodbye
Acknowledgments
Foreword
Preface
Introduction

Part One: The Building Blocks of Better Mouth Care

1. The Dentistry Dilemma—One Step Forward, Three Steps Back?
2. Watch Your Mouth—What’s Visible, and Invisible, Within Our Mouths
3. Saliva’s Got a Secret—And It’s Time to Spit It Out
4. Flossing, Fillings, and Fluoridation—The Three “Fs” of Dentistry
5. Dental Science + Common Sense = Something to Chew On

Part Two: The Complete Mouth Care System™

6. The Tooth and Nothing but the Tooth—My System, Step by Step
7. Xylitol—The Most Powerful Friend a Mouth Can Have
8. When Your Mouth Goes South—How to Stop High-Risk Dental Issues
9. The Four Keys to Preventive Mouth Care—Unlocking All the Doors
10. You and Your Dentist—Can You Ever Be Friends?
Conclusion
Glossary
About the Author
 Acknowledgments

I am so honored to have Dr. Corky Willhite write the Foreword for this
book. Dr. Willhite is the Clinical Assistant Professor, Department of
Prosthodontics, LSU School of Dentistry and Faculty at the Center for
Esthetic Excellence in Chicago. He is also the owner of a private practice
that has been limited to cosmetic dentistry for over 30 years, during
which time he has built a reputation providing the highest-quality
treatments and creating wonderful smiles, while specifically striving to
have these restorations last as long as possible.
During the 1990s, I attended several of Dr. Willhite’s lectures at the
University of Rochester, New York, and after the seminars he was always
gracious and found time to discuss the overlooked impact of mouth
acidity and preventive strategies. Few dentists would have been
prepared to consider and listen, but this was how our professional
friendship began. For his courteous and always open-minded support, I
remain deeply grateful.
It took twelve years from the day an idea entered my mind to the
completion of the first edition of Kiss Your Dentist Goodbye, which landed
in bookstores in 2008. This second edition has taken less time to prepare
but it has posed entirely new challenges in terms of overall flow and
presentation. The result of these efforts is the book you now have in your
hand, and there are many wonderful people I wish to thank for helping
me reach this goal.
There is personal coach Judy-Lee Chen Sang of Landmark Worldwide
for her wisdom and understanding even as this journey began, together
with the consistent guidance and encouragement that has been so kindly
provided by Square One Publishers’ experienced editor Anthony Pomes
and respected publisher Rudy Shur. They recognized the potential for a
concise yet more expansive, and simplified yet more descriptive second
edition. I remain grateful for their repeated aid and stewardship in
helping me to reach this exciting moment.
I also wish to thank my daughters Chrissie and Lauren, who have
remained inspirational coaches along the way. At other times, my son
John-Paul (“JP”) and daughter Holly helpfully answered those “phone a
friend” calls—and my oldest daughter Suzi, who is always a voice of
caring and calm, provided delicious soup and warm hugs as well.
Thanks also to hundreds of my patients, extended family members,
employees, dental and non-dental friends, and followers who have also
been ready to believe and support me over the years. Thanks to my social
media team—Katey, Denise, Logan, Casey, Winston, Charlie, and
Christopher—for your continued good humor and help every step of the
way. I must also thank a special group, whose support and
encouragement to complete this mission has been ongoing and remains
priceless: Aurora, Christie, Megan, Valerie, and Laura (for their collective
support at work, which gave me time necessary for writing); Anne and
Helen (my best school friends from Great Britain); Judy and Bud, LuAnn,
Steve, Tina, Vicky, and Stacy (all friends who have encouraged me but
always ensured I had sufficient downtime on the porch or pickleball
court).
Within dentistry, I have been blessed with a vibrant tribe of strong
supporters—hygienists and dentists who are enthusiastic about a new
era for dentistry—and these good people include: Elodie and Shelly
(such savvy hygienists); Cyndee Johnson, who coaches those in dental
offices how to raise productivity with preventive education and xylitol;
Dr. Steve Edwards, an entrepreneur for the past twenty years (and
counting) who is passionate about oral fitness and always adds a friendly
“like” to my LinkedIn posts; Dr. Chris Kammer, who is on a similar
mission to limit unnecessary treatments and educate patients about the
importance of oral health; Dr. Ameet Trivedi, an outspoken dentist on
social media; Donna Crawford, a health expert who supported my
system of care in the nitric oxide world (when many mouthwash myths
were still prevalent); Dr. Spencer Wood, a champion for new ideas and
professional networking; Dr. Quinn Yost, a vibrant pediatric dentist
blazing a trail in California; and also, Sarah Luetki together with Dr.
Christine Hao, two dedicated professionals who operate “Sound Care”
mobile units for elderly and disabled patients—and who have created a
website for patients to access testimonial-driven preventive care
providers.
The world of minimally invasive dentistry includes some of the finest
dentists in the world, some of whom you will read about in this book,
particularly in the sections that discuss xylitol or the no-drill Atraumatic
Restorative Technique (ART) that is gradually being offered in more
dental offices worldwide. Some of these fine professionals include dental
therapist and mission caregivers Gerry Beauchemin and Jason Padvorac.
Also in this group are highly respected educators, thought leaders,
dentists, and doctors including: Dr. John Frachella, Dr. Jeremy Horst, Dr.
Peter Milgrom, Dr. Eva Soderling, Dr. Greg Valentine, Dr. Brad Bale, and
Dr. Amy Doneen. Thank you all for your professional friendship,
expertise, and enthusiasm for our shared mission.
I could never have become a dentist without the scientific education
offered by the prestigious Cheltenham Ladies College in England. Back
in the day, I found out firsthand that women were only welcomed into
the male-dominated world of medicine if they achieved the highest
grades in chemistry, biology, physics, and Latin. This scientific basis
inspired me to delve deeper into the biochemistry of oral health and be
encouraged by other free spirits, throughout history, who dared to veer
from the well-trodden pathway with new ideas about health and
wellness. And so, I send my thanks to all those great minds as well. We
have come a long way . . .
 Foreword

Only in the last few years have I come to appreciate the fact that I was
missing an important component for ultimate patient care—the
underlying balance of a patient’s oral health. Whenever I can convince
my patients to follow the simple steps that my trusted colleague and
friend Dr. Ellie recommends, both through her patient education
coaching and in the pages of this book that you are now reading, I’m
confident that the dentistry in their mouths will last longer and is more
likely to be a permanent solution for their lifetime.
Checking the insurance industry records of treatments performed each
year continues to reveal that people of all ages—children, teens, young
adults, middle-agers, and senior citizens alike—struggle with expensive
and invasive dental problems that can affect their physical and mental
health in damaging ways. This is an unacceptable outcome and anyone
who cares about their oral health should be able to learn how to avoid
being one more of these scary statistics—and this is why I am delighted
about this fully revised second edition of Dr. Ellie’s longtime bestseller. I
feel certain, beyond a doubt, that this wonderfully ambitious new book
will empower those in search of useful dental knowledge and relevant
answers to questions about so many confusing oral care issues.
The first edition of Kiss Your Dentist Goodbye challenged us to stop
believing that sugar was the only culprit in dental disease—and consider
the idea that acidity should take more of the blame. Now, in this new
second edition, Dr. Ellie weaves this knowledge together with an
understanding of oral bacteria and layers it with the impact of mouth
resting, xylitol, and the effect of nutrition on the microbiological ecology
in our mouths. It feels to me as if this new book will move forward the
understanding of experts and laypersons when it comes to maintaining
healthier teeth and gums. So, here’s to Dr. Ellie’s ongoing and brave new
work, which I believe will continue to create positive change in the world
of dentists and dentistry—and, of course, in the lives of so many people
worldwide.
—Corky Willhite, DDS, Accredited Fellow, American Academy of
Cosmetic Dentistry (AACD), Owner, the Smile Design Center, private
practice limited to cosmetic dentistry, New Orleans, LA
 Preface

The great thing in this world is not so much where we are, but in what
direction we are moving.
—OLIVER WENDELL HOLMES, SR.

I f you are concerned about tooth care, you are not alone. As a native
Brit, my dental career has unfurled between two continents—first in
Europe, and then North America. Working on both sides of the Atlantic,
I have gradually recognized a stark contrast in dental care—with dentists
and access to dental offices touted as an apparent necessity for oral
health in America, whereas a reliance on natural healing, diet, and the
use of xylitol appears to deliver effective prevention to minimize dental
needs in many European countries. Dentistry in North America has
experienced amazing technological progress in recent years. For patients
to be adequately empowered to make good decisions about their
treatment needs, however, we need to recognize and unpack a large
amount of mouth health knowledge that has been ignored by
professionals and misunderstood by laypersons for over a century.
Much of my early motivation in helping people care for their teeth
came from my own family’s unfortunate dental health experiences.
Looking back at most formal dental school training programs on both
sides of the Atlantic shows glaring omissions within the science of why
people suffer tooth loss, gum disease, and cavities. Even today in dental
offices worldwide, the blame is unfairly placed on two habits that are
directly under a patient’s individual control—either too much candy, or
poor tooth brushing and flossing habits. In my family, however, I knew
that my own parents rarely ate sweets and were meticulous about oral
hygiene—and yet they both suffered severe cavities and gum disease.
My father had all his teeth extracted and replaced with dentures at the
age of 35, a military strategy that assured soldiers would avoid dental
problems on the battlefield. Likewise, my mother was told when she was
45 years old that she would need to have the same procedure that my
father had undergone. Her diagnosis came at a time when I was studying
at Guy’s Hospital Dental School in London, in the Preventive Dentistry
department. Back then, there were no dentists specializing in gum or
periodontal disease in the UK and very few hygienists, so it was the
general dentists who were instead trained to clean patients’ teeth and
perform the gum surgery known as a gingivectomy.
This surgery involved cutting and stitching a patient’s gums, so as to
try and tighten them in an often-futile attempt to prevent the tooth—or
teeth—from falling out. It seemed obvious to any observant student that
these efforts only led to pain, disfigurement—and to a somewhat delayed
but eventual tooth loss. This was not the treatment I recommended to my
mother, but there were more reasons why I wanted to help my mother
find a different—and better—option to overcome gum disease and keep
her natural teeth intact for life.
In the 1960s, an initial study had been published about the oral,
general, and mental health of nuns living in a convent. The final study
that followed spanned several decades and confirmed a concerning
correlation between early full-mouth tooth extraction in these women
with an increased risk of dementia. Given my own family’s experiences
with early-onset dementia, I implored my mother to avoid full-mouth
extractions, to refuse a gingivectomy, and to instead let me find the best
way for her to care for her teeth at home. This was how I came to create
and develop a basic system of over-the-counter mouth rinses that she
could use—and the results were nothing short of remarkable. Not only
did she evade early-onset dementia, but she also maintained healthy,
disease-free teeth for the next fifty years until her passing at age 95. Being
able to help my mother as I had not only expanded my practical
knowledge about the value of home daily dental care for effective disease
prevention, but also instilled in me a confidence in the belief that every
individual has the power to stop, prevent, and even reverse dental
problems by themselves.
When it comes to doing things a little differently in the world of
dentistry, I have noticed that being open to new ideas often depends on
having a history of diverse clinical experiences—perhaps even more than
from a prolonged academic education or beliefs derived from so-called
scientific study results. Most of us have watched as scientific studies are
overturned by new information and understanding. Personally, I was
blessed with the benefit of working in three different countries—and
learning important lessons in each place.
Soon after I graduated from Guy’s Hospital Medical School, I began
work as a dentist in Lausanne, Switzerland. It was there where I noticed
that the majority of the patients that I saw enjoyed consistent oral health
without the need to have repeated fluoride treatments, to drink
fluoridated water, or to floss. I came to understand that the fine quality
of their teeth had everything to do with nutrition and eating patterns,
ending every meal with some kind of tooth-protective food.
Additionally, it was under the guidance of my Swiss counterpart that I
learned how gum massage could restore gum health. Armed with these
formative experiences, I returned to England and opened my own
preventive dental office in the resort town of Eastbourne. It was there
that I built my practice—teaching patients everything I knew about the
science of oral care.
By the end of 1980 I had a large and loyal following of patients in the
UK, nearly all of whom had achieved sustainable oral health without the
need for ongoing dental treatments—and many finding that even
periodic cleanings became less necessary. Family responsibilities led me
to leave my practice in Eastbourne, though, and relocate to Rochester,
New York. Now that I was working in the US, I specialized in pediatric
dentistry and became the outpatient clinic director at the Eastman
Institute for Oral Health. In this capacity, I was fortunate to work
alongside a professor whose career had been steeped in the research of
xylitol. A unique and delicious sugar derived from plant sources, xylitol
has been used for decades in Switzerland, Finland, and elsewhere
throughout Europe to support general and oral health. Xylitol—when
used frequently and appropriately—can actively help to prevent cavities
and improve overall gum and tooth health.

Something to Think About

Please understand that this book is not meant to criticize or wantonly
demonize the dental profession, or the professionals who care for you
during dental visits. Its purpose instead is to share the latest scientific
knowledge and equip you with strategies that allow you to take control of
your oral health and defend your teeth from damage and disease—and to
do so every day of your life. Understanding the new and ever-growing
science surrounding mouth bacteria will revolutionize your view of what it
means to have clean teeth, and your approach to traditional treatments
and routine dentistry. However, it all begins with valuing your mouth
health and embracing the natural healing capabilities of your mouth. By
adopting these principles and utilizing the information in this book, you
will discover effective and empowering ways to improve the condition of
your teeth and gums.

Armed with a fuller understanding of xylitol and my experiences in

prevention prior to my arrival in America, I was eager to share this
knowledge with fellow dentists and patients alike. The science of
preventing and reversing tooth decay was just becoming recognized in
the US and was taught as a system called: Caries Management by Risk
Assessment (CAMBRA). Spearheaded by Dr. John Featherstone, the
Dean of the University of San Francisco, the CAMBRA movement
resonated with me deeply. Dr. Featherstone—along with the US Surgeon
General at the time, Dr. Richard Carmona—recognized the importance of
disseminating this kind of preventive scientific knowledge to the public,
and this has always been my passion. The encouragement and
inspiration from these two professionals, with support and interest from
many other dental and medical practitioners, led me to pen and then
publish the first edition of this book.
For decades, I have been amazed by the remarkable capabilities of my
at-home system to sustain oral health, remineralize teeth, and help to
reverse and heal cavities and gum disease. The universality of this
system’s ability to address gum disease and cavities has always
interested and excited me. Also, it works for all ages, for men and
women, for anyone young or old with adult teeth who is able and willing
to use a specific sequence of mouth rinses and toothpaste in the method I
recommend. Talking with my patients showed me what many studies
had begun to illustrate—a connection between oral, digestive and
systemic, whole-body health. Patients using my system had noticed on
tests that their body inflammation was improving, without medication.
This is why I helped to create the American Academy for Oral Systemic
Health (AAOSH), a not-for-profit organization dedicated to sharing
science and information linking systemic with oral health.
I have watched with joy as the oral care system that I developed—and
which you will learn about in greater depth throughout this book—
became a staple for my family, friends, and countless patients over the
years. Incredible numbers of people have followed this system faithfully
for decades and have marveled at the results, as their oral health
improved, and they witnessed cavities and gum disease heal and often
completely reverse. These fortunate individuals have experienced years
of sustainable oral health—and still today maintain a cavity-free mouth
and healthy gums.
The excitement surrounding this system remains palpable since the
release of my first edition of Kiss Your Dentist Goodbye. Yet, since the
book’s publication, the awful statistics of cavities that occur in young
children and adolescent teeth—along with overall costs for office
cleanings, X-rays, fillings, implants, surgeries, and gum treatments for
young and old alike—continue to escalate. Drawing from the information
in this newly revised and fully updated Second Edition, readers across
the globe—and parents in particular—will now be able to take charge of
their family’s oral health and offer children the oral health protection that
can give them a future with fewer dental problems or need for
interventions. This book explains the easy strategies that will bring this
rapid improvement in oral health, and will empower you to ultimately
limit all unnecessary dental treatments and expenses—for life.
 Introduction

Natural forces within us are the true healers of disease.

—HIPPOCRATES

F or most of us, the process is the same. You do your best each day to
take care of your teeth and gums—only to learn at your next dental
visit that you once again have new cavities, that your gums are bleeding,
or (worse yet) have become infected. Meanwhile, there are also people
you know who seem to never have a problem with their teeth. If you
happen to ask them for the secret to their success, chances are that they
don’t give their teeth much thought and cannot even tell you about
specific things they have done. Frustrating? Certainly.
When it comes to overall success with dental care, there seems to be
little fairness in the equation. Why does it cost you an arm and a leg each
time you or your kids go to a dentist, while these other lucky people
simply have check-ups and are done? Is it their good genes? Is it because
of the water they drink? Or is it perhaps just a case of good—or bad—
karma?
For years, we have been told to take care of our teeth by brushing and
flossing. And yet, the majority of American adults by age sixty-five find
themselves in constant need of fillings, dental repairs, crowns, and
cleanings that seem to get progressively more expensive and complicated
no matter how often they visit a dentist. What is it that these other folks
are doing right, and that the rest of us seem to be doing wrong? These are
important questions, and they just illustrate how complex tooth care can
be for most people. This book has been designed to make oral care easily
understandable and explain how to take control of your mouth health
and feel more empowered so that you can avoid unnecessary dental
treatments, cavities, and the dangers of gum disease.
As a longtime dental professional and author of this book, my role is
twofold. I am here to open your eyes to the most effective oral health
strategies and information available, gleaned from decades of research
data and combined with years of experience observing patients in a
plethora of clinical settings. Perhaps the most important help I can offer
has to do with home care remedies and professional treatments that I
believe you should avoid. At the same time, I recognize the fact that many
of you who have picked up this book are not dental experts—and are,
therefore, in need of guidance explained in a way that is easy to
understand and from which one can benefit sooner rather than later. That
is why we will begin with the ABCs of oral health, after which I will then
break down and describe in detail the amazing, long-time oral care
system that I recommend.
The first part of this book, as mentioned above, will be a primer on the
basics of how teeth become damaged and how the mouth, gums, and
teeth can heal. We begin with a short history of how dentistry has
evolved over the ages, since the first recorded dental treatment in Egypt
at the time of the Pharaohs and how things have progressed to the
present day. Next, we will explore key mouth troubles that people
experience—from plaque buildup, tooth wear, cavities, gum recession,
swelling, yellowing teeth, and mouth sensitivity—presented alongside a
simple discussion of how to keep your mouth in a state of consistent
balance and health. Special attention will also be given to the incredible
value of the mouth’s saliva, and how it serves as a crucial determinant of
mouth health. I will introduce and clarify the various things that can go
wrong with teeth at any given point in life, and how poor mouth health
can drastically impact the overall health and lives of adults and children
alike.
After this overview of these common problems and “tooth topics,” I
will share the strategies that have helped many thousands of patients,
friends, family, and followers around the world to become empowered
when it comes to their dental health. How great it is that the usual
“process” has shifted, so that people can now sit down in the dentist’s
chair with confidence and say “Ah”—just as their dental professionals
puzzle over how dramatically their patients’ oral health improved, and
why they no longer need ongoing treatments or dental cleanings.
Part Two of this book will be focused tightly on my “Do-It-Yourself”
system of oral care for your teeth and gums. Each element of this method
can help you achieve a healthier mouth, and the way this happens will be
defined and explained in a deliberate “step by step” fashion. My system is
tailormade for both adults and children with adult teeth, and I
emphasize—through both analysis and anecdote—how important it is to
start this strategy as early in life as possible. Next follows an in-depth
exploration of the naturally occurring health sugar known as xylitol, a
product that is a cornerstone of this strategy for effective preventive care.
Also sprinkled throughout the book are a handful of informative insets
that touch on various topics, including:

Why some toothbrushes help more than others

The all-too-real fear many of us have when going to the dentist
The difference between treating a cavity and having your teeth
cleaned at the dentist, compared with an effective home care
strategy that can help you to avoid cavities and prevent gum
disease

Many people are aware that lifestyle changes can improve general
health, but few have considered that there are similar habits and ideas
that can boost your mouth health. I recommend a few lifestyle
modifications that can be used in tandem with my Complete Mouth Care
System™. This can be found in a section dedicated to what I call the
“Four Keys of Health” for optimal mouth care, which includes:

1. The establishment of a consistent, practical, and effective Oral Care

Routine;
2. The importance of Your Mouth’s Own Saliva in maintaining
healthier teeth and gums;
 3. The pivotal importance for you and your family to adopt healthy
habits and to make educated Lifestyle Choices and Daily Habits;

and

4. The self-regard and protective treatment of your own body’s

immune system as A Healing Machine, with a focus on the need
for probiotics, prebiotics, and overall dietary supplementation
wherein your body’s own continual repair leads to a stronger and
more consistent prevention of mouth disease.

After the book’s Conclusion, readers can also consult a Glossary of

specialized terms that you may have heard being used at a dental office
during examination and/or treatment.
As you witness the impact you can have on your oral health, your
relationship with your dentist will most likely evolve. Dentists excel at
identifying visible signs of the invisible bacterial imbalance in our
mouths, such as cavities and gum damage. Your new objective will be to
use dental visits to help you to periodically evaluate your oral health,
and that of your family. You may consider selecting a dentist who offers
advanced diagnostic tools, comprehensive bacterial testing, and
personalized protocols beyond the standard “cleaning, X-rays, and
probing” approach. Armed with the knowledge provided in this book,
you will be able to weigh for yourself the consequences of dental
treatments and to make more informed decisions about fillings, sealants,
fluoride treatments, and cleanings than ever before. Keeping a record of
your progress over time can only enhance your understanding of the
remarkable home care strategies that I will teach you about in the pages
to come.
So, let this journey into a new world of oral health help make your
future dental visits more intriguing, helpful, and rewarding. You have
nothing to lose by taking this first step—except, of course, a lot of
unnecessary treatments, expense, inconvenience, and time in the dental
chair.
 PART ONE:
The Building Blocks of Better Mouth
Care
 1. The Dentistry Dilemma—One Step
Forward, Three Steps Back?

Time is relative; its only worth depends upon what we do as it is passing.

—ALBERT EINSTEIN

W hile it is true that dentists excel at addressing cavities and gum

disease, it is also the case that most do not know any ways to halt
these ongoing dental issues or to confidently prevent or reverse these
common dental problems for their patients. The current approach from
dentistry can be frustratingly one-dimensional and short-sighted, as they
keep focused largely on continual and periodic repair of existing
problems and fixing acute damage as presented to them on each visit.
Many laypersons believe—mistakenly—that once a cavity is fixed, the
decay problem has been solved. Similarly, dental cleanings are often
wrongly viewed as the best way to fight cavities. Both assumptions can
lead those searching for better oral health far astray of their goal.
My experience over the years has proved to me that a good number of
oral health practitioners rely on well-marketed and seemingly plausible
explanations to justify ongoing dental problems to their concerned
patients. I consider these so-called “explanations” as something else—I
see them as convenient excuses. These excuses lack scientific evidence and
can be harmful because they divert attention away from the actual and
underlying causes of dental disease. False narratives have pervaded
dentistry for decades, and many dentists seem to still believe them. Only
by having the confidence to reject wrong ideas—for example, the
erroneous concept that your toothbrushing is causing gum or enamel
damage—will a deeper investigation then reveal that an acidic mouth, a
reduced flow of saliva, or some kind of breathing obstruction may be far
more likely the real reasons behind such maladies as tooth erosion, gum
diseases and recession, plaque, cavities, or the need for repeated fillings
and treatments, tooth sensitivity, and discoloration. Without defining the
factors that really underlie these dental problems, the longer they will
remain unaddressed, and the less chance you have of determining a
remedy that will be able to control, prevent, or reverse them.
When you ask your dentist why you have cavities, enamel wear,
sensitivity, or gum disease, a good percentage of patients will likely be
told that they are to blame for their problems. Common allegations
include: incorrect or insufficient flossing; aggressive brushing or not
using an electric toothbrush; and tooth clenching or grinding. There is a
condition called bruxism, which is why an accurate diagnosis is
important, because this more serious kind of tooth clenching can be
associated with a breathing or airway blockage, and in this case, you
should be working with an airway specialist.
Catch-all explanations are fundamentally directed at the wrong target—
at the symptom and not the cause. This is why so many dentists are
bewildered by how to prevent or stop dental disease and damage, and
why their only remedy is to treat the symptom. But your hope lies in
something that you can do for yourself: take the time to try and figure
out the underlying conditions of mouth acidity or dryness—the real causes
of most dental problems and the primary reason why your mouth
bacteria or chemistry is out of balance, creating the conditions for plaque
to form, enamel to erode, or gum disease to occur. There is, without
doubt, an unfortunate consequence of missing the diagnostic target, as
patients need to return over and over for ongoing office therapies. But if
you address the actual cause of these problems, they normally resolve in
a shockingly rapid fashion, and this will put an end to those progressive,
often never-ending dental treatments.
This shift in thinking appears to be the fatal flaw at the heart of modern
dental practice—and as we step forward with new dental treatment
modalities, we are at risk for taking the proverbial “three steps back” and
missing the very thing that helps patients achieve what she or he truly
wants—less treatment and a simple way to enjoy healthy teeth and
gums.
 Only through a blended approach—mixing equal parts of scientific
knowledge, clinical observation, and some kind of a standardized
method of oral health assessment—will we uncover the best ways to
prevent dental problems and limit unnecessary dental treatments. Until
this occurs, it is only with an accurate diagnosis (or discovering the real
reason for dental problems), that patients will be able to select the correct
strategies tailored to prevent, improve, and even reverse those specific
problems. To understand why this is not how mainstream dentistry
operates today, it may be helpful to look at how dentistry evolved over
its one-hundred-year history—and examine how, and why, ideas from
the past continue to cause confusion and antagonism within the
profession to the present day.
Examples of this include the supporters and dissenters on topics such
as the impact of a dead tooth on general health, the risks and benefits of
fluoride, those who believe silver fillings and root canals are toxic, and
others who decry implants or warn of harm from home-care toothpaste
and mouth rinsing. Some of these subjects cause friendly animosity, but
others have caused division and hostility within dentistry and a split in
the profession. The result is that patients can feel confused and lack trust,
often stirred by mischievous marketing, financial interests, and chatter
on social media. On these controversial topics, I find myself on
challenging but interesting “middle ground,” which may be the result of
my long and diverse clinical experiences, my opportunities to learn about
decay prevention and gum disease from world-renown researchers, from
treating patients in high-risk communities, or by being exposed to the
recent and evolving science of the oral microbiome. So, let’s look back at
the history of dentistry to understand how this colorful palette of dental
ideas originated and developed over time.

DENTISTRY OF YESTERDAY
As far back as recorded time reveals, oral health care has stood as a basic
and consistent part of the human story. Before the modern-day advent of
commercially sold toothbrushes and toothpastes, many cultures across
the globe have made successful use of various natural sticks and
powders to help keep their teeth and gums clean. Indeed, the origins of
dentistry can be first traced back thousands of years to the time of the
Third Dynasty of Egypt circa 2686–2613 BCE (Before Common Era). This
was the period when an early physician known as Hesy-Ra was recorded
as treating Egyptian citizens for problems with their teeth.
Just as important as the first evidence of dental care are the tools that
have been used to keep teeth strong and healthy. Take, for example, the
Miswak stick. This twig (or root cutting) is trimmed from what is known
as the “toothbrush tree” (Salvadora persica), and the Miswak stick has
been (and is still) used as a natural mouth care tool to clean the teeth and
massage the gums in many countries around the world—particularly the
Middle East regions and across the continent of Africa.
The ends of these wooden sticks are purposely shredded and frayed to
create a small brush that is used to massage the gums. To avoid
transmitting infection, this brush is maintained regularly by clipping the
end, to remove any worn or infected bristles. The Miswak stick contains
compounds that stimulate saliva flow and provide essentials oils,
minerals, silica (a common mineral in the earth’s crust), and even fluoride.
The Mizwak stick has thousands of years of history and studies to
illustrate its positive benefits. Today, the Mizwak is readily available
online and its use may be of interest to some patients and dentists as an
effective strategy for travel and in other specific situations.
Similar tools for dental care were known to the indigenous people of
North America to be cut from birch trees. Many simple but effective
remedies have emerged throughout history and a natural approach to
oral well-being is appealing. This stands in contrast to a treatment-
centered dental approach that appears to have its origins in the early
1300s. At this time, people in the Western world generally showed little
interest in the personal care of their teeth. They usually relied on others
to deal with any dental problems that arose. Without daily care, many
people suffered from dental decay and the consequences of rotten teeth.
Dentistry’s solution was treatment that mainly involved tooth
extraction. This kind of dentistry was performed by the medieval “barber
surgeons” who used crude forcep-like instruments to do the job. In the
1700s, a particularly aggressive “door key” tool became popular, used to
loosen and extract diseased and damaged teeth from patients’ mouths.
Since dental anesthetics like lidocaine and procaine were not used in
dentistry until the early 1900s, dental treatment of this era must have
been extremely traumatic and unpleasant.
As mentioned, there has been a long history of oral care, long before
the invention of the toothbrush, forceps, or tooth keys. The indigenous
people of North America used a form of “chew stick” fashioned from a
white-barked birch tree that grows in many colder climates, especially in
North America, Scandinavia, and in northern parts of Turkey, Russia,
and China. Birch-derived sticks were used to clean teeth and found to
naturally promote and maintain oral health. Within the fibers of this
wood is a sugar called xylitol. (We will discuss xylitol in greater detail in
Part Two of this book.) With the help of these sticks, users were able to
stimulate saliva and prevent plaque buildup in the mouth. Even today,
children in parts of Russia and Scandinavia are trained to rinse their
teeth with the sap from birch trees, and in Finland, there are public
health programs to supply daily xylitol in chewing gum to preschool
children across the country. In Turkey and China, it is common to chew
xylitol gum and gain protection from plaque and decay. However, while
the value of xylitol has been recognized in many parts of Europe, it has
not yet been fully recognized or appreciated by the profession of
dentistry in the US or across the British Isles.

Getting a Handle on the Toothbrush

Though there exist similarly structured antecedents dating back to 3500
BCE in Egypt, the earliest invention of the tool that today we recognize as
the toothbrush dates to early seventh-century China during the Tang
Dynasty. Its initial design stemmed from a small bunch of hog hair bristles
attached to a sturdy handle made from wood or bone. These preliminary
brushes were further refined in design when they were first introduced to
Europe during the seventeenth century. Manufactured brushes began to
be produced in the 1780s, and although this may seem like progress for
dentistry, it was perhaps the tool responsible for leading us into a dental
backslide. These new brushes were merely wooden sticks with coarse
pig hair or beaver bristles attached at the head—and, as it turned out,
they easily picked up bacteria.
Many people shared the same toothbrush, which would have caused a
spreading of the bacterial infection that grows plaque and causes dental
disease. Perhaps the invention of the toothbrush has caused more dental
disease than it has solved. Of course, at this same time in the Western
world, communities began to have easier access to less expensive and
more refined grains and sugars, which likely exacerbated the rampant
problems of dental decay and gum disease.
The toothbrush was progressively improved in design, and one with
three distinct rows of brushes became popular after its introduction in
1844. By the late 1930s, rough animal-hair bristles were replaced with
nylon and produced internationally by Dupont de Nemours—to create
Doctor West’s Miracle Toothbrush, which was introduced to the
marketplace with excitement.
By the 1950s, the advent of television advertising generated surprising
interest in home care products and a toothpaste called Pepsodent. Many
companies experimented with ingredients and their formulations of
toothpaste. By this time, there had been the discovery of the mineral
fluoride in certain water supplies in areas of America and later it was
found to have a relationship with lower risk for cavities. The first company
to run clinical trials and prove the benefits of fluoride toothpaste was
Crest. This was also the time when the world had entered the Space
Age, and many new technologies were emerging, including the Squibb
Corporation (who later merged in 1989 with Bristol-Myers to become one
of the biggest pharmaceutical companies in the world) and who were first
to introduce an electric toothbrush—known as the “Broxodent.”
The 1970s was a time when sugar was believed to cause cavities and
food particles were believed to cause gum disease. A toothbrush with a
single row of bristles was suggested and the technique was to hold the
brush below the gum line at a specific angle. This Dr. Bass brush and
brushing technique is still recommended by some dentists today, but
there are problems with it—particularly since the benefits of gum
massage are now more commonly recognized, and a brush with more
bristles is seen as the more effective method for this approach. For
adequate tooth cleaning and massage, we need a brush with a dense
bristlehead, although now the problem is that disease bacteria can
multiply and become more aggressive in the low-oxygen conditions
among the dense bristles. Toothbrushes require good disinfection, and
it’s a good idea to completely dry a toothbrush between each use to help
prevent problems. In addition, it is always a helpful idea to replace a
current toothbrush with an as-yet-unused one on a consistent and
periodic basis. While the frequency with which you swap out the old for
the new is ultimately up to you, a generally decent rule of thumb would be
once a month.
By the turn of the twenty-first century, the toothbrush had evolved to the
point where battery-driven oscillating brushes were marketed as the best
way to keep teeth clean and gleaming white, selling the ideas with
unrealistic animations of how the brush cleans your teeth. Today, there
are even more ideas and designs, some using Bluetooth-compatible
technology, to track daily brushing habits through a digital app owned by
the manufacturing companies. Even with all these advances and
technology, the incidence of gum disease is on the rise and cavities are
just as problematic as they have ever been for children and adults of all
ages. This explains why we need to look beyond toothbrushes and
toothpaste and uncover what is the real underlying cause of dental
problems. As we have begun to realize at this point across all levels of
life and culture, increases in technological refinement and know-how
mean next to nothing if not paired with the wisdom that comes from
knowledge. To be best equipped to handle oral health issues, one must
understand the subject at its core. Then we will be able to stop, prevent,
and reverse dental disease—forever.

There have, of course, been numerous discoveries and amazing

changes that have impacted dentistry in positive ways, especially in the
field of cosmetic restorations and the work that helps patients keep a nice
full smile. In the mid-1800s, for instance, dentistry began to offer more
comprehensive services and help people avoid the need for extractions.
These services included tooth repairs, fillings and, if necessary, some
kind of replacement for lost teeth. It was during this time that an English
chemist named Dr. Joseph Bell introduced amalgam, an inorganic
mercury-based material used to fill cavities in teeth.
Here again, the advancement came at a cost. At the time of its
introduction, there was a loud outcry from doctors and dentists about the
mercury content in this filling material. Mercury was known to have
negative effects on human health, and mercury poisoning was known
within the medical profession as erethism. The damage from mercury had
already been noticed and examined among workers in the hat-making
industry, where it had been found to cause lasting neurological damage.
In fact, the “Mad Hatter” character from legendary English author Lewis
Carroll’s iconic 1865 novel Alice’s Adventures in Wonderland was a satiric
reference to the problems that had been discovered from mercury
poisoning.
Despite the many concerns, enough dentists wanted to use amalgam
and were excited about its affordability when compared with the only
other alternative of the time—gold fillings. As dental organizations
debated the use of amalgam, the American Dental Association (ADA)
emerged in 1859 as a “pro-amalgam” group established in Niagara Falls,
New York—and which has continued to exist, and thrive, into the
present day.
As amalgam fillings were introduced and the ADA was starting to
become a dental force in the US, a remarkable figure from Hungary
named Dr. Ignaz Semmelweis emerged in Vienna. Dr. Semmelweis
proposed a theory that would eventually impact us all—he believed that
handwashing could reduce the spread of infection. Childbed fever was a
deadly disease that was killing many mothers and infants during
childbirth. Driven by his belief that better hand hygiene for physicians
amid child deliveries could save lives, Semmelweis fought all the
opposing views of the medical establishment.
Only after Semmelweis’ death in 1865 did German scientist August
Köhler invent the modern microscope (in 1893) and prove what Dr.
Semmelweis had only been able to demonstrate through conjecture and
observation. The microscope established visually that bacteria were
indeed transferred to others through contact during the birthing process.
Finally, scientific tools were able to show the accuracy of the clinical
observations of Dr. Semmelweis, which challenged the understanding of
the medical profession at the turn of the century.
Semmelweis was not the first person, though, to find a connection
between microorganisms and the clinical symptoms of disease. Indeed,
the notion that “invisible” germs can damage one’s health can be traced
back in time to the Roman scholar Marcus Varro, who lived and worked
in the first century BCE. Nearly five hundred years later, at the start of
the Middle Ages, this idea gained wider acceptance and a millennium
later, in the sixteenth century, the basic contagion theory is found
mentioned in Italian, German, and French medical textbooks. Then, by
the mid-nineteenth century, renowned scientific figures like French
chemist Louis Pasteur, British surgeon Joseph Lister, and German
microbiologist Robert Koch brought renewed attention to the idea that
microorganisms can cause disease. Today, we know that bacteria can be
both good and bad—with some that are essential to promote health,
while others harm us—and yet, most dental schools continue to ignore
this underlying mouth biology and focus almost exclusively on treatment
of the resulting symptoms.
Another crucial mouth care development to take place in the
nineteenth century was first introduced by an inventive dentist named G.
V. Black. Dr. Black revolutionized dental practices by inventing an
electric, cord-driven foot engine to power dental drills. He went on to
create and document what he perceived as the ideal method for filling
teeth. He standardized the formula for mixing amalgam for these fillings,
created a manual of dental terminology, introduced nitrous oxide
(known also as “laughing gas”) for anesthesia, and recognized the
damaging effects of acidity on teeth.
During a visit in the early 1900s to the city of Colorado Springs in
Colorado, he crossed paths with American dentist Dr. Frederick S.
McKay, soon to be known for his own pioneering fluoride research.
Surprisingly, despite his obvious love of mechanics, Dr. Black was so
impressed by what he learned in Colorado Springs that it changed his
vision for the future of dentistry. This was expressed during a speech in
1900, foreseeing a shift toward preventive care, saying, “The day is surely
coming . . . when we will be engaged in practicing preventive, rather
than reparative, dentistry.”
In these modern times, Dr. Black would likely question why dental
decay has remained such a prevalent issue—and why the national
spending for fillings and dental repairs continues to soar, exceeding $162
billion dollars in the United States in the year 2021 alone. On the other
hand, Dr. Black firmly believed in dentistry’s independence from
medicine, and it was at this juncture that the professions began to
diverge, starting to specialize in their respective areas of the body. After
all, the advent of the microscope alongside the development of
pharmaceuticals to control infections marked a new era for medicine,
reducing the need for many surgical interventions and the risks of
disfigurement associated with amputations that had previously been
used to control progressive infection.
What about dentistry, though? Going back to this same era, dentistry
looked for an antibiotic or vaccine solution to control the progression of
cavities but was never able to establish any kind of effective therapy.
Filling teeth was the preferred option to extraction, even though many
physicians raised concerns about the health consequences of filling
diseased teeth and the use of mercury in silver amalgam fillings. There
was also the belief that an infected tooth could become a primary source
of infection elsewhere in the body. The notion that was popular in the
early 1900s was that a diseased tooth could affect overall body health.
This was known as the Focus of Infection theory—and although it gained
attention for a time, the idea was generally ridiculed and eventually fell
from favor in the 1940s.
The rift between conventional medicine and dentistry in the Western
world deepened progressively over the years and the two separate
professions have focused in an almost blinkered way, viewing only the
importance of their own specific areas of expertise. This professional
divide resulted in a lack of communication and limited understanding of
the impact that poor oral health has on a patient’s overall well-being. Just
as most people throughout the world know that handwashing is an
accepted practice to reduce disease transmission, it was not until the
twentieth century before dentists even began to adequately sterilize their
instruments and use disposable syringes to decrease the risks of disease
transmission to patients. Another big shift occurred in 1980, when
concern about the transmission of the AIDS (Acquired Immuno-
Deficiency Syndrome) virus prompted dental professionals to finally
wear gloves, masks, and eye protection.
Within this atmosphere of general disregard for disease transmission,
ignorance about the links between oral health and medical conditions,
and despite some enduring remnants of 1940s ridicule, a small group of
us created an organization in 2010 that was designed to publicize the
plethora of research and information linking oral health with systemic
health. This organization, called the American Academy for Oral
Systemic Health (AAOSH), has grown and evolved since that time, but it
still struggles to find a pathway to link the medical and dental
professions.
Certainly it has been able to raise awareness about the importance and
value of oral health in the treatment of chronic inflammatory and other
medical conditions, but there is still much work to be done to alert OB-
GYN doctors about the value of xylitol to limit pre-term birth, and the
impact of oral health on digestive health—and in 2022, the American
Academy of Periodontology showed that in a study of patients
hospitalized with COVID-19 there was a correlation between poor oral
health and severe COVID-19 outcomes and death.
The COVID-19 outbreak of 2020 also drew attention to other concerns
within the operation of dental offices—things that for decades have been
ignored as possible sources of disease transmission. Suddenly there was
new interest in aerosol splatter from dental drills and tools; air quality in
the dental treatment rooms; and the contamination of dental water lines,
all of which are potential sources of infection and justifiable cause for
concern among dental patients.

DENTISTRY OF TODAY—AND TOMORROW?

Today, we recognize the urgent need for medical and dental
professionals to collaborate and address the interconnectedness between
oral and systemic health. The advent of social media and increased access
to information has shed further light on this issue, prompting a push for
better communication. Too often doctors forget the impact of poor oral
health on physical and mental health—and dentists ignore the impact of
plaque, cavities, and periodontal disease on systemic health. Many also
ignore the toxicity from plastics and other dental materials used in
sealants, fillings, and retainers, and the fact that these plastics used in
dentistry may have a long-term impact on the general health—
particularly of young or high-risk patients.
While medicine has made significant advancement in educating
patients about the effects of lifestyle on disease prevention and has
promoted the idea of personalized risk evaluation, dentistry has
remained deeply reliant on demonizing sugar and two specific
treatments: tooth fillings for cavities and battling gum disease with
dental cleanings. However, the Human Microbiome Project (HBP) of
2007 provided so many new insights into the importance of our oral
microbiome.
The oral microbiome is defined, by and large, as a specific and
enormous collection of microorganisms that live in the human mouth.
The HBP was a lengthy study undertaken in various countries, and it
showed us the importance of nurturing a healthy bacterial population in
the mouth if we want to experience oral health. This is a radically new
shift in perspective from the old idea that every mouth grows plaque,
and we have no control over the damage that plaque causes. This
revelation offers hope for the kind of preventive era in dentistry that Dr.
G. V. Black spoke of back in 1900, where patients can actively manage
their oral health by nurturing a healthier oral ecosystem.
 By understanding a few simple things about mouth microbes, you can
become your own best advocate for this preventive approach—and
furthermore, you can opt to leverage personalized bacterial testing to
evaluate and monitor changes in your oral health. This empowerment
can allow individuals to be more proactive and to prevent the
debilitating, systemic health problems that often occur in middle-age—
problems we now know have associated links with poor oral health.
For a century, dentistry has promoted itself as a highly organized but
reactive professional system, offering skills to identify and treat oral
disease, hunting principally for any damage that has occurred since your
last dental visit. Dentists and hygienists are trained to search for cavities
and gum disease using tools called dental explorers, and X-rays, to detect
problems. However, all these tools are designed to look for areas of
weakness, decay, bone loss, and infection, and none of these tools can
offer a comprehensive assessment of improvements in mouth health over
time. Given the significant impact of oral health on our well-being, it’s
crucial we incorporate more relevant oral and general health
measurements and evaluations into the routine of dental office visits.
The intricate connection between teeth and the rest of our body is far
too often overlooked. Every tooth is connected to a network of blood
vessels and lymphatic drainage system that extends throughout the
entire body. Some of the cells inside teeth have arm-like extensions that
extend into the harder section of the tooth, and these are immersed in
lymphatic liquids and communicate directly with nerves that travel to
the brain. It is wrong to consider teeth as indestructible objects that can
be artificially whitened and bleached, drilled, and filled, sealed with
plastics, and covered with metal, without causing some kind of
consequence. We cannot ignore the effects of chemicals and acidity levels
on our mouth’s microbiome, and how vulnerable teeth and gums can be
to acidity, yet healthy enamel has a strength that is harder than steel. This
is why careless daily habits can impact the normal process of natural
healing and lead to poor oral health and potential damage to overall
body health.
 Understanding the intricate relationship between oral and systemic
health appears to be a vital part of the equation for those wanting to
maintain a healthy lifespan. Picture your teeth not as hard inanimate
structures, but rather as a sturdy coral reef, covered with delicate and
easily damaged crystals. Teeth rely on the surrounding “ocean” of saliva
to maintain and repair them daily. This is why saliva can both nurture or
damage teeth as it interacts with them constantly—and goes on to
influence their surface hardness.
Saliva quality and flow vary with a daily rhythm known as a Circadian
rhythm, and this rhythm is affected by many things, including our eating
and drinking habits. Some foods and beverages can make saliva highly
acidic, eroding minerals from teeth and weakening them. Healthy saliva
has the opposite effect and can quickly replenish minerals to compensate
for any loss, provided that the assaults on teeth are not too frequent and
occur at a time when saliva flows freely afterward. At night, when we lie
down to sleep, salivary flow decreases and may stop, and this is a time
when saliva usually becomes acidic, making late-night snacking or
drinking particularly dangerous for dental health. This explains why the
optimal time for oral care, using products that support tooth health, is
right before sleeping at night, ensuring a clean and protected oral
environment overnight.
As a dental student, I learned along with my colleagues that a
gleaming smile and pearly white teeth were a universal symbol of overall
good health and habits. But times have changed, and white teeth may no
longer guarantee a healthy person is behind that smile. Often those
deceivingly bright smiles are artificially whitened, masking a world of
plaque and a mouth teeming with the harmful, transmissible bacteria of
chronic periodontal gum disease. Crafty marketing campaigns have
convinced almost all of us, including dentists, that tooth whitening is a
safe and effective solution to improve the color of your teeth. The many
negative consequences of artificial tooth whitening are dismissed,
disregarded, or ignored, and in many dental offices the service is offered
with great enthusiasm and gusto.
 The fact is that all artificial whitening products weaken the structure of
teeth, damage the tooth’s outer enamel, and disrupt the tooth’s outer
protein protection to some degree. In addition, they can harm the
mouth’s healthy bacterial population, and potentially cause irreparable
DNA damage to the valuable stem cells that live inside the central pulp
area of adult and children’s teeth. Dentists, once staunchly against
whitening, have succumbed to public pressure, as everyone clamors for
more brilliant, whiter teeth—with choices today that merge into the color
spectrum blue, a shade that intensified the color white. Sadly, the long-
term consequences of these treatments, especially if they are frequent or
in younger teeth, can be very destructive, and weakened enamel can
become sensitive, gums may recede, and teeth can even die or fracture.
Here’s the consideration: Artificial tooth-whitening products make
teeth porous, which makes enamel stain more easily and thus creates a
greater risk for wear, fracture, sensitivity, and changes that loosen
fillings. Peroxide, an active chemical ingredient in whitening products, is
capable of irritating tooth nerves, particularly if you have an untreated
cavity that provides an opening for the peroxide to seep deeper inside
the tooth. The peroxide and acidity of these products combine to quickly
strip the protective protein layer from the outside surfaces of teeth,
leaving them defenseless against invasion by cavity bacteria, and at risk
for enamel fracture and loss from tooth brushing or from clenching your
teeth.
So, you may ask, what about those dazzling celebrity smiles that look
so great? The shocking truth is that most of those perfect smiles, possibly
including the smile of your own dentist, are illusions, created by veneers,
cosmetic crowns, implants, and even dentures anchored to the jaw by
screws and press studs. The truth behind most glamorous grins is a far
cry from the beauty of a healthy and natural smile.
There are dentists who refuse to offer tooth whitening, and many
dentists with whom I have discussed this topic share a sense of despair,
being concerned that too often patient demands so frequently dictate
offerings in dental offices, sometimes with complete disregard for long-
term oral health. The line blurs between what constitutes inappropriately
straightened teeth—all championed by the marketing machinery of the
American dental industry. The corporate giants peddle not only
whitening products but dental equipment, filling materials, retainers and
implants, and lasers, while a parallel universe of marketing gurus and
business coaches frequently guide dentists on how best to maximize their
income, maneuver the insurance systems, and form lucrative alliances
within the political hallways of Washington, DC. (In Part Two, we will
describe the strategies that strengthen and concurrently whiten teeth
naturally, while safeguarding our precious oral health.)
The good news is that dentists in the United States still command great
respect from the public, and many patients feeling genuine affection for
their dentist. The crux of the issue is not practitioners or their treatments,
but rather the widespread misconceptions about the dentist’s role in
helping individuals achieve ultimate oral health. Today we grasp the
profound impact of oral health on overall health, reaching far beyond the
desire to avoid pain, preserve teeth, or remove an infected tooth. The
desire is to know how to best enjoy sustainable mouth health that is
known to be a necessary goal for longevity, and a way to preserve our
health in our senior years. Oral health is a vital asset, capable of reducing
our risk for heart attack, stroke, diabetes, arthritis, pre-term birth,
digestive disorders, cognitive decline, Alzheimer’s, and early-onset
dementia.
The most important challenge is to create a true definition or
description of what constitutes a healthy mouth. This is a formidable
challenge with the rise of computer-generated crowns and veneers that
have blurred the line between genuine and artificial smiles, making it
difficult to discern the authenticity of a beautiful smile. How can we
gauge the health of our own mouths? Straight teeth, a lack of bleeding,
no cavities, or even a dentist’s assurance that your mouth is healthy does
not provide a definitive indication.
A healthy mouth transcends these superficial outcomes and operates in
an active way, where the biology and chemistry of the mouth is balanced
and ready to protect our teeth and gums by immediately repairing and
healing any damage that occurs. This delicate balance empowers us to
halt and prevent cavities, reduce sensitivity, heal gum problems, and
safeguard any mineral loss that can lead to erosion, abrasion, or enamel
weakness. When our mouths possess this capacity to swiftly reverse
damage, it allows us to preserve our teeth and gums year after year for
life.
If followed, this new and vibrant approach to mouth care should
improve both the present and future state of dentistry—and relegate the
notions of inherited dental problems, or the idea that we cannot control
cavities, into the ashbin of the past . . . where they clearly belong.
2. Watch Your Mouth—What’s Visible,
and Invisible, Within Our Mouths

I would not put a thief in my mouth to steal my brains.

—WILLIAM SHAKESPEARE, THE TRAGEDY OF OTHELLO

I n this chapter, my goal is to look at the human mouth—and explain

the various hidden influences, and health links, that exist between the
mouth and other areas of the head and neck. I will also provide an
overview of the fascinating connections between the chemistry and the
microorganisms that reside within our mouth, and in many adjacent and
interconnected anatomical areas.
This “invisible” anatomy of the mouth is finally being better
understood and appreciated. The more that we can fathom about this
world of liquids and particles (which are all too small for the naked eye
to see), the more we realize the crucial role they play in supporting our
mouths’ regenerative capabilities. Unfortunately, many individuals
unknowingly damage their mouth health through their own harmful
daily habits and improper oral care routines. The mouth’s ability to keep
itself safe has long been ignored because, in a healthy mouth, these
interacting elements work harmoniously to shield our teeth and gums
from any potential damage.
The problems of cavities and progressive gum disease occur when
these hidden assets are absent, impaired, or have been rendered
dysfunctional by our own damaging daily lifestyle choices. The
connection between our mouth and the anatomy surrounding it also
needs to be considered by anyone who has unsuccessfully tried to control
the spread of cavities, bad breath (often called halitosis—please see the
Glossary at the end of this book for a fuller definition of this term, along
with many others that you will read about as we move forward), or
interrelated gum and periodontal disease. The adjacent areas of the head
and neck do, in fact, have great potential to support or adversely affect
our oral health. So, perhaps we should begin to view the condition of our
teeth and gums in a more expansive way—as being all in our heads,
literally.

MOUTH 101—EAR, NOSE, SINUS, AND THROAT

The anatomy of the human mouth can be divided into two categories—
that which is visible (teeth, gums, tongue, and the inner skin of the
mouth) and that which I would describe, by way of comparison, as
invisible. When it comes to our mouth, the seldom-appreciated links can
be found in the connection of the mouth to the throat; and how the throat
leads to the breathing tubes that travel into the lungs and also the
esophagus, which then leads into the digestive tract.
There is also a less recognized, but no less direct, connection at the
throat-mouth junction. This is where a part of our head’s anatomy—the
Eustachian tubes—enters into our middle ear at the back of the throat,
positioned close to the entry points for the back of the nose that leads out
from the sinuses and nasal passages. The sinus areas of the face and
forehead regions are spaces of relative emptiness within the bones of our
face—and they stretch and wind their way behind our nose and cheeks,
and even into the center of our head. Ultimately, all these passageways
are connected in one or more ways to the throat and therefore indirectly
to the environment within our mouth.
Understanding that our mouth is connected to all these separate areas
can help us look at oral health in a more expansive way. The health of
one area of the head and neck can influence an adjacent area, either
positively or negatively. Anyone of any age who experiences chronic
cavities or gum disease should always consider their nasal and sinus
health, as well as their gastric and lung health. After all, it is knowing
about the linkage of these pathways—and balancing the health of so
many interconnecting yet apparently different areas of the body—that
can impact your personal journey toward improved and sustainable oral
health.
Blood Flow to the Face and Mouth
The surprising number of blood vessels that connect our face and mouth
is yet another anatomical wonder. Blood from the face, mouth, nasal
passages, and sinuses circulates and eventually returns to the heart and
lungs through what are called venous (related to the body’s veins) blood
vessels and—in particular—the brachiocephalic vein, which extends
directly from the body’s thorax (the area of the human body that rests
between the neck and the abdomen—see Glossary) and then travels
further downward to the upper right portion of the chest. In the lungs,
blood is continually oxygenated and then pumped back to the face, nose,
and mouth area. The venous blood vessel system from the face and
mouth is especially complex, with many intercommunicating and large
caliber veins that lead to small valve-less veins located on each side of
our jaws. This area is called the pterygoid plexus. Researchers do not yet
know the functions of this particular spot in the mouth, but it appears the
veins are massaged by muscle movements whenever we smile, eat, or
talk.
As it turns out, masses of what we call stem cells (a specific type of cell
in the human body that can change its form to develop into any kind of
new bone, skin, or gum cell—in essence, whatever the body needs to
repair itself) are found on the inside walls of veins. Stem cells anywhere
in the body can be stimulated by certain signals, including massage in a
nearby area, to travel outside the vein walls. Once this takes place, they
can flatten and curl up to create a form of new blood vessels, which then
will carry blood for healing to an area where skin, bone, or gum tissue
has been damaged. This process is called angiogenesis, and it is the initial
step in the natural process of repair that the body puts into motion every
time we cut ourselves—or when we need to grow new skin on our face
or on the inside of our mouth.
The presence of so many stem cells in the blood vessels of the
aforementioned pterygoid plexus has not yet been fully evaluated. It is
interesting, however, to consider the utility of this complex blood supply
to the mouth and face. Clinical experience indicates that massaging the
gums with a suitable toothbrush—by brushing above and around the
gum supporting a tooth—is precisely the type of stimulation that can
help to regrow the lost gum tissue. This process likely begins with the
encouragement of stem cells to form new capillaries (very small blood
vessels), which would then carry blood for the transportation of all the
necessary nutrients and materials required for gum healing.
For decades, dentists have protested that our gums cannot regrow. I
suggest, however, that the stimulation of surrounding stem cells can in
fact encourage restorative growth in this area of the mouth—through the
simple process of gum massage. To achieve this outcome, patients need
to use a sufficiently dense and resilient toothbrush in tandem with a
good brushing technique. I have witnessed decades of clinical success
stories—but in every case, the patient had to first stop damaging their
gums.
This worrisome situation can unfold for a number of reasons. It can be
the result of improper tooth movements during orthodontic treatments,
either after teeth are straightened with braces or from the ongoing use of
a preformed series of retainers that remain in common use today (known
generally as Invisalign). The trouble can also start as a result of what are
known as night guards. These products are plastic plates made by a
dentist to protect teeth from the continual grinding that may occur while
we sleep. Plastic retainers, used to prevent teeth from moving out of line,
may also be the culprit. Surprisingly enough, it may even happen as a
side effect of ineffective or insufficient brushing; aggressive cleaning
between teeth with small cone-shaped or graded tools or brushes; or
even from the harsh and excessive use of dental floss. The instructions
for gum massage techniques—along with my Complete Mouth Care
SystemTM—will be described more fully in Part Two of this book.

Dental Fears
Are people naturally afraid of dentists—or is it something that is learned
from the culture? For as long as the profession of dentistry has existed,
there seems to have been some level of suspicion and distrust when it
comes to dentistry and dental procedures. For millions of people, going
to the dentist can be a major source of stress and anxiety, especially when
an individual feels they have no control over their dental problems.
As with so many things, a fearfully imagined dental procedure can
frequently be far from what occurs in reality. Many people develop
serious dental fears early in life—often after negative experiences they
may have had as young children. When I was growing up in England, it
was not unusual to hear parents threaten to take a misbehaving child to
the dentist as punishment. Those who have had negative dental
experiences usually feel the worst anxiety. Conversely, the less treatment
that you need during dental visits, the more likely those visits will be
enjoyable.
This is why it is important to feel empowered, and to use effective care
methods that will help you to protect your mouth, teeth, and gums from
unnecessary dental treatments. Your own active participation in keeping
your mouth clean and healthy will give you the best opportunity for a
lifetime of happy dental visits—and sustainable oral health.

A NATURAL SYSTEM OF TOOTH REPAIR

In any discussion and exploration of the human mouth, one must never
forget or overlook the crucial importance of our teeth—and especially the
natural system of repair at play. To get a better sense of this remarkable
natural process, I encourage you to consider any one of your teeth as
being similar to a chicken egg—with a fiercely protective outer shell that
shields the far softer parts inside. Maintaining the strength and integrity
of this shell is paramount to preserving the health of your teeth, and this
next section will provide you with a better sense of the scope and detail
with which the natural elements of your mouth will help preserve those
pearly whites that comprise the smile you show to the world—by
fortifying the dental strength therein.

Welcome to the Enamel Kingdom

Our teeth are covered by a thin shell that we call enamel—this is a
substance made up of crystals arranged in such a way that they provide
teeth with an amazing level of protection and strength, especially
considering the enamel crystals’ delicate composition. Some people are
surprised to learn that the outside of a tooth is so dynamic and ever-
changing, but it is this specific attribute that allows enamel to maintain
its enormous strength which, when healthy, protects the softer layers of
dentin and pulp inside a tooth.
Dentin is a naturally occurring organic material that occupies the bulk
of a tooth’s mass. It is a porous layer that supports the enamel shell on
the outside, while surrounding a central chamber—known in this context
as the pulp—that is located inside every tooth. The pulp serves as the
nerve center of each tooth and the home to many vital cells, nerves, and
blood vessels that give life to a tooth. This area is also full of lymph (a
clear to near-white fluid comprised of white blood cells, whose primary
biologic mission is to rid the body of bacterial infection). Also within the
pulp are tooth-protecting cells, with long arms that travel through the
porous material of the dentin, and which also float in the lymph that fills
these open spaces. These dentin cells are sensitive to any kind of tooth
irritation or damage, including but not limited to: cutting with a drill;
pressure from a dental tool; and they can easily initiate a pain-based
reaction when they sense any pressure or temperature changes—from
hot or cold air, or liquids.
For the protection of these softer and vital inner parts of a tooth, it is
important for dental enamel to stay strong throughout life without any
sign of aging—but this requires we care for it effectively and in a way
that allows the ongoing, and necessary, natural repairs that cause its
crystals to regenerate every day. Proper daily tooth care can assist this
process and help tooth enamel to stay strong and accomplish its
protective tasks throughout life.
Viewing enamel under a powerful microscope is awe-inspiring, and
learning about the structure of enamel can help us better care for our
teeth and perhaps see them in a new way—as a particularly exciting part
of the human body. As we have already established, enamel is made up
of small, hard crystals packed tightly inside the open spaces of a mesh-
like scaffold that surrounds them. Small amounts of protein add
resilience to enamel, supporting the delicate but hard enamel crystals
that have an ability to shrink and grow, depending on the composition
and acidity of the mouth liquids that surround them.
The repetitive and organized arrangement of the enamel crystals
within this lattice creates the outer shell that covers and coats our teeth.
The intricate but tough framework is packed with enamel crystals that fit
like grains of salt into every open space. In healthy enamel the crystals
are separated by a thin, watery film between the crystals—the thinner
this layer, the healthier the enamel will be, and the more your tooth will
sparkle and shine. The strength and density of enamel fluctuates
constantly, depending on how tightly the enamel crystals are packed
within this lattice, as well as on the quality of the crystals themselves.
Inside enamel’s lattice structure, these crystals are arranged in a
complex but consistent manner. Most enamel crystals lie adjacent to one
another, in an alignment that creates solid tube-shaped structures known
as enamel rods. These crystalline rods travel in parallel and stretch the full
thickness of the enamel, from the inside to outside of each tooth’s enamel
coating. Between these rods are contrasting areas that are packed with
crystals arranged in a different and more curved fashion. These curves
can appear haphazard, but they are, in fact, highly organized into a
crisscrossed and interlocking configuration that offers exceptional
strength to this thin enamel layer on the outside of your teeth. At a high
microscopic resolution, it is possible to see that the structure of human
enamel is consistent and that every tooth is similarly organized with
these complex and intricate patterns.
One of the more surprising facts about enamel is that it is the hardest
substance in the human body—harder even than bone. The hardness of
enamel ranks “5” on the Moh’s scale, a form of established measurement
that serves to classify naturally occurring minerals into a ranked list
where diamonds land at the top with a rating of “10.” Moh’s
measurements tell us about the resistance of minerals to being scratched
in any way—the hardness of a human fingernail or the mineral gold, for
example, would produce a Moh’s rating of less than “2.5.” The
measurement of “5” for enamel further indicates that healthy tooth
enamel is less likely to be scratched than the metals of steel or iron, which
have a lower Moh’s number of “4.5.” Enamel that has lost its hardness
through exposure to acidity may, however, become softer than a
fingernail and quite easily worn and scratched by many products—
resulting in enamel wear, known as abrasion.
Enamel’s unexpected strength stems partly from its mineral content,
but also from the incredibly complex arrangement of the individual
enamel crystals and from the way they adhere to one another. Enamel’s
microhardness can also be measured using what is called a Knoop
Hardness Test (KHT), which determines the resilience of enamel by
pressing into it with a diamond point. As a result, a Knoop Hardness
Number (KHN) shows enamel’s overall hardness as a measured range of
“343 to 370,” whereas the inside dentin of a tooth has a KHN of “68”—
and this helps explain why dentin is so much more easily abraded or
damaged than enamel.
This type of damage occurs—for example—when there is a “caving in”
of the enamel shell of a tooth (as a cavity forms) and this exposes dentin
to the mouth’s environment, or when there is a loss of gum protection
(because of gum disease), which allows softer dentin to be in contact with
the mouth’s environment and in real danger because it is no longer
covered by strong tooth enamel or protected by normal gum tissues.
We have already discussed enamel and have explored its physical
structure, but let’s define it even more sharply at this point. Technically
speaking, enamel is composed of natural hydroxyapatite crystals, and
hydroxyapatite is a compound formed from the binding of calcium and
phosphate—two minerals that occur at high levels in the spit that our
mouths produce on a constant basis (and which is referred to in dentistry
as our saliva). The acidity of liquids can easily be measured on a specific
level of acidity, or pH scale. These measurements range from the numbers
0 to 14, where a neutral liquid is assigned a pH of “7.” The saliva in our
mouth can vary greatly in acidity. When it is flowing naturally, the pH
measurement can fluctuate between pH “5” and “7.4,” depending on
many individual factors.
We find in all cases, however, that when saliva is stimulated to flow
more rapidly (and we will discuss how this can occur later in this book),
this stimulation immediately increases its pH to several numbers higher
than its normal (or resting) pH level. When we measure minerals in
saliva, we find that the less minerals the saliva carries, the lower its pH
number. The higher the pH of saliva, the more minerals it will hold.
A healthy saliva measured at a pH of around “7.4” will, in fact, hold
more minerals than expected. This is known as super-saturation—and as
you can imagine, holding more minerals in solution is not a stable
situation, so this so-called metastable state leaves saliva ready to change
back to a more balanced state. This happens when saliva releases some of
these excess minerals and deposits them on teeth. This is an amazing
benefit for teeth, but specifically for the tooth’s enamel shell covering. At
a mouth pH level of “7.4,” minerals will therefore move on automatically
from our saliva and into any defects in the enamel surface with which it
makes contact.
These minerals then diffuse and seep from the outside surface and into
the enamel latticework, provided that our saliva is not diluted, thinned,
or changed in any way. Here the minerals will either combine with
existing crystals to expand their size, or they will seed new crystals to
replace lost ones. The strength of enamel increases as the integrity of the
structure develops, and as more and more minerals enter the lattice. As
hydroxyapatite crystals from saliva fill all the open spaces, the tooth’s
enamel crystals become densely packed and thus create the solid, smooth
enamel found in a healthy mouth. The physical structure of enamel
unites high strength with extreme toughness, qualities that are not easily
mimicked by synthetic materials.
Tooth enamel must withstand upwards of a million bites over a
lifetime—bites that are created as the jaws clamp together, and which can
produce a force equal to 224 pounds of pressure on the top of the tooth
surfaces. Every molar tooth therefore needs to be strong enough to
withstand high intermittent pressure without damage, if it is to offer
sustained protection to the tooth’s soft and valuable interior.
Not only is our tooth enamel strong, but it is also uniquely personal. In
fact, it has been discovered in recent years that every person has a
distinct pattern of enamel crystal design. Enamel crystals are grouped
together to form enamel rods, and these radiate in a three-dimensional
arch around the tooth’s surface, curving in all directions. The rod
structure gives our teeth extraordinary strength, and their design pattern
recalls the construction systems used to generate passive strength in the
building of cathedral arches. A voussoir arch is a building method where a
central voussoir, or keystone, is used to supply critical arch strength. In a
tooth, crystalline keystones do not work two-dimensionally but rather in
a three-dimensional way.
Enamel design thus supports downward pressure by effectively
forcing the enamel crystals together by compression, rather than apart.
Here we see the way enamel derives its strength from its microscopic
organization, and how forces are dissipated and released by the rods and
crystals—scattering and radiating the forces through, and over, the entire
tooth structure. So, when a dental drill cuts away the keystone crystals of
enamel, the overall strength of the tooth is immediately compromised—
and no filling will exactly repair or replace its original design.
The cutting of tooth enamel means it can no longer rely on its
microscopic structure to dissipate the forces created by biting and
chewing. The result is that these forces travel instead through the filling
until they reach its base. Here they will spread sideways, shooting in a
straight line toward the widest part of the tooth. This is how surface
cracks can develop and become a vulnerable entry space for bacteria on
the side surface of a tooth. If cavity bacteria floating in saliva gain access
to a microscopic gap or crack, they can penetrate deep into the tooth and
create a decay problem that is known as an interproximal cavity.
Interproximal cavities often occur on several teeth simultaneously and
are usually a secondary problem, discovered just a few years after one or
two small central fillings or sealants have been placed on the top biting
surface of a tooth.
Teeth offer us a varied collection of grinding and slicing surfaces that
allow us to bite into and chew up every imaginable kind of food. The
flatter molar teeth at the back of the mouth are useful for mashing or
grinding food, while our front teeth efficiently incise or bite things. A
tooth’s vulnerability to damage is not related to its function, but its shape
is most often the underlying reason why certain teeth are more
vulnerable to fracture, erosion, or cavities. For example, the enamel in the
center of a molar tooth is indented with deep grooves and, at their base,
the enamel is thinner and more vulnerable to the attack of decay-causing
bacteria than the thick smooth enamel covering the surface of a front
incisor, or of a corner canine tooth.
Enamel may be strong, but it is not indestructible—as anyone who has
had a cavity knows. When enamel crystals are weakened by acidity,
small pieces of enamel can quite easily be shed or break off around the
neck of a tooth, where the enamel crystals are shorter and have less
strength as they are angled away from the biting surface. This is how
channels of lost enamel can arise on the sides of teeth, creating a problem
known as enamel erosion. The damage usually affects several teeth at the
same time, most often on the outside surfaces of upper or lower molars.
Dentists are trained to recognize which teeth are more easily damaged
and therefore know where to look for the first signs of erosion or decay—
problems that occur in certain areas of specific teeth in a relatively
predictable sequence. This explains why dentists learn so much about
tooth anatomy and it can assist them in their daily task of inspecting
tooth surfaces, so they know where to look for cracks; dark spots of
decay; the gray hue of a dead tooth; or the brown lines that can signal a
breach in the tooth’s integrity.
Do not let the fact that some teeth are vulnerable to decay fool you,
though. Enamel has the power to heal itself under the right conditions,
and it is also incredibly durable. In 2022, a 1.8-million-year-old human
tooth was discovered near Tbilisi, the capital of the East European nation
of Georgia near the Mtkvari River on the Eastern end of the Black Sea. To
date, this is the most ancient tooth ever discovered. Furthermore, in 2015
scientists in southern China discovered forty-seven human teeth that
have since been dated back to the prehistoric year of 77000 BCE. Some of
these ancient teeth may have a few erosion marks on their surface, but
their overall condition is spectacular after so many thousands of years,
and without any sign of cavities.
Yet even though teeth are strong enough to survive long after the body
has disintegrated, it is easy for us to unknowingly create situations that
overwhelm their defenses and deactivate the mouth’s repair systems.
Tooth enamel is vulnerable to acidic attack and therefore to the
development of tooth weakness and the acid-promoted disease that
results in all kinds of tooth damage and cavities. The saliva in our mouth,
when it is healthy, provides everything a tooth needs to repair enamel,
and the dentin layer (inside this enamel shell) is home to cells that can
sense danger, and which even have an ability to secrete a cement-like
barrier that can slowly block off incoming damage or disease. (Saliva will
be discussed in greater detail in Chapter Three.) And so, with much of
our oral health reliant on the body’s ability to provide dependable
protection, it is crucial that our lifestyle choices not get in the way of
what nature has already given us.

Dentistry Endgame—Now What?

The problem for our body and mouth is that often the body’s natural
repair systems are confronted with a barrage of assaults from the
phenomena of the modern age—and this includes everything from
damage caused by whitening procedures, a loss of minerals from careless
daily habits, or those hidden danger signals that are being muffled by
desensitizing oral care products—or simply ignored because we don’t
know what to do. There are so many things that abuse or disable the
body’s regeneration system, and we court danger whenever we flood our
mouths with dangerous acidity from soft drinks and fast foods; take
medications that decrease our saliva flow; ingest a steady diet of sugary
and high carbohydrate foods; or live with so much continual stress that it
depletes our saliva of essential minerals.
In addition, many people live and interact in crowded communities, at
least for a part of their lives—at high school, at college, during hospital
stays, or later in life at assisted living centers. In these situations, our
mouths can be exposed more prevalently to waves of directly
transmissible oral and tooth infection, which can come from others living
in these communities or from hugging and kissing with family and
friends. Infection by cavity-forming plaque bacteria can easily wreck
teeth, sometimes so rapidly that a baby tooth can become decayed almost
before it has had time to grow and line up in the mouth. Tooth damage
and disease is not the result of faulty natural tooth design. Instead, it
more frequently results from an imbalance created by habits of constant
eating and drinking and a lack of understanding about how to effectively
support the incredible yet invisible mouth defense systems that have the
power to protect and restore our teeth and gums.

White Fangs?
A tooth’s outer enamel crystals are colorless and transparent, akin to a
clear glass window. However, when these enamel crystals come together
to form enamel, they start to refract and reflect light in a way that gives
teeth their white appearance. This visual illusion is orchestrated by a
watery layer surrounding each crystal, and it is the consistency of this
liquid that alters the trajectory of light. In healthy enamel, the result is a
sparkling, brilliant tooth, reminiscent of a diamond that is in fact a clear,
translucent crystal but appears to the eye as a radiant, white gem.
Unfortunately, the aim of many “tooth-whitening” products is to disrupt
this delicate water balance between the enamel crystals, replacing the
water with air or other substances that alter light’s interaction with our
tooth enamel. This is how artificial whitening products change the color
of teeth and why they often give them an unnatural, uniform, and often
chalky, ultra-white hue.
While these alterations may produce the desired illusion, it is crucial to
recognize that such tricks contribute nothing to oral health. For anyone
who wants to naturally whiten their teeth, the key is to help your teeth
become fully mineralized. This means correct care, which includes
carefully avoiding prolonged periods of acidity, damage from products
that strip teeth of their natural protection, and avoidance of sensitive or
so-called “mineralizing” toothpastes that usually create a barrier over the
enamel surface, which can potentially obstruct or prevent this natural
process of enamel mineralization.
Other tooth-color enhancing products may be potentially harmful
because they etch, scrub, or bleach the tooth surface. Many individuals
mistakenly believe that the more we polish our teeth, the brighter they
will be, but this too is untrue. Delicate crystals can be eroded by abrasive
oral care products, and acidity will dissolve away minerals, leaving a
tooth vulnerable to wear, changes of color, fractures, sensitivity, and
infection. The apparent increase in demand for bite plates and night
guards may have nothing to do with an increase in tooth grinding, but
rather an epidemic of weakened tooth enamel caused by modern
snacking habits, tooth whitening, and constant sipping of sparkling
water, energy and sports drinks, gummy candies and vitamins, sugary
chews, and supplements—all of which may contain enough citric acid to
dissolve tooth enamel.
The natural renewal of enamel can only occur under reasonable
circumstances and, once this level of abuse tolerance has been breached,
not only will it become harder to restore lost minerals, but there is also
some danger that the vulnerable interior of the tooth will become
sensitive to temperature changes in the mouth and infections caused by
intruding plaque bacteria. The tooth’s core pulp, which houses live cells
and nerves, desperately needs to be protected by healthy enamel.
Inflammation or infection of these interior tissues can cause swelling to
occur inside the confined pulp space in the center of the tooth, and this
can lead to an increase in pressure that may be sufficient to crush the
tooth’s nerves, limit its blood supply, and literally kill the tooth. Many
artificial whitening products breach the enamel layer with strong acids so
that protein-altering compounds can change the color of the tooth’s
interior dentin. Pulp inflammation has been observed—sometimes
lasting for weeks—after this kind of tooth-bleaching procedure. Tooth
death may not be evident for ten to fifteen years after the initial irritation,
noticeable as a little tooth sensitivity or pulp discomfort, but which
eventually and slowly progresses to tooth death.
It has often been said that one must suffer to be beautiful, but this
extreme kind of product-inflicted damage to our teeth is ridiculous—and
it needs to be stopped.

CONCLUSION
In this chapter, we have looked closely at what can be found in the
human mouth—elements both visible, like teeth and gums, and invisible,
which is practically everything else. We also looked into some of the
reasons why so many of us dread going to the dentist, and how
improvement to our daily home maintenance can make a difference to
our dental visits and help us to conquer that fear. Lastly, we took a deep
dive into the key systems of repair that occur in our mouths every day—
and why so many people end up on a downward slide toward
increasingly frequent dental appointments, and bills, by taking for
granted the remarkable world of biology and interwoven chemistry that
exists to heal our mouths . . . if we would only tend to it.
The teeth that we are able to see in our mouths live in a naturally
occurring partnership with all the invisible life and liquid chemistry that
surrounds them—all day, and all through the night. This delicate
interplay continues to fill me as a dental professional with wonder and
awe—particularly as tooth cells, nerves, and regenerative enamel crystals
all work together in seemingly magical ways. My hope is that this
beautiful picture of mouth harmony, with all its natural splendor, will
help everyone begin to appreciate why their teeth are so precious and
valuable; why careless or inappropriate home care is more than just a
mistake; and why harmful, or unnecessary, dental treatments should
never be accepted as inevitable or—worse yet—that cavities and gum
disease typify a kind of collectively uncontrollable, or progressively
destructive, fate. And as we move into the next chapters, this is a good
time for a reminder that we have more control over our mouth health
than we may think—if we can embrace and appreciate the power of
prevention.
 3. Saliva’s Got a Secret—And It’s Time
to Spit It Out

Getting well is easy, it is getting sick that takes years of constant, dedicated
hard work.
—DR. RICHARD SCHULZE

W e all know what spit is—but what, some might ask, is saliva? It
turns out that they are the same thing—the spit in our mouth is a
naturally occurring secretion officially called saliva. An adequate flow of
this unique substance is essential for oral health, and the protection it
offers is the result of the many component ingredients that work together
to keep our mouth in perfect harmony. If this flow of saliva is reduced
for any reason, or its composition is changed and becomes less protective,
then tooth damage and disease are likely to occur in the mouth.
This is frequently the starting point for nearly all cavities and gum
disease. When it comes down to it, saliva remains one of our strongest
secret weapons in our struggle to maintain optimal balance in our mouth.
Consider the following idea:
Our mouth health is a canvas.
Our teeth are works of art.
And our saliva can be seen as a renewable and remarkable coat of
protective paint.
Saliva plays many important roles when it comes to keeping things
healthy in our mouths. When this protection works in synergy, it keeps
our mouth healthy—but often we are unaware of saliva’s benefits and
simply believe that we are lucky benefactors of effortless oral health. It
may be a stroke of luck for you, but in reality, it is another example of the
way our body has power to control disease and create a positive health
balance.
 Saliva is also a lubricant that moistens the mouth and aids us when we
swallow food. It keeps the lining of the mouth and teeth adequately
hydrated and protected from mechanical damage that often occurs as we
chew and consume foods of different textures. Saliva is such a helpful
ally to us when it comes to our digestion. It serves to dissolve tasty
particles from foods, which allows us to experience a vast assemblage of
culinary flavors through the taste buds on our tongue. This, of course,
makes eating that much more enjoyable and safer for our total body
health—and we have saliva to thank for it.
Certain immune proteins in saliva play an antimicrobial role and help
to clear bacteria from the mouth, while other proteins exert a healing
effect on gum and mouth tissues. Over 300 kinds of proteins have been
identified in saliva, and potentially more interactions and benefits will be
discovered as salivary research expands in the future. Enzymes in saliva
initiate important digestive processes in the mouth, especially the
breakdown of carbohydrates, which are separated into more digestible
sugars before being swallowed.
Recent work has focused on genetic markers discovered in saliva,
which can be used to diagnose dysfunction and disease in other parts of
the body. This kind of testing may one day put dentists in a more
preventive health care role, where they potentially become primary
providers for identification—through salivary testing—of all manner of
important information about a patient’s overall health, even
incorporating breath technology where volatile organic compounds in
breath become signals called biomarkers that alert us to early cancer,
bacterial imbalances, and diseased organs.
Saliva has an ever-changing composition, and the total mix of its
ingredients—at any given moment in time—is called whole saliva. This
liquid will usually contain a high number of electrolytes (electrically
charged natural minerals found in one’s blood and other bodily fluids)
along with immune cells and a varied range of proteins, in proportions
that are constantly changing. Saliva is squeezed out from two major
glands that are found on each side of the jawbone—one in each cheek of
the face, and one at the back of the nose. Each gland generates, modifies,
and paces the secretion of saliva’s various elements, which are then
pumped automatically along ducts that travel from these glands and into
the mouth, with openings under our tongue and on the inside of our
cheek. These salivary variations are influenced by hormones (and the
resultant emotions that we experience), circulation, digestive health, and
biologic commands that originate from our nervous system.
This changing composition and flow rate has other influencing factors,
including messaging from the nerves that connect to our eyes and to our
sense of smell. This means the rate saliva flows into our mouth is
variable, and these differences are layered over a flow speed that
automatically fluctuates with a repetitive 24-hour cycle, every day and
night, a variation that we first identified in Chapter One as a Circadian
rhythm. These alterations in saliva quality are important because the
varying chemistry creates either a positive influence on our mouth, or it
can be a hindrance to our oral health efforts.
The overall quality of our saliva naturally ebbs and flows almost every
hour of every day. In the morning hours, saliva can be somewhat more
acidic—but after midday, most people find that their saliva is a higher
pH (less acidic) and more healing. Since the health of saliva is also
quickly reflected by our diet, noontime is perhaps the ideal time for
saliva-promoting foods like salads and greens, that can enhance this
naturally healing afternoon saliva flow.
The main concern is to stop snacking and sipping during the time
when you have quality saliva in your mouth. Another way to benefit
from saliva is to stimulate a flow with some xylitol, and then do not eat
or drink for one or more hours afterward to allow this healing saliva
adequate time to mineralize your teeth and heal your gums. (Look ahead
in Part Two of this book for more details on xylitol.)
The most difficult time for mouth health is while we are sleeping at
night. This is because saliva’s Circadian rhythm reduces saliva flow
during the night, and it is more acidic in the hours after midnight—when
we are sleeping. This acidity and reduced flow can leave our teeth and
mouth dry and unprotected. If a dry mouth and lack of saliva is a bother
to you at night, start by considering the value of rest and relaxation—
which have a beneficial effect on saliva flow—especially before sleeping
at night. This lack of help from saliva during the night also makes it
important to use a well-selected oral care routine prior to sleeping. (In
Part Two we will discuss in further detail my Complete Mouth Care
System™, which helps to keep teeth safe during this difficult time in the
night.)

ACIDIC SALIVA
For oral health we want our saliva to be perfect, pristine, and the carrier
of minerals and immune cells into our mouth. Sometimes, unfortunately,
you may find that your mouth’s saliva is acidic, and then, no matter how
well you brush and floss, you will be at a higher risk for cavities and
tooth decay. We can test the acidity of our saliva by allowing the liquid
in our mouth to pool on the tip of our tongue, and then spit this into a
spoon. We can dip the end of an absorbent paper strip (called litmus
paper) into this spat-out sample, and the special dyes in litmus paper will
change color to illustrate the acidity of the sample (which, as defined
earlier in this book, is called our saliva’s pH).
The measuring scale for pH levels is between zero and fourteen, so that
a pH of 7 would indicate a non-acidic or neutral state. If this pH test is
taken with normally flowing saliva in your mouth (which is called resting
saliva), and if the result is neutral or slightly alkaline (around a pH of 7.4),
then this would be considered a healthy result. At a pH of around 7.4,
saliva has a composition that will be able to defend the integrity of your
gums and the skin of your mouth (known as the oral epithelium). It will
also be able to transport sufficient minerals for the maintenance, health,
and strength of one’s teeth.

The “It” of Spit When You Eat

As mentioned, saliva pH is rarely constant, and it can change for many
reasons. Some of the most dramatic changes in saliva’s pH occur when
we eat or drink. Many foods reduce our mouth to a low pH of around 5
or 6, and some foods and drinks can even cause the mouth pH level to
dip between 2 and 4. Whenever the mouth’s acidity level falls below 6,
every tooth surface is at risk for mineral loss. Harmful plaque bacteria
also gain momentum in acidic mouth conditions and will use this pH to
their benefit and form thick plaque on tooth surfaces, where multiplying
bacteria can damage our teeth and gums.
There is a direct mixing of drinks with our saliva as we sip and
consume them. The beverage entering our mouth immediately dilutes
the consistency of normal saliva, and the two different liquids quickly
intermingle to create a pH that is approximately an average between their
different pH values. While we eat meals, soluble ingredients from food
dissolve in saliva. These saliva/food and saliva/drink mixtures then
circulate everywhere in our mouth—they touch every tooth surface, and
enter every groove, pit, or gap in and between teeth, fillings, or crowns,
flowing between teeth—even teeth that appear very tight and crowded.
This means that all meals, snacks, and drinks—even a sip of water—
will change the composition of our saliva and potentially disable its
healing quality. Any drop in the mouth’s pH levels will also pull
minerals from tooth surfaces. As a result, any lingering or prolonged
periods of acidity will likely promote negative changes in the health of
our tooth enamel and encourage less beneficial bacteria to populate our
mouth.
Alas, this is why frequent eating, snacking, and especially the sipping
of beverages will stress teeth, gums, and our overall mouth health.
Especially damaging are any foods and drinks that contain
carbohydrates, sugars, strong acids (like phosphoric or citric acid, which
are found in many flavored waters and sodas), or even a consistent
consumption of carbonated sparkling drinks—which, of course, also can
make the mouth highly acidic. Remember that story you heard once
about how soda drinks can peel the paint off an automobile? Just think
about what those same destructive liquids are doing to the inside of your
mouth!
Saliva and the Sugar Cycle
In the mouth, it is specific plaque- and cavity-forming bacteria that
metabolize sugars from our diet. When we consume any sugar-
containing or carbohydrate-rich foods, these sugars they contain will
dissolve in saliva and be transported around the mouth to feed these
harmful bacteria. This situation occurs almost instantly as the food enters
the mouth, which does not give anyone time to run and clean their teeth
to stop the interaction. The sugar can nourish plaque bacteria, especially
any located on the surface of teeth, which will be able to use this energy
to multiply and grow thicker and more hazardous to your teeth and
gums. The byproduct of growing plaque is an acidic liquid, which seeps
through the plaque mass to damage teeth but also to mix with saliva and
create even more acidic mouth conditions—which then favor even more
plaque growth.
Constant snacking, especially with sugary or carbohydrate-rich foods
or the sipping of any sugary or acidic drinks, causes plaque to grow into
a thick mass on teeth. This unhealthy cycle is the main cause of cavities,
filling deterioration, and the first stage of gum disease that is called
gingivitis.
There remains a misconception in our culture that sugar and sweets are
to blame for tooth decay—and certainly sugars are a part of this
unhealthy saliva sugar cycle. Make no mistake: It is possible to give up
the consumption of all sugary and carbohydrate foods and, if you
carefully brush and floss, be able to improve and maybe control some
dental problems. If, however, your mouth is acidic, then sugar control,
even with excellent brushing and flossing, will not offer sufficient
protection.
Your acidic saliva will continue to create tooth-damaging and plaque-
forming conditions in your mouth—despite your oral health efforts and
sugar-restrictive diet. Conversely, it is not necessary to insist on a
completely sugar- and carbohydrate-deprived diet for oral health. If you
do not like the idea of dietary restrictions, be encouraged because mouth
health can be controlled by the timing and frequency of your grazing,
snacks, sweets, meals, drinks, gummies, protein bars, chewable vitamins,
and other fun foods that are known to cause tooth decay. In fact, if we
want to point a finger of judgment at all the things that damage oral
health, then we should also direct this to every sip of water or liquid
(sugary or not) that changes the composition of saliva, as diluted or thin
saliva can play its own deleterious role.
Now don’t panic—and please don’t think that you can never eat or
drink anything again. Quite the opposite, in fact. The good news is that
you have almost total flexibility about your food choices at every meal
and snack, without limitations or even sugar restrictions. All we need to
do is corral our eating or drinking sessions into a reasonable number of
times each day—and I suggest to clients that this should be a daily total
of five (5) to six (6) meals/snacks/drinks, each of 15 to 60 minutes’
duration. One thing to realize here is that the longer you take to consume
meals, snacks, and drinks, the more potential there is for tooth damage to
occur. With this approach there is no longer any list of taboo foods or
drinks, since nothing you eat will cause damage if you end your meals
with a tooth-protective food. This way of eating will allow you to enjoy
the foods you wish—provided that you know how and when to eat and
drink and still ensure the safety of your oral health.

SWEET SALIVA
As we eat foods, the particles of food are crushed by our teeth and then
mix into our mouth’s saliva. Dissolved in saliva these food particles are
carried through our mouth, mixed together with all our mouth liquids.
Any sugars from food dissolves instantly, but carbohydrates are also
quickly broken down into smaller particle sugars by enzymes in saliva.
This means that any sugars create a sweet solution of saliva that flows
everywhere in your mouth, feeding all the sugar-loving, acid-producing,
plaque-forming bacteria lodged in every nook and cranny of your teeth
—and even the bacteria floating in saliva and on the skin of your mouth
and throat—in places that cannot be cleaned by either brushing or
flossing.
 This explains why people who meticulously clean their teeth can still
wind up with cavities and gum disease because of their eating habits and
patterns. It also explains why trying to clean your teeth after a meal is
ineffective to stop this kind of damage, which occurs almost
instantaneously—seconds after a nibble on that sugary carbohydrate or
acidic food. The time interval between the act of eating food or sipping a
drink and the resultant pH change is immediate, making it impossible to
“brush your teeth” and prevent this damage, no matter what you were
told as a child.
The acidity caused each time we eat can cause a pH drop in the mouth
that will continue for up to an hour. This acidic environment can
promote harmful bacteria and may dissolve minerals from the enamel of
your teeth. Eating multiple times each day simply adds multiple hours of
extended acidic damage. This may sound depressing but read on because
you can easily limit this post-meal period of acidity and turn acidic saliva
back into a naturally occurring tooth-healing saliva. This needs to happen
each time after we eat or drink, so that we can replace any lost minerals
and repair any “demineralization” damage.

HOW TO IMPROVE SALIVA HEALTH

It should by now be obvious that our saliva can be impacted directly by
almost anything we put into our mouths. For instance, smoking and
vaping are damaging habits that dramatically affect the composition and
flow of saliva—and this, of course, will serve to dry the mouth and
reduce or eliminate saliva’s health benefits. Many familiar medications
can also create dry mouth problems and, in this way, suddenly increase
someone’s risk for cavities and gum disease.
So, now let’s look together at the actual health of saliva as it enters your
mouth. Poor-quality saliva can be the outcome of a bad diet. However, it
can also be a silent symptom of:

Our digestive health;

Inadequate rest and sleep;
 Insufficient exercise;
Medication side effects;
The result of stress or hormonal imbalances (especially during
pregnancy, menopause, and in later life); or
A consequence of open-mouth breathing, sinus infections, allergies,
and possibly the result of wearing dental braces and retainers
(which impedes saliva flow).

Our saliva provides transportation and dietary support to the large

assortment of bacteria that live in our mouths. Approximately twenty
percent (20%) of the mouth’s bacterial community float freely in this
liquid and travel wherever saliva travels, in and out of teeth, and down
the throat and into the digestive tract. The majority of mouth bacteria,
however, are also nurtured by saliva, but they do not float in the mouth
liquids. Instead, this eighty percent (80%) portion of the mouth’s bacteria
is wrapped in protein strands and covers all the surfaces of our mouth,
teeth, and gums. This film of bacteria woven in a web of proteins is called
oral biofilm, and its health is influenced directly by the quality and
features of our mouth’s saliva.
For example, healthy biofilm is damaged if it loses moisture for an
extended period. When saliva dries up or does not coat tooth surfaces
adequately, or if saliva is unable to keep the gums moist, this is when the
protective oral biofilm shrinks, and this can expose tooth and gum
surfaces to harmful bacteria—and a risk of infection. How we breathe,
our stress levels, and even hormonal shifts can cause saliva to flow less
fluidly, become too dilute, or ineffective—all factors that will damage the
health of our mouth biofilm.
So how can you fight back and manage the health of your saliva, so
that you can support the health of your biofilm—the film that protects
our teeth and gums from damage and disease? This question is especially
important if you are taking medications that dry your mouth or if you
have allergies that make you breathe more through your mouth.
 The first place to look is at the foods you are eating regularly. Certain
foods will benefit the biofilm directly—fruits like raspberries and
blackberries—which themselves contain the natural sugar xylitol, also
shown to have protective effects within the mouth. Other studies show
how vegetables normally served in salads—lettuce, cucumber, celery,
and beets, in particular—support the production of an altogether
healthier alkaline mouth environment, which over time will impact the
health of your teeth and gums. Salty foods, cheeses, and oily foods (like
avocado) are also on the list of foods that are called tooth-protective
because they are helpful, not harmful, and because they can help
generate and maintain a healthy saliva flow.
It may seem discouraging to think that everything we consume can
damage our teeth and gums. You may feel frustrated to know that even
water can thin and dilute the saliva, thus making it impotent when it
comes to healing teeth. Consider, for example, that the commercially
available Fiji and Evian waters each have a pH of 7.4 (equivalent to the
exact pH of healthy saliva), but although they do not add any acidity into
the mouth, these waters will dilute and thin saliva. And so, although
they are not in themselves harmful to teeth, they are not as helpful as
saliva.
Now, let’s quickly agree that drinking water is a healthy habit. What we
need to do is drink water without allowing it to dilute our valuable
saliva. So, what is the answer? The solution is to generally drink either
before, during, or after mealtimes—and less during intervals between
meals. If you do not want to drink at meals, then you can just set aside
some other “water snack” times during each day when you drink more
than a sip or two at a time. In recent years, more health practitioners have
begun to recommend that people should limit snacks and create
boundaries for their eating routines, so this advice should fit into that
approach—keeping our food and drinks within a schedule, as opposed to
one that is continuous and never-ending each day from morning until
night.
My career began working in a dental office that recommended the
adding of tooth-protective foods to the end of meals—for their protective
effect. There are various of these food options (as we have discussed),
and some people will want to explore these—but if you have a busy life
and need a convenient and arguably ultimate tooth-protective food, let
me suggest xylitol. Little mints and chewing gum sweetened with xylitol
are amazing tooth-protective foods and are particularly helpful for
people with a dry mouth or anyone experiencing chronic dental or gum
problems. (You can read more about xylitol in Part Two.)

WHAT DOES “HPV” HAVE TO DO WITH ORAL HEALTH?

The eighty percent (80%) of mouth bacteria that do not float around in
saliva are the bacteria we are going to consider next. This is because they
are the most ignored and least understood, and they create the special
biofilm that exists over the entire surface of the mouth. When the mouth
is healthy, this translucent film stands as our best ally to manage the
onslaught of “intruder” bacteria that come into our mouths from the
world around us.
The integrity of healthy oral biofilm can help reject intruder bacteria
traveling in saliva droplets that are shared when we talk and interact
with one another. Healthy biofilm can work as an almost-bulletproof
shield against other assaults that can cause damage to our teeth and
gums. Healthy biofilm’s bacterial communities live as a communicating
unit within its mesh-like structure, with a wide variety of healthy
bacteria that are able to coexist with each other and perform as if in
unison—like a well-organized army—exhibiting characteristics that are
more potent and defensive than any individual bacteria could muster if it
were floating individually in saliva liquids. Our biofilm protection covers
our teeth, gums, and the skin inside our mouth, defending these surfaces
from physical trauma that could otherwise cause ulceration and from
infections by fungi, intruder viruses, or bacteria that could otherwise
cause conditions such as the often-experienced fungal mouth infections
known as candida, lichen planus, and thrush.
If our biofilm protection dries out (because saliva flow is slow or
stopped), then this can leave the mouth more vulnerable to ulcers, tooth
enamel erosion, cavities, and gum infection. Damage from wrong oral
care by artificial whitening products, hydrogen peroxide, or baking soda,
for example, or from chemo- or radiation therapy, and even from deep
dental cleanings, can strip away our mouth’s protective biofilm and open
the door for problems of every kind, even the possibility—in some
specific situations—of infection by the Human Papilloma Virus (HPV).

The Viral—and Bacterial—Dance of Love

The Human Papilloma Virus (HPV) is a sexually transmitted virus, and it
is one of the most common sexually transmitted infections today in the
United States. HPV is transferred through skin-to-skin contact and by
oral sex, and HPV has the potential to raise someone’s risk for cancer in
areas of the mouth and throat.
HPV is the leading cause of oropharyngeal cancers today, primarily
discovered in the tonsils, base of the tongue, throat, or at the front of the
mouth. The Centers for Disease Control note that 10% of men and 3.6%
of women test positive for oral HPV, and that the percentages increase
with age. HPV may be more of a danger if the mouth’s protective biofilm
has been damaged or stripped away.
As the statistics show, more males than females develop HPV-
associated oral cancers, and to explain this, a study by Gillison suggests
females often become infected by HPV early in their sexual life, but
rapidly develop a systemic antibody, which offers a full-body protection
throughout life. Protection takes longer to develop in males, and it may
require multiple exposures to HPV for a male to generate his immune
response. This may be part of the reason why oral cancer in men is
increasing in the age range 35–55, and why men are more at risk for oral
cancer than women by a ratio of 4 to 1.
Fear of virus transmission can be alarming, as witnessed during the
initial COVID-19 epidemic of 2020–2021. It is important to remember that
the human body is beautifully equipped to resist invasion from intruder
bacteria, provided that your defense systems are healthy and
functioning. Problems occur when these protective systems are breached
or overwhelmed, in what is commonly referred to as “perfect storm”
situations.
Despite the resilience of oral biofilm, many medications, antibiotics,
and even routine daily habits can damage this barrier—creating a portal
for viral or bacterial infection to enter the mouth from one partner to the
other. A defensive biofilm is found everywhere inside our nose, sinuses,
and lungs—and it is useful to know that small amounts of xylitol (see
Part Two) can help keep our mouth and nasal biofilms healthier.
HPV is a widespread viral infection, and at least one person develops
an oral HPV infection in America every 20 minutes—with 26 million
Americans currently infected by the HPV virus, according to the
National Health And Nutrition Examination Survey (NHANES), which
is a nationally representative study that has assessed the overall health of
children and adults in the United States since 1999. This certainly sounds
alarming—but before you rush to be tested, let’s consider the other side
of the equation.
There are over 200 strains of HPV, and the commonly used Polymerase
Chain Reaction (PCR) test developed in 1983 is not only prone to error,
but we know that only one percent (1%) of individuals testing HPV-
positive will be at risk of this infection cascading into cancer (and this
may actually occur many decades after the original infection).
HPV-16 is the primary cause of oral cancer today, surpassing tobacco
and alcohol, but it appears that tobacco and excessive alcohol will
increase this risk. Other more positive studies show drinking twenty-four
(24) ounces of coffee per day (about 3–4 cups) can offer up to fifty percent
(50%) protection from oral cancer. Fruits, vegetables, and green tea are
other foods that can support our immune system and be protective and
helpful.
The connection between intimacy and shared bacteria and viruses is a
developing science—and it does appear that the greater the number of
sexual partners, the more likely a person is to contract an HPV infection,
and this applies as equally true for oral sex. PCR salivary testing
continues to be a primary way to determine HPV levels and search
specifically for HPV-16, the virus associated with throat, cervical, anal,
and penile cancers. Most people—even those with the 16, high-risk
version of HPV—do not develop cancer, and often do not show
symptoms. HPV also goes into long periods of dormancy over decades,
which explains why PCR testing is being questioned by experts in this
field, and why it may be preferable to have a visual oral cancer screening
with an oral surgeon before having any additional PCR testing as
necessary.

Risks from Transmission

As humans, we are always at significant risk from bacterial transmission
during skin-to-skin contact, and this is especially true between intimate
partners. As previously mentioned, our mouth and nose are home to
hundreds of different kinds of bacteria, most of which are healthy and
helpful, and the biofilm covering our mouth and nose offers a defense
against itinerant or intruder bacteria. Every part of the human skin
covering the inside and outside of our bodies is host to its own specific
and diverse bacterial community. Problems only occur when something
upsets this normal balance and allows harm-causing bacteria to
overgrow their normal levels and become dominant––often the result of
changes caused by certain medications, a depleted immune response, or
bacterial upset caused by antibiotic therapy.
The transfer of harmful bacteria can cause unexpected mouth problems
in a partner, so this possibility will now be discussed while working to
keep these concerns in perspective. There is substantial oral health risk
for romantic partners to consider at any stage of life—particularly if
someone is taking medications; is older or has a compromised immune
system; or for anyone after a course of antibiotics.
There is always potential, however, for harmful plaque or periodontal
(gum disease) pathogens to transfer in droplets of saliva during any
intimate contact, and even when talking or simply living in a shared
physical space. Typically, partners who are together for years will
experience this transfer—and if they are able to maintain oral health, can
potentially reap the benefits from a wider diversity of bacteria in their
biofilm.
In 1970, we learned from dental studies that plaque bacteria from a
mother’s mouth easily populates the teeth of her baby—and this transfer
influences the child’s oral health for life. Sharing chronic periodontal
gum disease bacteria can be very problematic for partners, because the
infection they cause is below the gums and may not cause any visible or
tangible symptoms. Periodontal disease involves a specific group of
bacteria that multiply in low oxygen conditions as single cells in saliva
and travel from the throat, mouth, and sinus in the liquids that circulate
in these areas. They are present in the mouths of most adults and reach
high levels in people who have chronic periodontal disease, sinus
infections, and often in the airways of those with chronic breathing
issues.
These harmful bacteria cannot be brushed or flossed from salivary
liquids but flow wherever body liquids flow—even into our digestive
tract. These are the bacteria that can cause serious damage to our gums if
they lodge alongside a tooth inside a dark, low oxygen space called a
periodontal pocket. These bacteria can infect the mouth of a partner if this
partner has periodontal pockets, often causing deterioration in the
partner’s oral health both silently and rapidly.
The speed and severity of a transferred periodontal problem will
depend on the recipient’s immune system health; their absence or
presence of periodontal pockets in their gums; their daily mouth care;
and overall health and habits. The risk of transfer can occur whenever we
live closely with any individual who has chronic gum disease, recurring
sinus infections, or breathing problems. Those who engage in oral sex
should also be aware that specific bacteria, most often recognized as
contributors to periodontal disease, can transfer to or from the vagina of
a partner.
Oral salivary testing is available to determine the pathogen levels in
your mouth, but at present this new science seems to be creating as many
questions as it provides answers. The specific bacteria that are implicated
in this kind of transfer are: porphyromonas, prevotella, peptostreptococcus,
and fusobacterium bacteria. Porphyromonas gingivalis (PG) and
Aggregatibacter actinomycetemcomitans (AA) are two highly transmissible
and aggressive periodontal pathogens, with the ability to breach the skin
surface that allows them to both damage gum tissues and potentially
invade the body to cause chronic inflammation around the heart, joints,
brain, and gut. PG and AA pathogens may also shorten the gestation
period for an unborn baby, which is how gum disease raises a pregnant
woman’s risk for pre-term birth.
Interestingly, a 2022 study in Malawi showed that two pieces of one
hundred percent (100%) xylitol gum—one gram consumed before
sleeping every night and the other after lunch—was able to significantly
reduce this risk of pre-term birth. New studies are looking at changes in
the periodontal pathogens with xylitol use in pregnant women, and
perhaps we can hypothesize that xylitol may exert an effect on PG and
AA levels in the mouth.
Kissing and sharing bathroom spaces appears to be major contributing
factors for sharing periodontal bacteria in close quarters, and usually this
requires contact for more than a day. The recipient of the periodontal
pathogens floating into his or her mouth will only be vulnerable if they
have periodontal pocketing, which is why being vigilant to eliminate any
periodontal pocketing is so important for your overall health. People
without this type of gum pocketing condition in their mouths have no
suitable habitat for the multiplication of periodontal bacteria—and so
they are relatively safe, as a result.

How to Keep Oral Biofilm Healthy

As we have by now firmly established, healthy oral biofilm is critical for
the maintenance and defense of your mouth health. Healthy saliva
supports the integrity of tooth enamel and also the health of oral biofilm.
Sometimes during hormonal change and pregnancy, it can be almost
impossible to control the acidity of saliva, and this is when teeth and
gums need extra help.
If you are experiencing hormonal changes; are stressed, or pregnant; if
you take medications that dry your mouth (allergy medications, blood
pressure medication, and diuretics, for example); if you have had a
course of radiation or chemotherapy; or if you have an autoimmune
problem that has attacked your salivary glands, then you will need to
understand the many ways we can directly assist our saliva to protect
our mouth—and avoid the many problems that have too often been
accepted as uncontrollable, age-related, or inherited. The variable least
appreciated is the value obtained from the interaction of undiluted saliva
with our mouth and teeth each day. We must consider this—especially
for anyone at risk for problems—if we are to help maintain oral health
for life.
Stimulated saliva is a perfect solution to counteract the loss of minerals
from teeth that occurs in every mouth, every time we eat and drink.
Those at higher risk because of a dry mouth or acidic saliva can use
stimulated saliva as their personal rescue resource. Stimulated saliva has
an exceptional load of minerals suspended in it, as it is emitted from the
salivary glands. This kind of highly mineralized liquid is known by
chemists as a super-saturated solution. In other words, minerals are
virtually dripping out of saliva as they flow into the mouth, immediately
ready to coat the surface of our teeth and mineralize, heal, and beautify
them on contact.
In the end, there is no way we can brush, polish, or shine teeth as
effectively as healthy saliva’s daily interaction with our tooth enamel.
Oral health problems will always occur when saliva is devoid of
minerals, is frequently thinned by the liquids we sip, and when saliva
flow is interrupted or reduced.

CONCLUSION
Your dentist can physically repair and clean your teeth, but he or she
cannot make your saliva healthier. This is something we must do for
ourselves. As we bring this chapter to a close, here is a review of the
three most important things to consider for the support of your saliva
health.

1. Saliva is a valuable and “secret”—or as-yet unrecognized—

weapon in your oral health arsenal. Its underappreciated benefits
can be compromised by careless eating and drinking habits. Try to
reasonably control your daily eating and drinking sessions, ending
each meal, if possible, with a tooth-protective food—followed by a
period of mouth resting for at least an hour, and ideally longer.
2. Our entire body works as an interconnected unit, and saliva health
demonstrates how impulses generated by stimuli from our eyes,
nose, and even emotions can change the composition and texture
of the saliva in our mouth. Take time before eating to rest and
relax, or maybe at least a few seconds to observe and appreciate
the food you are going to consume. Your saliva will thank you for
this relaxing gesture and, in return, you may discover it delivers
positive contributions to your teeth and overall health.
3. Healthy saliva helps maintain a delicate balance of good bacteria in
our mouths. Mouth bacteria are associated with the first stages of
digestion for certain foods, and many oral bacteria are swallowed
in the saliva that moistens food. Healthy digestion encourages
more nutrients to enter our blood and be transported around the
body. Healthy digestion also nurtures our immune system, and
supports the production of immune cells, proteins, and the
antibodies that help us fight disease. Exercise circulates blood
around our body and into the vascular salivary glands nestled in
our face. In these glands there is a direct exchange of nutrients,
immune cells, and proteins that go from the blood into the salivary
fluids, which are then squeezed into the mouth. These nutrients,
cells, and proteins are the essential components that help saliva
 maintain a healthy balance of good bacteria in the mouth, to aid in
the digestion of food—and so, the salivary circle of health repeats.

In the next chapter, we will take an in-depth look at white and silver
amalgam fillings, flossing, and fluoridation—areas of oral care that have
just about as many dentists who endorse them as dentists who don’t.
4. Flossing, Fillings, and Fluoridation—
The Three “Fs” of Dentistry

I am lying—true or false?
—PARAPHRASE OF GREEK PHILOSOPHER EUBULIDES’ “LIAR PARADOX” (DATE UNKNOWN)

S o, we all know that we must clean our teeth, but how can we do that
in a way that encourages superior oral health—and keeps dental
problems at a minimum? Well, the American Dental Association (ADA)
recommends that we brush and floss and have semi-annual dental
cleanings. However, statistics continuously show—including those
generated by the National Health and Nutrition Examination Survey
(NHANES)—that ninety-six percent (96%) of Americans retire with
cavities, extracted teeth, fillings, root canals, and gum disease—even
dentists, who should be the “brush and floss” experts. Financial planners
warn us dentistry becomes more expensive as we age, which stands as
further confirmation that oral health generally deteriorates if you follow
traditional advice. Yet entire nations around the world experience better
oral health with far less problems and expense.
Let’s understand why oral care advice is only partially accurate and
generally inadequate—and how we, as individuals, can better manage
our own oral health. To begin the process of sorting this out, let’s talk in
this chapter specifically about some of the incredible frustration caused
by disagreements between dental professionals on certain topics. In
particular, three topics that start with the letter “F”—and these are
Flossing, Fillings, and Fluoridation.
As dentistry changed from a business of tooth extraction in the late
1800s to our modern-day idea that dentists enable us to enjoy ideal oral
health, recommendations for patients’ home care have not kept pace with
new scientific discoveries. There is, after all, an impact—good or bad—
that can stem from our choice of oral care products. The importance of
our “daily use” strategies may make all the difference between having
good oral health or continuing to experience problems. The game-
changing effectiveness of home care is slowly being realized by dentists
—but it has been an incredible oversight to leave this particular door into
the world of mouth care products unlocked, unattended, and open to
companies who may not have your oral health as a priority or concern.
Oral care companies, on the other hand, have been able to quickly
understand people’s collective desire for whiter teeth and they have
walked decisively into this area of public need, invading it with
aggressive marketing and the promotion of what can charitably be
deemed a cavalcade of dubious products. Unfortunately, dentists are
constant targets for “solution-based” products that do not work, created
by these corporations and marketed to become the next “smoke and
mirrors” phenomenon. Experienced hygienists are usually savvy to this
repetitious event, but often are forced to watch as yet another unworthy
product quickly becomes the newest darling of dental offices. Many oral
health professionals refer to these hyped-up products and devices as
dentistry’s “shiny new toys,” and some examples of these products from
the past have included:

Strong fluoride gels and toothpastes. These are many times more
concentrated than the fluoride added to drinking water and were
designed upon the false and never safety-tested premise that if a
little fluoride is good . . . then more must be better.
Remineralizing toothpastes. This product entered the dental arena
in the early 2000s, prompted by companies trying to find a use for a
surplus of powdered milk and some science that shows cheese can
halt cavities and help mineralize teeth. These pastes were a dismal
failure that caused a number of milk allergy problems—until they
removed the milk and added a synergistic combination of xylitol
and dilute sodium fluoride to the products.
Total-care pastes. This product hit the market next with triclosan
 (now banned from toothpaste). The selling point was that this
toothpaste could keep plaque away for twenty-four (24) hours. It
transpired, however, that triclosan could react with the chlorine
present in most water supplies to form formaldehyde on your
toothbrush, and it also acts as an estrogen hormone disruptor.
Nano-hydroxyapatite (NHA) toothpastes. NHA pastes were first
developed for astronauts on space flights from a product that has
such an affinity for fluoride that it was previously used in
agriculture as a cheap and easy way to extract excess fluoride out
of soil and water. Ironically, the marketing was to appeal to people
looking for an alternative to fluoride toothpaste. The problem is
that it did not truly repair damaged enamel but formed a layer on
the outside of teeth.
Charcoal. This substance has been claimed to whiten teeth by social
media influencers. Its abrasive nature was not well-understood
until people began to experience sensitivity and thinning enamel.

Dentists have never shown much interest in exploring the impact,

benefits, or harm from the daily use of home oral care strategies. Most
don’t believe that cavities can reverse naturally to avoid a filling, and
they insist that flossing is the key to oral health. When it comes to the use
of fluoride to prevent cavities, dentistry is split between those who
recommend all kinds of fluoride gels and pastes—and others who fear
fluoride so much that they will never recommend a fluoride toothpaste
or rinse ever . . . even if a patient’s teeth are falling apart. You may hope
that your dentist is able to recommend a personalized and ideal home
care regimen for you—but usually their advice is a mixture of dental
school information and industry advertising. This is why we need to
explore these topics of disagreement so that you can find an ideal
method of home care for your teeth—and feel empowered to enjoy the
benefits of improved oral health.
TO FLOSS OR NOT TO FLOSS—
THERE IS NO QUESTION
I have always maintained that the more you floss, the more you will need
to floss. On the other hand, I am well aware of the floss training that
hygienists receive—and the instructions that most laypersons have been
given by dentists for decades. Ditching a mandatory floss regimen can be
an emotional challenge, but I assure you that the best oral health I have
ever seen as a dentist was at a time—and in a country—where I didn’t
even see or recognize any applied knowledge of floss or flossing in
treatment. Instead, I saw scores of people imbued with great mouth
health simply because they practiced good oral care and had sensible
eating and drinking habits. This is why I have often looked for science to
incontrovertibly support the act of flossing—and found instead only
vague folklore and untenable dogma.

Flossing Optional
An effective oral care routine must do three things. It must:

Protect you from plaque;

Work to reverse cavities; and
Stimulate gum health to combat gum disease.

I recommend an approach (described more comprehensively in Part

Two) that involves xylitol, resilient toothbrushes, and specific oral care
products, but—believe it or not—flossing is optional. This is because the
critical flaw at the heart of flossing is that it fails to deal with the plaque-
forming bacteria that float in saliva. Unless we address plaque on teeth
and in saliva, these bacteria will drop from saliva and land on the
surfaces of freshly cleaned teeth to repopulate and reinfect them. Plaque
bacteria in saliva will flow into and around every surface of your mouth,
entering tiny crevices in tooth enamel, going under crowns, around
fillings, and deep into gum pockets—areas that are impossible to clean
sufficiently with any kind of flossing string. Only through the help of
products in liquid form, or xylitol—which dissolves in saliva to become a
liquid—can we hope to clean around and inside these hidden areas. The
idea of not flossing may seem shocking at first, but below is an account of
the published story of Helen Rumbelow, a Times of London reporter who
stopped flossing in 2012.

A Times of London Report

Helen was writing an article for The Times of London, and she contacted
me during her search for an oral health expert who could describe the
best way to floss. I explained that I have never flossed, and never
recommended flossing to any patient, which was not the answer she had
expected. I explained that as a dentist in Switzerland, I had seen so many
healthy mouths—of patients who never flossed.
Helen had flossed for years, and despite her best efforts, had never
managed to please her dental hygienist. Before she started using my
strategies, she booked an appointment and asked her dentist for a
numeric score to describe the status of her dental health. Her score was a
six out of ten. Then Helen asked her hygienist what would happen if she
gave up flossing and—as you would guess—the description was one of
disaster. She listened to the gloomy description of plaque, crusty so-
called calculus deposits under the gums, areas of bleeding, and spaces
called pockets that would open around her teeth—virtually the complete
demise of her mouth.
Learning from me, Helen began using my regimen and stopped
flossing her teeth for a month. Then she returned to her dentist for a
review, without mentioning the changes she had made. To her surprise—
and without prompting—her hygienist exclaimed in amazement about
the significant improvements she noticed in Helen’s mouth. There was
no longer any bleeding and no sign of plaque or gum inflammation.
Helen walked out of her appointment with a shining ten out of ten—for
the first time ever.
Helen contacted the Chief of the British Oral Health Foundation and
the Professor Emeritus of dental public health at University College,
London. Both dentists agreed xylitol was a wonderful adjunct for oral
health and that it could prevent the accumulation of plaque. They agreed
people should be more aware of the power of xylitol and felt dentists
simply get “bogged down” with the mechanics of dentistry. These
experts also corroborated that flossing was not supported by science and
was more of an ongoing legend than a science-based tool. Helen’s article
ignited a firestorm on both sides of the Atlantic, and the BBC World
Service did an interview where I discussed xylitol with two eminent
British dentists—who also agreed xylitol is more effective than floss.
Another article came in the summer of 2016 from Jeff Donn (a writer
for the Associated Press wire service), where Donn asked for government
records to show evidence about the need to floss for oral health. The US
government acknowledged floss was never proven to be effective—
something required for it to be a national guideline—and so it was
removed. Donn also asked a dental school professor why there is no
scientific evidence for the benefits of flossing, and the professor quipped
that study results are always bad because people just “don’t know how
to floss properly.” Really? So why do dentists cling to this old idea that
flossing is the mainstay of oral health—when obviously it is not?
Perhaps floss sales provide financial support to the American Dental
Association (ADA), but the real root of the matter is that dentists are
simply wedded to their ingrained dogma on the topic. For this reason, it
seems highly unlikely that your dentist will support any idea to give up
flossing—but if you are fed up with the process or feel like a flossing
failure, then maybe you can use the interval between dental visits for
your own experiment. Most people see improvements within days and
feel positive differences as they start using my strategies. You can ask
your dentist why he or she has not recommended xylitol. The answer
may be either that they have not yet seen “enough” studies; they perhaps
have believed several inaccurate media headlines on the topic; or they
have been trained by a dental school professor who thinks that you—the
patient—should learn to floss better.
Downside of Flossing
If you are a happy flosser, be aware of concerns about polyfluoroalkyl
substances (PFAS) lurking in most commercially sold string. These PFASs
are synthetics put into consumer products since the 1950s, to help floss
glide more easily between teeth. PFAS chemicals have been linked to
liver damage, immune system issues, even cancer—plus the chemicals
can remain in your body for years. We could argue the ideal time to floss
is with toothpaste on your teeth—even adding additional paste to the
string. Then the floss will move toothpaste between your teeth for added
benefit, assuming you are using a good toothpaste. Every now and again,
we all find something stuck between our teeth, and the first thing to do is
to rinse with water. If this does not release and solve the problem, try a
toothbrush if possible—or xylitol. My advice is to use floss only as a last
resort—because, again, it appears that the more you floss, the more you
will need to floss. Another concern with floss comes from the possibility
that people with gum disease may unwittingly push bacteria into their
blood while flossing.
This idea needs further investigation, especially since a study
(published in June 2024 in the Journal of Dental Research) indicated that
people with advanced gum disease, even young adults—who had none
of the signs or factors normally associated with heart disease—had more
risk for strokes and plaque buildup in their carotid arteries, three months
after a deep dental cleaning.

Water Flosser or Mouthwash?

Most dentists are frustrated when patients do not floss well enough, and
hygienists know that chiding us to floss is annoying. The solution for
ineffective flossing arrived in dental offices as an expensive device that
squirts liquid between teeth. Brilliant marketing of this equipment has
convinced dentists that a water flosser can do a better job than string. It is
interesting that dentists will regularly promote water flossing but usually
ignore or even dispute the easier, safer, less expensive, and arguably
more effective liquid cleaning achieved by using mouthwash.
We know plaque bacteria float in saliva, so it is easy to see that mouth
cleaning will be more complete when a liquid is swished between teeth,
rather than trying to remove it with a length of string—especially if your
teeth are crowded or your mouth has obstacles like retainers,
bridgework, crowns, or braces. The kind of liquid used as a mouthwash
or in a water flosser will impact its success, so we need to understand the
effect of the kind of liquid used in either case. It is fine to add salt or
xylitol to a water flosser, for example, but never use bleach. Also be
aware that the jet should never be angled into pockets, as you may risk
pushing periodontal bacteria into your blood and it can prevent gum
pockets from healing. If you have periodontal pockets, stop using the
device until your pockets heal (using the strategies described in Part Two
—no water or string flossing required). I will discuss the
misunderstanding about mouthwash’s effect on oral bacteria in Part
Two, along with other details about the products that comprise my
Complete Mouth Care SystemTM.

So, Are Fillings Full of It?

A small filling sounds like an easy fix, but before you agree to treatment,
consider there are ways to prompt cavities to heal naturally. Most
dentists agree that a small cavity in enamel can be reversed with correct
care, and doing this offers the opportunity to preserve a valuable pristine
tooth. Even a cavity into dentin may reverse, so ideally, ask your dentist
if you can delay any cavity treatment for three (3) to six (6) months. This
should give you time to improve the way you are looking after your
teeth in this time interval. Even if the original cavity does not completely
heal, and your tooth still requires a filling, any drilling will be safer for
the tooth and less likely to damage the nerve inside the tooth, after three
or more months on my strategies. A dentist who values teeth should be
thrilled if a cavity has reversed itself, and you should be happy to have
maintained a pristine, uncut tooth.
 Some dentists, however, have a more flippant attitude to fillings, and
are often fixated on the notion that all cavities need immediate repair
with a filling—and they don’t feel any concern about negative
consequences. Most cavity diagnoses are subjective to some degree—and
always remember that once a tooth has been drilled, filled, or sealed,
these treatments cannot be reversed, and natural healing will no longer
be possible. Dental marketing can be aggressive, sensitive diagnostic
detection equipment can create false positive results, and research shows
many cavities are filled that could have healed with correct care. In some
offices, the dental staff are choreographed to work as a team and to
consider how much insurance money is available for your dental care.
More treatment is not better for your mouth, so be a wary shopper.
White fillings are made of plastic, and they attract sticky cavity-
forming bacteria to their edges, which is why they are often called plaque
magnets. This is a problem in a mouth where saliva is acidic or when a
patient is not using effective home care strategies. In such cases, white
fillings will appear to need repair and refilling every ten (10) to fifteen
(15) years. This means that if you decide to change an old silver-amalgam
filling for a new white one, you will likely need frequent replacements,
and each one can endanger the life of your tooth.
When a tooth’s nerve dies, it will need a root canal and crown, or an
extraction and implant. Many patients do not consider all these facts
before agreeing to the replacement of their old silver fillings, and end up
enduring repeated fillings, dead teeth, root canals, and crowns. This is
why many people I know wish they could reconsider their decision to
replace amalgam fillings, in light of how their respective stories ended.

Stop vs. Prevent

A filling is dental material that blocks holes in teeth, like a patch in the
pavement—and this can make the surface smooth again, help your tooth
to look good, and improve its function for eating and chewing. A filling
stops damage from progressing through your tooth, but unless the
bacteria that cause these cavities are addressed, more cavities will form
in your mouth in other teeth or around the edges of this original filling.
On the other hand, if you decide to take immediate action and
eradicate the cavity-forming bacteria with the strategies described up
ahead in Part Two, you will improve the condition of your mouth to
prevent future cavities—and potentially reverse the original cavity at the
same time.
There is a difference between treatments that stop—and strategies that
prevent—cavities and gum disease. Most people understand that fillings
stop cavities, and that dental cleanings can slow gum disease, but
neither treatment can prevent a future cavity or gum problems. To
highlight this important distinction, let’s consider a scenario where your
dentist finds an early cavity in your tooth. He or she may suggest that it
be filled immediately, but sometimes you may be given the chance to do
something that can seem a little unusual at first glance. Some dentists,
especially if you have a perfect and as-yet unfilled tooth, may suggest
they wait and see if this cavity deteriorates between then and your next
visit.
Why would you ever wait for a cavity to grow? Instead, you can use the
specific oral care products and strategies that will be explained in detail in
Part Two to dazzle your dentist by healing this tooth and preventing its
progression—before your next appointment. It makes no sense to
continue using the strategies that allowed this cavity to happen in the first
place. Anyone with a cavity must change something in the way they care
for their teeth and alter the direction of the disease. This new strategy
would be called preventive, as it addresses the future as well as helping
to heal the initial cavity.
Similarly, if you follow dentistry’s traditional advice to brush and floss
and have regular cleanings, then you can wait and see if you end up with
gum disease—the dental woes experienced by ninety-six percent (96%)
of older Americans. Or you can decide to take control of your oral health
and avoid the situation that I will describe in the following story.
An employee of the American Dental Association (ADA) contacted me
to explain that for forty years, he had habitually brushed, flossed, and
routinely gone for professional cleanings every six months. Despite his
meticulous approach to oral care, he had developed periodontal gum
disease—and now blamed his family genes. The fact is that cavities and
periodontal gum disease are bacterial diseases—transferred in droplets
of saliva as we talk, kiss, and hug within our circles of family and friends.
For this gentleman, disease bacteria likely transferred from family
members, and the disease may have been accelerated by inherited
habits, or an inherited anatomy such as a jaw or lip shape, that could
make it hard for him to close his mouth, making him a mouth breather,
drying his saliva, and putting him at more risk for gum disease. You can
also have a genetic disposition that puts you at more risk for gum
disease, but the problem is always initially caused by plaque bacteria. An
effective strategy will combat these bacteria and control them, since we
know periodontal disease is preventable.
This individual had experienced sufficient protection from his careful
brushing and flossing to suffice for most of his life, but as he aged, this
traditional form of oral care was insufficient to protect him or prevent the
bacteria that ignited the condition of gum disease in his midlife years. So,
knowing this, why would you wait for periodontal gum disease to happen
to you?

Silver amalgams are more durable than white ones, but there is
concern about the mercury they contain. There is some disagreement
about the absolute toxicity of silver mercury fillings, but most dentists
agree that they pose the highest risk as the amalgam is being used to fill a
cavity and when it is being drilled out in the process of removal. Some
studies have shown it can take seventeen (17) years for our body to
naturally detoxify mercury amalgam particles that may have been
swallowed or left in your mouth during the placement of a silver filling.
If you have fillings from decades ago, your body may have already
detoxified itself and you need to ask if the dangers from replacement are
a desirable option. Studies with autopsy indicate that a healthy person
can naturally detoxify a total of ten (10) to twelve (12) silver fillings over
a lifetime. Everyone with silver fillings should know the damages of
artificial whitening products and peroxides, which cause mercury to be
released as a gas from any silver fillings you may have in your mouth.
Sealants are a plastic coating made with a material that resembles the
white plastic used in fillings, but with a thinner consistency, so it flows
into cracks and gaps in teeth. Sealants are frequently suggested to
parents as a treatment to block the crevices in young children’s teeth, a
treatment that dentistry considers useful to try and prevent cavities for a
few years. In molar teeth, sealants play a defensive role and block up the
grooves where cavities could form in a decay-prone mouth. But cavity-
forming bacteria are only blocked from entering the grooves of teeth with
this superficial plastic glue. Usually, five (5) to ten (10) years later, the
cavity-forming bacteria that have remained active in the saliva of a
cavity-prone child will cause new damage around the edges of these
sealants, resulting in a bigger area of decay and the need for even larger
fillings.
Recurrent decay is the name given to this continuing cavity infection in a
mouth. Xylitol has the power to stop recurrent decay for children and
adults within a year, by eliminating cavity-forming bacteria in saliva and
promoting healthy bacteria. When a mouth is free of cavity-forming
bacteria, cavities cannot occur—with or without a sealant. In the 1980s,
xylitol studies showed how the regular use of xylitol could protect
children from cavities as effectively as sealants—over a ten-year period
in children ages six (6) to sixteen (16). Longer-term studies, however—if
they had been done, or if there was any interest in a retrospective study
—would certainly show xylitol outperforming sealants, because in a
decay-prone mouth sealants fail during the teenage years, but xylitol
promotes healthy bacteria and eliminates plaque proactively for several
years, even if the regular use of xylitol ends.
If a child has a healthy mouth and no sign of decay, then a sealant may
be an even worse idea because they stop good bacteria from gaining
access to molar crevices, which is a natural habitat and secure foothold
for them. Sealants were developed before we had any understanding of
good mouth bacteria, and today we know that forty percent (40%) of
bacteria in an adult mouth becomes established in childhood—and that
the crevices in a child’s molar teeth operate as vehicles to carry good
bacteria into an adult mouth.
Remarkably, it appears that the impact of sealants on a child’s
digestive health has never been studied, especially with respect to the
possible development of gluten intolerances. The mission of the
American Academy of Pediatric Dentistry (AAPD) is to seal every child’s
tooth in America, despite the risks from exposure to microplastic
molecules and chemicals in the plastic, along with changes that sealants
potentially cause to a child’s developing mouth and digestive bacteria.

Beyond Fillings—A Dental Implant

You could be forgiven for thinking implants are like a birthday gift—an
easy way to have a new tooth, or set of teeth, to replace the ones that
caused you trouble, after the point in time when a filling is no longer
possible. It is shocking to discover that, in America, twenty-five percent
(25%) of seniors by age seventy-four have lost all their natural teeth and
require tooth replacements.
When you explore implants, they are often described in flowery
language that makes patients imagine something very different from a
screw drilled into the jawbone with a fake tooth glued on top. You may
think implants are a solution to your dental problems, and that after a
little sedation, you will simply wake up to a gorgeous new set of teeth.
Certainly, they can dramatically change your mouth but realize that any
infection that damaged your natural teeth will be even more likely to
ruin your implant, unless you make changes to ensure that your mouth is
as healthy as possible before the change.
Sometimes an implant will replace a missing tooth—one that never
grew or was lost in an accident. Implants may also be suggested
following tooth loss from gum disease or when fillings wrecked your
tooth’s structure. Consider that gum disease can happen to implants—
and if you have plaque, it can cause worse damage to an implant. In a
healthy mouth, a natural tooth attaches to the jawbone and derives
strength and support from a special periodontal fiber attachment.
The problem is that implants do not integrate in the same way with
your jawbone. The periodontal barrier fibers create a defensive barrier
around a natural tooth but not around an implant. Select a dentist with
experience if you are having an implant, as minimal mistakes can lead to
failure and fracture of this new tooth, or the loss of the supporting screw.
Implants cause more trouble for people who smoke or vape, and for the
elderly, and those who take medications—particularly the kind of
pharmaceuticals used to help treat anxiety, depression, rheumatoid
arthritis, and/or acid reflux.
Most implants will last for ten (10) or more years, but their
maintenance is challenging, particularly if you are someone who relies
on regular cleanings. Particles of titanium can easily be scratched off the
implant and your hygienist should use a special (albeit expensive)
cleaning tool with a softer blade designed for implants. Titanium
particles are sometimes associated with chronic inflammation in the jaw
and symptoms of autoimmune disease in susceptible individuals.
Internet fears have persuaded many people to avoid a root canal in favor
of an extraction and implant. My advice is to consider every way to
preserve a natural tooth, even if this involves a root canal and crown,
before deciding on an implant. Extraction will cause a loss of connection
between the tooth’s supporting periodontal fibers and the brain—
something that may reduce release in the brain of an enzyme called
orexin, a neuropeptide that affects both vision and cognitive health and
has an impact on the body’s sleep-wake cycle.

Minimally Invasive Dentistry

Good dentists should always be concerned about the potential damage
that can be caused to a tooth’s nerves whenever a cavity is drilled or
filled. Nerves can die during the removal and replacement of a filling, or
if a crown is made to cover a tooth, but often it takes time for these
problems to become obvious. Sometimes it can take ten or more years
before you are aware that the nerve has died in your tooth, alerted by a
sudden throbbing pain that signals dead tooth problems. This risk is not
generally understood by patients, but in the 1970s, a number of forward-
thinking dentists started to consider how fillings and other treatments
could be performed to avoid these drilling risks, and they looked for
ways to fill teeth with care and avoid damage to either the tooth nerve or
its essential structure—a practice known as minimally invasive dentistry.
The group eventually split into two:

1. Some dentists formed the Academy of Biomimetic Dentistry

(AOBMD), a group of dentists who share skills and experiences
with each other, working to create the most ideal fillings—ones that
stop cavities with the least amount of drilling and tooth trauma.
AOBMD dentists work to preserve the life of teeth with minimally
invasive techniques. These dentists attend endless classes after
graduation and learn exacting filling techniques that mimic nature,
working with fiberglass and ceramic—extremely strong materials
with less potential to harm the inside of the tooth. They use
computers to design fillings with the least amount of drilling and
tooth damage. Originally, this process was called Chairside
Economical Restoration of Aesthetic Ceramics (CERAC)—but
today the techniques are even more effective, and they continue to
raise the public’s expectations of good restorative dental care.
2. Another group focused instead on teaching patients how best to
prevent cavities in the first place, by changing their risk for decay.
They assessed the patients’ daily habits, diet, and home care with a
program called Caries Management By Risk Assessment
(CAMBRA). In recent years it appears some of these ideals have
changed—as leaders have developed more associations with oral
care companies. I am shocked to see CAMBRA proponents
recommend bleach and concentrated levels of stannous fluoride—
strategies that I do not endorse because of the potential harm they
can do to teeth and mouth bacteria.

The world needs a dental organization that embodies minimally

invasive dentistry and ideal motives. This organization should teach
effective do-it-yourself (DIY) home care for individuals and promote
non-drill techniques to heal tooth decay that can be used by dental and
medical professionals for children and adults. The mission of this
organization should be to eradicate the pain, fear, and ongoing disease
that is still prevalent globally. The focus should be on the development of
an approach that is useful for rural and underserved areas around the
world. I am proud to have helped support one such fledgling
organization at its inception, but I believe we need more robust change
across America and a wider acceptance of the practical answers outlined
in this book that provide smart and painless dental help for children and
adults.

FLUORIDATION—CONTROVERSIAL, AND CONFUSING

Is fluoride toxic to our brain––and if so, why do dentists want everyone
to drink it, have teeth coated with it, and brush with toothpaste
containing it? The actual word fluoride has created so much fear and
confusion that some people choose to let their teeth decay, crack, and
even die—rather than rinse and spit with a fluoride mouthwash. This
repulsion is so generalized in the world of alternative health that oral
care corporations like the Colgate-Palmolive Company—reviled because
they make fluoride toothpastes—have purchased trusted “non-fluoride”
brands (like Tom’s of Maine) so they can blithely continue to sell
products and reach a base of customers who would never knowingly
purchase a Colgate-affiliated product.
This fluoride debate was unwittingly seeded in 1901 by a newly
graduated dentist named Frederick McKay. He had noticed some of the
patients in his Colorado Springs, Colorado-based practice had teeth that
were malformed and discolored. With help from famous dental expert
Dr. G. V. Black (who we already discussed in Chapter One), the two men
studied these teeth under a microscope and saw that the discoloration
was caused by gaps in the enamel where it had not formed properly.
They shared this discovery at dental meetings around the world and
many others had seen similarly malformed teeth. In every case, the teeth
in question were amazingly strong and without cavities.
Fluorosis—What It Is, and How It Happens
Today we understand more about these tooth malformations, which
occur if children under the age of six (6) drink fluoridated water at the
time their adult teeth are forming. Cells in the child’s jaw—called
ameloblasts—make tooth enamel, but they are extremely sensitive to
fluoride. If these cells die, the adult tooth forms but gaps can occur in the
enamel where the ameloblasts died. The defects usually show themselves
as white lines or spots on tooth surfaces, but in severe cases they occur as
brown patches. This problem is called fluorosis, and it can only happen to
children under the age of six, while their adult teeth are forming.
Dr. McKay studied the problem for twenty years and was finally
convinced these malformations were the result of something occurring
naturally in his local water supply. This is why Dr. McKay arranged for
the water of Colorado Springs to be re-routed—and within ten years,
children in his area were no longer developing malformed teeth. This
could have been the end of the story, except that there were four
hundred (400) other cities in America that had reported similar issues to
the United States Public Health Service. H. Trendly Dean was the
government official tasked with investigating the severity of these tooth
defects, and in 1931 he began to grade them as mild, moderate, and
severe. By 1934, he had made an association between the severity of the
damage and the amount of fluoride these children were drinking in their
naturally fluoridated water supply. Dean showed that the more fluoride
they drank, the more severe the pitting and enamel discoloration in the
tooth surfaces—a condition that he called enamel fluorosis.
The immediate goal was to find a way to remove fluoride from
drinking water supplies where it was naturally too abundant.
Developments over the next fifteen (15) years, however, redirected this
plan, and a new idea developed—to put fluoride into drinking water
supplies of cities where fluoride was absent. Dean’s mindset started to
change as he began to compare the number of cavities in children’s teeth
with the amount of fluorosis in them, as he looked at children’s teeth in
the twenty-one (21) American states where problems had been reported.
Fluoridation of Water
Fluoride is one of the most common elements in nature, and it is found in
varying concentrations and in many soils and ground water in the
United States and other countries around the world. Again, H. Trendly
Dean had discovered that when there was a concentration of one (1) to
two (2) parts per million of fluoride naturally occurring in the drinking
water supplies, fluorosis of teeth was generally mild, and the number of
cavities was low. Dean proposed adjusting water to what he called “an
ideal concentration” of fluoride so that drinking this water would help
teeth to resist cavities.
Cavities at this time were viewed as an epidemic problem in the United
States, and particularly for military recruits who were being enlisted
amid the rising tensions that preempted World War Two. By 1940, a
rapid twist had occurred in the fluoride investigation; from the
consideration of water supplies with too much fluoride, public
discussion and goals of the issue moved over to the seemingly
contradictory notion that water could instead be called deficient in
fluoride. It is interesting that this was also the moment when an unusual
fluorosis problem surfaced in the state of Arkansas.

The Twist in the Story

Fluorosis had been observed within communities in the city of Bauxite,
Arkansas, located close to the Aluminum Company Of America
(ALCOA), where testing showed that the levels were fifteen (15) times
higher than Dean had pronounced safe for teeth. For years, the fluoride
that was produced as a waste product by aluminum manufacture had
been sold by ALCOA as a registered pesticide across the USA—until the
advent of stronger chemical pesticides. ALCOA became involved in the
government investigations because of the high fluoride levels around its
manufacturing plant, but soon thereafter Dean became interested in the
idea that fluoride should be adjusted and even added to cure a
“deficiency” in all of America’s water supplies, and ALCOA soon began
to sell their industry excess fluoride to water authorities.
Records show ALCOA’s engineers and attorneys, and one of their
stockholders and founders—the famed American industrialist Andrew
Mellon—began to develop connections and sponsor research at the
Carnegie-Mellon Institute (the institution which in 1967 merged with the
Carnegie Institute of Technology to become today’s Carnegie-Mellon
University in Pittsburgh). The Carnegie-Mellon Institute was ideally
positioned for these fluoride studies as a part of its mission to support
comprehensive scientific studies that would serve industry and benefit
mankind through the development of industry.
By 1945, fluoride supplementation of water began in the populous city
of Grand Rapids, Michigan; and by 1951, water fluoridation had become
an official public health policy in the United States. In 1952, concerned
scientists argued at the Delaney Committee Congressional Hearings that
fluoride levels in drinking water in the United States were too high,
especially for children and people with diabetes or kidney disease. This
was also when the fire of distrust concerning fluoridation was sparked,
and it has blazed in the dental profession ever since. The end of the story
was that Dean became the first director of the National Institute of Dental
Research. Finger pointing continues, even at a political level, questioning
all the legal and institutional fluoride decisions—back to the government
investigation in the 1930s. The American Dental Association has
consistently backed water fluoridation, and dentists are generally trained
to believe in the wonders of fluoride.

A Lack of Trust
Personally, I join the dentists who vehemently oppose water fluoridation
and question why our water supplies are still fluoridated in the twenty-
first century. Indeed, a report issued by the US government in the
summer of 2024 indicates that fluoride at twice the recommended limit in
drinking water has now been linked to lower IQ levels in children
worldwide. There are non-fluoridated cities and countries where they
enjoy the same levels of oral health as those that are fluoridated. There
has never been any regard to fluoride’s interaction with materials in local
plumbing, or pharmaceuticals and chemicals found in modern water
supplies. At a City Hall meeting in Austin to vote on local water
fluoridation, it stunned me to watch as valid concerns were rebutted by
bogus, non-scientific arguments from ADA spokespeople. Do the
supporters of water fluoridation have any demonstrable knowledge of
fluoride’s dubious history or the effectiveness of topical products? I think
newly graduated dentists may not, but perhaps this may be the
generation to challenge the ADA and question why they are still so
heavily invested in fluoride.
Fluoride offers no benefit to baby teeth, and young children are the
ones at risk for fluorosis if they drink fluoridated water before the age of
six. In the 1970s, in areas without fluoride, parents were encouraged to
supplement with fluoride drops. I gave my oldest children this fluoride
“supplementation” in the suggested dose, but when their adult teeth
grew into their respective mouths by around the time that they each were
seven years old, they had brown marks and rough surfaces on them as is
commonly seen in cases of moderate fluorosis. As a dentist, I myself was
ignorant of this potential for fluorosis damage as recently as 1980. This is
why we should allow people to choose a method of adding fluoride if
they desire. In Switzerland, fluoride is offered in salt, and consumers can
select fluoridated or non-fluoridated salt—just as in the United States
some salt is iodized. In addition, we see that milk fluoridation occurs
presently in parts of Eastern Europe, China, and South America.
Since fluoride is naturally occurring in many water supplies, it ends up
in many foods we consume—and especially in many drinks. Excessive
amounts of fluoride should always be avoided, especially by children
under the age of six who are at risk for fluorosis. Most brewed teas—iced
tea, in particular—have high concentrations of fluoride. Raisins, grapes,
and wine also have a high fluoride content. Potatoes and other foods
have fluoride in them. We used to think that fluoride was rendered
inactive by milk, but this is not correct. It is simply that when fluoride
and milk—or any calcium-rich food, for that matter—are consumed
together, less fluoride will be absorbed into the bloodstream from ninety
percent (90%) percent to about sixty percent (60%).

Topical Use Only

If the fluoride antics of industry and government make you angry, you
may be surprised that I now want to discuss the benefits of fluoride.
Many who fiercely oppose fluoride will never use a topical drop—either
in a rinse or a toothpaste. The key to effective dental home care is to
recognize the important difference between treatments to stop a cavity
and strategies that prevent one from forming. To illustrate this in the
context of fluoride, we can consider how acidity softens a tooth by
pulling minerals from its surface. Then cavity-forming bacteria enter the
porosities in the tooth and begin to undermine its structure. At some
point, the tooth caves in and creates a cavity. We have discussed how a
filling can stop a cavity from progressing by repairing the hole in the
tooth—but to prevent a cavity, three things must occur:

1. Mouth acidity must be controlled;

2. Cavity-forming bacteria must be eradicated; and
3. Lost minerals from a tooth’s surface must be replenished.

The only part of this preventive sequence where fluoride can

contribute is to help speed up the deposition of lost minerals on the
tooth’s surface. If minerals deposit often and fast enough, this may
completely combat demineralization. On the other hand, fluoride does
not change the mouth’s acidity, and the compound of fluoride that I
recommend—sodium fluoride—has no effect on bacteria. This is why the
use of fluoride for prevention should always be paired with xylitol
strategies to control mouth acidity and support a healthy mix of mouth
bacteria.

Remineralizing with Fluoride

The benefits from brushing and rinsing—with a low concentration of
sodium fluoride toothpaste or a 0.05% level of sodium fluoride mouth
rinse—can help reverse tooth damage for adults and children over the
age of six (who can rinse and spit effectively, that is). Regular use of this
specific type of fluoride, at this specific dilute concentration, can improve
weak, sensitive, or damaged teeth. Personal friends of mine are doctors
who specialize in thyroid, Alzheimer’s, and enzyme conditions, and who
have tested to ensure that this kind of topical fluoride use is not absorbed
through the mouth. They concluded, after twenty years of observation,
that the risks were negligible or none, and the benefits from topical
fluoride drastically improved their patients’ oral health—and even their
systemic health.
Why refuse the benefits of remineralization in exchange for the
possible toxicity of white or silver fillings, the pain and suffering or root
canals, lost teeth, and health consequences from damaged teeth and need
for implants? This is like a drowning person who refuses a life preserver
because they dislike the texture of the fabric from which it has been
made. This is why I have not included the word “future”—as a final or
fourth “F” of dentistry. Change is coming that may allow development of
personalized equipment, so patients can measure and monitor their own
mouth health.

CONCLUSION
In this chapter, we looked at three areas of dental care where controversy
abounds. We investigated the nooks and crannies of flossing, a care
practice which I think is largely unnecessary if you approach oral health
with more complete and effective methods. We explored the topic of
fillings, and their need, which I believe can be dramatically reduced by
effective self-directed oral care applied at home. And we considered the
topic of fluoridation, and why some fluoride can be useful—but how there
are extreme differences between the various kinds of fluoride; how
concentration levels matter; and how consuming it presents us with
dangers, though we can safely enjoy its benefits with the topical
application of a toothpaste or through use of a dilute sodium fluoride
rinse.
The overall secret should now be obvious—we all need to take charge
of our own oral health. We need to divorce ourselves from dependence
on a system that appears so influenced by other unspoken goals—and
unseen agendas. Simple strategies can help you to care for your teeth,
including the use of xylitol that has provided decades of positive
experiences in other countries—and which remains at the core of my
system.
My general advice, therefore, is to find a dentist you trust—possibly
even through “virtual” tele-dentistry sessions that can be achieved at
home—and ensure, through that dialogue, that you have regular
evaluations to ensure you are moving in the direction of gum, tooth, and
mouth health. Saliva testing, periodic X-rays, and cancer screening are
always helpful, but try to sidestep or ask if you can delay traditional
preventive treatments. You will have to consider your feelings toward
flossing, sealants, small fillings, frequent cleanings, and strong fluoride
treatments—which, if you take my advice and embrace my system, you
will no longer need.
 5. Dental Science + Common Sense =
Something to Chew On

The problem with common sense is that it’s not so common.

—FRANÇOIS-MARIE AROUET (PEN NAME: VOLTAIRE)

A ccording to a recent World Health Organization (WHO) report,

untreated cavities and gum disease affect over 3.5 billion adults
and 514 million children across the globe. Most readers, especially in the
United States, assume that their fellow Americans generally have good
teeth. However, clinical observation and insurance industry statistics
show that the volume of treatment and disease rates in this country are
extraordinarily high—with a staggering ninety-six percent (96%) of
seniors forced to endure a spiral of dental expenses for fillings that need
repair; teeth that die and need extraction; cleanings that become more
invasive and complicated at each dental visit; and gum health that
deteriorates to the point when it may require the surgical removal of skin
from the roof of the mouth to graft or sew into areas where it has
disappeared.
All these horrors are simply the consequence of an ongoing but
preventable disease in our mouth that has been allowed to fester and
attack our teeth and gums. The treatments that your dentist can provide
will stop any pain and may delay the loss of your natural teeth, but it
would all cease to be necessary if the bacterial disease and imbalances in
your mouth were adequately controlled by your daily home care and
routines.

CAN A DENTIST STOP CAVITIES . . . AND OTHER

DENTAL PROBLEMS?
Many patients assume their dentist knows how to stop cavities. If,
however, you have had the unpleasant and costly experience of ongoing
dental treatments—fillings, repairs, crowns, and years of cleanings,
possibly with the unfortunate ending of extracted teeth and implants—
you may question how this happened. Perhaps you have been
indoctrinated to believe it was your fault, due either to a failure to follow
some fancy flossing instructions or because you missed a dental cleaning
appointment.
You will begin to unravel the truth, however, if you ask yourself the
following question instead: Can a dentist stop cavities and other dental
problems—or is it up to an individual?
The answer will surface if you dive into the science of cavities and gum
disease and notice how these infections are improved or worsened by the
variable daily conditions in our mouths. A dentist can fix dental damage
after it has happened, but she or he cannot control the daily conditions in
your mouth—and it is these that increase or decrease our risk for cavities
and gum disease. Consider a similar situation—can your doctor prevent
you from catching a cold? Obviously not, but your doctor can advise you
how to manage your body’s defense systems so you can have a better
chance at avoiding any sickness. In the same way, the only person with
the power to stop cavities and gum disease is you—and just like
preventing a cold, the best strategies are defensive ones.
The second question we should ask is: Why is there so much dental
disease? Some professionals say it’s because patients don’t floss enough,
while others blame too much sugar in our diet. Plaque and sugar are
certainly a part of this problem, but cavities and gum disease are
infections sparked by specific bacteria that can fester on dirty
toothbrushes and become worse if habits and bad care choices dry out
our mouths or allow teeth to become porous. Dentists are trained to fix
dental problems after they occur, but if you want to stop dental problems
and enjoy a cavity-free future, then it is you who must become
empowered and be ready to take charge of your own mouth health by
modifying your daily habits and care, to protect your teeth from harm.
Sometimes it is difficult to grasp the reality that dental treatments cannot
prevent cavities or gum disease, even if you have your teeth
professionally cleaned several times a year. The answer lies in how you
care for your teeth every day—before, after, and between dental
appointments.
This brings us to the final question: Why is there so much disagreement
about the most effective home care strategies for oral health? With social media
pressures and industry marketing, there are more questions than
answers when it comes to selecting the best or most helpful products for
daily care. Because of this, we have some dentists who proclaim that it is
impossible to expect complete protection from cavities and gum disease,
and so they have no faith that teeth and gums can heal naturally. This
pessimism often develops during dental school education, and it can be
perpetuated by dental office culture.
Remember, of course, to never blame yourself or your age for dental
problems. Instead, let’s look at the status of oral health in some other
countries where oral health outcomes are superior to America, and
consider some of their approaches—at a national level, within families,
and as individuals.

From Nation to Nation

In countries that enjoy the healthiest teeth, dental education has been
able to teach the concept of how children’s dental problems begin as
cavity-forming bacteria transfer from the mouths of parents to their
children and then from child to child. Cavity-forming bacteria can travel
in droplets of saliva as people talk, hug, or kiss their babies and family
members, or share eating utensils and living spaces together. Xylitol can
eliminate this bacterial transmission by cleaning the saliva.
This is why parents are encouraged to enjoy a regular xylitol regimen
during pregnancy and after the baby is born. In some countries, xylitol
gum is distributed in preschool for the same reason—to reduce the
transfer of cavity-forming bacteria from child to child at this important
stage of tooth development. Studies show that children who grow up in
this preventive culture will have eighty-five percent (85%) to ninety-two
percent (92%) less incidence of cavities.
 At an international level, oral health is computed by counting how
many decayed, missing, or filled teeth are found in examined mouths.
Using this measurement, America is in tenth place globally, with
Denmark as number one, and then Germany, Finland, and Sweden as the
top four countries on this list. As mentioned, xylitol is endorsed by the
dental associations of all these top countries, and the Danish population
have almost perfect teeth—with less than a quarter of a tooth showing
any decay, either in baby or adult teeth. Remember also the important
fact that the health of baby teeth will go on to impact the health of
developing adult teeth.

Family
Today, we understand how bacteria transfer from person to person—
from a parent’s mouth to a child, and even jumping from the surfaces of
a five-year-old’s baby teeth to that of their new adult teeth as they enter
and grow in the child’s mouth. Family oral health is important, and
parents—through sheer proximity—will automatically pass healthy or
harmful bacteria to the mouths and teeth of their children.
Many people are surprised that adult teeth enter toward the back of a
child’s mouth as early as his or her fifth birthday. Many of these new
adult teeth develop cavities—often within twelve months, and even
before a child’s sixth birthday—simply because the parents were
unaware how to effectively manage cavity-forming bacteria with daily
home care. This is why it is also good to use effective strategies for family
members: before the birth of a baby, as babies’ first teeth are breaking
through their gums during childhood, and as children grow into
adolescence—and while they are developing a full complement of new
adult teeth. These changes will make a dramatic difference to the dental
health of families, but particularly for those who already have a painful
history of bad teeth.

Individuals
Cavities and chronic periodontal gum disease are common but
completely preventable dental problems. With effective daily care, you can
enjoy the benefits of oral health and lessen your need for dental
treatments and interventions. Of course, the earlier we start, the better
our chance of success. Current statistics show that two percent (2%) of
the United States adult population have no teeth, while ninety-six
percent (96%) have fillings, cavities, and chronic gum disease by their
retirement age. The size of a filling usually increases each time it is
replaced, which means that over the years fillings will cover more tooth
surfaces. Eventually, most fillings will be replaced with full-coverage
crowns—and, unfortunately, all this ongoing dental work can cause
nerve damage, killing the tooth and leading to the next potential problem
—a root canal or extraction.
The number of initially preventable and reversable fillings that are
considered normal for American adults is between ten (10) and twelve
(12) per person. This illustrates how inadequate the widely accepted
“brush and floss” advice has been over the long term—and why you
should seriously consider other methods, even if you see them as
supplemental. The key is to avoid the downhill spiral that usually begins
with a small filling or simple treatment. Why? The reason is because that
dental work will likely deteriorate a decade later and then become a
progressive need for repairs amid worsening oral health—a situation so
common that many dentists believe it is merely an unavoidable
consequence of age. By using my strategies, however, you will be able to
prove that belief wrong.
Here are three actions you can take immediately:

1. Control the amount of daily damage that your teeth experience

from tooth-destructive habits. What are these habits? It begins
with eating and drinking. Teeth are damaged every day by a
variety of our all-too-human “tooth destructive” routines and
habits. Unless we discover a way to compensate for this damage,
our teeth will gradually become weaker and at more risk for decay,
and our gums will slowly deteriorate and become vulnerable to
 disease. Similar damage can result from habits that involve
constant sipping (even water); the smoking of cigars and/or
cigarettes; vaping; chewing tobacco; continuous snacking
(especially candy, sugary cookies, crackers, carbohydrates, and
processed foods); or from going to sleep at night without
appropriately cleaning your teeth.
2. Provide your mouth with resting intervals between meals, when
you do not eat or drink anything. Why do this? You do it so that
the saliva in your mouth is given the chance to interact with your
teeth and gums. Saliva carries all the minerals necessary to rebuild
—and repair—tooth enamel and immune cells that help heal your
gums. These periods of healing are our mouth’s daily repair
experiences, and they must be long enough and frequent enough to
balance out the damage created by the negative experiences that
come from our daily tooth-destructive habits.

Foods that damage our teeth are the aforementioned sugary, acidic,
and carbohydrate-containing foods. Some cause a direct acidic attack,
while others cause acidic damage indirectly as sugars turn to acids.
Surprisingly, the severity of this damage is not influenced by the amount
of sugar you eat, and two grains will potentially cause as much mouth
damage as a pound of sugary pudding. The amount of tooth damage
caused will depend specifically on the length of time acids attack your
teeth. This means that damage will be influenced by the stickiness of
food, as this prolongs the time sugar sits in your mouth. Moreover, acidic
mouth damage extends for an hour after your last bite of food, but once
this acidity has been neutralized, then your saliva will begin to deposit
minerals and repair any damage caused by foods.
Most dentists suggest it takes an hour for our saliva to clear acidity
after eating, but with a xylitol regimen we can shorten this to a matter of
minutes and turn this hour of damage into an hour of healing. If you eat
meals four (4) times a day, you can turn the post-meal hours into four (4)
hours of healing. This, combined with nighttime healing, may be a
sufficient change to maintain mouth health. The more time you allow for
healing, of course, the more help you will have for your gums and teeth.
This also explains why snacking and sipping habits are so dangerous,
as they continue to compound the amount of time your teeth are being
damaged. Their presence in your daily life delays the end of your eating
and/or drinking times. You get caught in a vicious cycle—as you graze
on just one more piece of food or take another sip of drink, your actions
serve to restart the mouth’s “one hour after eating” period of damage.
Consider the number of eating or drinking sessions you have each day,
and the length of after-meal coffees, snacks, or extended sipping. Add
these numbers and see how much time you spend each day damaging
your mouth health. For someone who eats four (4) meals and one (1)
snack, your teeth could be under attack for at least five (5) hours a day!
The ideal is to keep meals and snacks to confined sessions and then
cease eating and drinking for an hour or longer. In addition, ending
snacks and meals with xylitol (see Part Two for more detail on this topic)
will stimulate a flow of extra-healing saliva. This can be particularly
beneficial if you allow this saliva to coat your mouth for an hour or two
in this interval between eating and drinking.
Xylitol is an ally that helps us shorten periods of tooth damage and
turn our mouth environment from damaging acidity into one of healing.
Instead of waiting an hour for acidity to normalize after meals, a xylitol
mint or piece of gum instantly stops the damage and starts the healing of
your gums and teeth. When you end every meal or snack with xylitol,
assuming you eat four meals and one snack per day, you can create five
hours of healing rather than damage—and this can create a dramatic shift
in mouth health.

3. Support the goal of creating a positive balance between the

amount of healing our mouth experiences versus the amount of
damage it experiences daily. How? Well, we have the power to
shorten any periods of daily damage by rinsing our mouth with
water or some tooth-protective drink, ending meals with tooth-
 protective foods, or using xylitol. Then if you choose to not sip or
snack, and if we consume foods that support salivary health
(nutrition for saliva health will be discussed in Part Two), we can
extend the length of these daily periods of healing and help our
teeth and gums become healthier. Good daily tooth care, with the
right choice of oral care products, should help support and speed up
this healing process—while, at the same time, it slows down mineral
loss during times of damage.

CONCLUSION
Certainly, dentists are not purposefully withholding information, and
most patients agree that dentists are some of the most conscientious and
caring physicians who want only the best for their patients. That said, be
aware that it is difficult for a dentist to recommend an ideal method of
care for you—because most dentists have no long-term experience with
one product or system. Many learn about home care in dental school,
taught by salespeople from product companies, and today many dental
offices are integrated groups working under the umbrella of a bigger
business. This is why it is vital for you to be empowered and know about
your dental problems and available solutions—including the option of
reversing a cavity or gum disease at home, by yourself, with the
strategies and products that will be discussed in Part Two of this book.
By now, I hope you are excited by this idea and that you feel ready to
take new steps toward oral health. And so, let’s move on to Part Two—
and into a world of empowerment for you and a future of happier and
healthier teeth and gums.
 PART TWO:
The Complete Mouth Care System™
 6. The Tooth and Nothing but the
Tooth—My System, Step by Step

To put everything in balance is good, to put everything in harmony is

better.
—VICTOR HUGO

T his chapter will give you step-by-step instructions for my Complete

Mouth Care SystemTM. It is a method that can help anyone with
adult teeth achieve an improvement in their oral health—often at
surprising speed. It is a protocol that requires the frequent use of: small
amounts of an oral health sugar called xylitol (which will be described in
more detail in Chapter 7); three different mouth rinses; and—while using
a special kind of toothbrush—an applied regimen of brushing your teeth
and gums consistently with a specific kind of toothpaste.
As with a musical score that has been written to create a delicate
harmony or an architecture blueprint that has been designed to ensure a
sturdily erected office building, this system of home dental care works
best if you have a firm command of the core concepts—and understand
that success depends on using an exact technique along with specific
products. I call this my “Three-S” approach, and that is what we will
explore together next.

THE “THREE-S” APPROACH TO BETTER MOUTH

HEALTH
Most of us already know that in every grocery and drug store there are
seemingly endless choices for oral care products that claim to solve
dental problems. Sensitivity gels, whitening pastes, and rinses for bad
breath or gum disease are among those products that have all been
specifically designed to “treat” your symptoms, but that do nothing for
the deeper concern—the fact that your mouth is out of balance. By way of
comparison, the products that I recommend work together in a
harmonious way to promote overall mouth health. Today we have
bacterial testing that can show how my system—developed and refined
over years of practical application with my patients—supports good
mouth bacteria, while reducing harmful ones. Through a strategic blend
of what I call my “Three-S” approach—Synergy, Sequencing, Success—I
am confident that you will be equipped with the winning formula when
it comes to daily use of these far more effective products in the
promotion of a sustainably healthy and comfortable mouth.

Synergy
The specific products needed for this method of oral care work
synergistically, so that one step leads into the next—without the need to
rinse with water between each step. The products are specific because
each contributes a variety of benefits, and each works in harmony with
the next step to help you achieve wonderful improvements in your
mouth health, over and above any achieved by using one or other of the
products alone. This also explains why adding or subtracting different
products or generic substitutions will by necessity change the synergy of
this system. Some people have used these exact products, but in the
wrong order—and that misstep in protocol will also change the outcome.
We know that any alteration in the sequence of cooking, together with
use of different products or techniques, can completely affect recipe
outcomes. The same principle applies here.

Sequencing
The length of time that you use the final rinses is somewhat flexible, but
the method—or sequencing—of rinsing is vastly important and will help
you to embrace just how easy it is to understand what each rinse does for
you. Most people who time themselves say that daily application of this
system takes less than five minutes, and it should be used twice each day
(three times maximum) and always as the last dental care step that you
take before you head off to sleep.
Success!
When the correct mouth biome balance has been achieved, you will
notice progress and see the results you have been searching for. Within a
few weeks, most people find that bad breath fades away, bleeding gums
begin to heal, and any “fuzzy” feeling in your mouth will disappear as
teeth start to feel clean, shiny, and smooth. And there it is, voilà—success!
This is a great experience for everyone involved—in fact, I have heard
several of my patients over the years describe this as achieving a feeling
of having “happy teeth”—something that they had never contemplated
as possible. What a wonderful thing it is to see dental problems heal.

ORAL CARE—A “NEW” APPROACH

Many people select a toothbrush or toothpaste by price-checking or by
reading the promotional language on packages. For our best level of oral
health, however, we need to apply a different set of criteria. We need to
obtain and make consistent use of a high-quality toothbrush, coupled
with a toothpaste that will help to heal cavities and reverse any areas of
demineralization in the enamel. Many oral-care products are, frankly,
quite useless. Some, in fact, can damage the oral environment and cause
enamel to weaken—which leaves teeth more susceptible to decay. The
worst thing any of us can do is to needlessly compromise the health of
our teeth and/or gums.
There is an art to brushing your teeth, and a quantifiable chemistry that
occurs between toothpaste and the enamel crystals that cover our teeth.
A mouth rinse travels everywhere in the mouth—and although certain
ones are helpful, others can damage teeth or upset the healthy bacteria in
our mouth. In the United States, the products that I suggest can be
sourced at local stores or online—and with relatively little expense.

Smoke and Mirrors vs. the Reality of Mouth Health

Many people believe—incorrectly—that optimal mouth health is achieved
by straightening teeth into perfect alignment, and then whitening them
artificially to create the “ultimate smile.” You may like the way your
teeth align, and you may be congratulated on your attractive white teeth,
but it is the invisible environmental health of your mouth that is the
control switch that determines the health of your teeth and gums—and
how long you will keep them. If you ignore this measure of health and
opt instead to cosmetically adjust your pearly whites through artificial
methods, you can easily end up with a mouth in distress. These fixes are
a temporary dental distraction from the disease and bacterial imbalances
that are often lurking silently in a mouth, waiting for the moment to
initiate recession, sensitivity, or other problems—perhaps at a time of
stress or illness, during pregnancy, or in the later years of life, when these
problems may cause chaos at shocking speed.
Today, we know the impact of a poor oral biome on a person’s general
health and how it contributes to the debilitating conditions of diabetes,
arthritis, cardiovascular disease, and even premature birth—all while
raising our risk for the horrible health outcomes of dementia,
Alzheimer’s, carotid artery blockage, and stroke among other maladies.
Most people would never willingly ignore the slow progression of these
health problems, but many people unwittingly allow this festering oral
imbalance to exist in their mouths. Why does this happen? The big
reason is because true mouth health is hidden behind a misleading
curtain of superficial “tricks”—the smoke and mirrors of artificially
whitened teeth, crowns, veneers, fake teeth, and implants.
It normally takes about ten years for the impact—or symptoms—of a
mouth out of balance to become visible and be subsequently diagnosed
by a dentist as cavities; fractured, weak, dead teeth; gum recession; or
disease. The perception created by extraneous dental work that makes
people look good can last for a time, often in a way that deludes us and
pushes us further away from enjoying healthy teeth and gums. When
you achieve environmental mouth health, your teeth, gums, tongue,
saliva—your whole mouth, in fact—will become comfortable and
disease-free, often within months.
This is why I want to explain the value of the Complete Mouth Care
SystemTM, which is a simple but strategic “do it yourself” method of
mouth care that respectfully supports the natural processes of repair that
occur every day. The changes you achieve are progressive and will be
reflected by gradual improvements in the condition of your teeth and
gums. Soon after you start this program, you will see changes—and your
present and past dental history will become increasingly irrelevant. Do
not focus on how many untreated cavities you have or worry that your
gum problems are incurable or caused by age or family genes. When you
use this system and balance your mouth health, it is a foregone
conclusion that new cavities and gum disease will no longer occur.
Environmental oral health cannot improve and deteriorate at the same
time—it can only go in a forward or reverse direction, which is why you
can be confident things are improving as soon as your mouth feels
healthier.

STEP 1: PRE-BRUSHING RINSE

Many people have used mouth rinses as a quick way to “wash” their
mouth, and basically clean up the smell of their teeth and/or breath. That
may seem a logical action, but the difference here is that my system goes
far beyond mouth washing, and into the realm of a treatment sequence
designed to benefit your mouth and make it healthier.

Changes in Mouth Health

Dental visits should inform you about changes in your mouth health,
and it is always encouraging to discover how much improvement you
have achieved between dental visits—outcomes that are often far
superior to those achieved by leaving your oral health in the hands of
others. Unless you have an acute dental emergency, like a tooth
abscess, I suggest that you use this system of care for at least three (3)
to six (6) months before you begin any kind of dental treatment.
Certainly, not every cavity will completely heal with this home remedy—
and yes, you may need a cleaning at some time, but this will be easier
and more effective after you have used the system for six (6) months.
Any filling or repair you need, maybe for some existing problem, will be
easier if your enamel has hardened and when your mouth is healthy
before the filling. This system will make your tooth stronger and less likely
to fracture during treatment.
Another problem occurs if you already have a dead or dying tooth,
because there is no way for this system to revive such a tooth. Treatment
for a dead tooth is called a root canal and this is best performed by a
specialist called an endodontist. A good root canal will allow you to save
this tooth in your jaw and eliminate any spread of infection, which could
cause damaging bone loss.
Even if you are someone who has suffered with hardened plaque under
your gums, and your dentist has suggested a deep periodontal cleaning,
or if he or she suggests skin grafting where you have lost gum tissues, all
these periodontal treatments will heal faster and have improved
outcomes if they are performed in a healthier mouth environment. This is
why I encourage everyone to begin with the Complete Mouth Care
SystemTM—ideally, a few months prior to any treatment appointment.
The minute you feel or see small changes these should be a cause for
hope—and for you to be encouraged. First, they illustrate your power to
change your oral health; and secondly, it shows that what happened in
the past—or the state of your teeth today—does not matter. Some
changes that you notice may seem a little odd at first. Patches of decay
can darken as they heal, and inactive plaque that is stuck to your teeth
can create shadowy areas that sometimes make enamel look as if it is
thinning or stained. These changes are annoying, but it is good to be
forewarned and alerted to them, because such changes confirm progress
and are good signals that your oral health is improving. There are several
ways to manage and try to prevent staining from happening, and there
are also several things you can do if you notice stains have already
formed on your teeth.
Stains often happen within the first eight (8) to twelve (12) weeks of
starting my system, and they are caused by the sudden improvement in
your oral health, which can result in a shadowy superficial patch that
becomes visible on tooth surfaces and sometimes between teeth. This
kind of superficial staining is not harmful and is not permanent, but it
signals that old plaque debris has deposited on your teeth—often in
areas that are difficult to clean.
 Plaque may have been stuck more firmly to tooth surfaces if your teeth
were porous prior to starting this system, or if you had a sugar snacking
habit. A professional cleaning can easily remove this surface color and
leave your teeth shinier, and your underlying enamel healthier and
stronger than ever. If you want to try and remove this debris yourself, an
effective idea is to sprinkle xylitol crystals on top of your toothpaste, at
the toothpaste stage of the system. This slightly granular paste will offer
more exfoliating power, and this may be sufficient to lift away the sticky
plaque deposit. You will need to use a well-designed brush—preferably
with flossing bristles, and never a sonic or soft brush, because removing
this debris requires a good collection of densely resilient brush bristles.

Why a Pre-Brushing Rinse?

Perhaps you are standing in front of your bathroom sink, ready to brush
your teeth. In this case, you may be surprised to learn that this system, or
process, begins best with a mouth rinse. This first step dispenses with any
possibility of causing abrasive tooth damage—a risk that can occur if
tooth enamel is softened by acidic saliva or directly after a meal, snack, or
drink. The stabilized chlorine-dioxide mouth rinse that I recommend—
called Closys in the United States, and Ultradex in the United Kingdom
—is a great way to prepare the mouth properly prior to brushing. This
ultrasensitive formulation is unflavored and appears to be easier on the
delicate gum tissues, which is helpful if your gums are sensitive or
swollen.
A chlorine-dioxide rinse is most effective if it is unflavored. You may
wonder if this colorless and tasteless liquid is working, but you need
only wait a week or two to enjoy its initial effects. People are sometimes
confused (particularly if they use pH testing paper to measure the acidity
of their saliva or other liquids) because they may find that this particular
rinse is acidic. This is not a problem because it is the way Closys interacts
with saliva to form oxygen, which neutralizes mouth acids. The more
acidic your saliva is, the more help you will need to neutralize it—and,
consequently, more interaction will occur between your mouth and the
rinse. So, I recommend this pre-brushing rinse to protect your teeth from
abrasive brushing damage, to neutralize mouth acidity and help heal
periodontal gum pockets around your teeth.

How Does It Work?

Closys will react with your saliva as it flows everywhere inside of your
mouth—and it can even travel down the sides of teeth and into
periodontal pockets, without the need for water-flossing or other similar
devices. As this reaction occurs, oxygen is released. This process then
disrupts the low-oxygen environments where harmful cavity- and gum-
disease bacteria breed, which will benefit your gums and disrupt
harmful bacteria in deep cavities and gum pockets. This is why Closys
produces surprising results. Salt water may alkalize your mouth, but this
would not help in the same way to combat cavities, pocketing, and
periodontal gum disease. An additional benefit from Closys is that it
addresses the bacteria that contribute to an unpleasant sulfur-smelling
breath.

The “Exact One-Minute” Rule

The amount of Closys you use is not important, so only dispense enough
rinse to be comfortably held in your mouth. On the other hand, this rinse
must be accurately timed as it takes at least thirty (30) seconds for the
rinse to interact with your saliva and travel into the gum pockets. You
want to benefit from this released oxygen, so be sure to go beyond the
traditional thirty (30) seconds that may be suggested and use Closys for
exactly one exact minute of sixty (60) seconds before spitting it out to
begin brushing.
Allow the liquid to bathe all your teeth, including back ones and areas
where you suspect gum disease could be problematic—most often
around molars, but sometimes also around your upper or lower front
teeth. Be sure to tip your head calmly back and forth during the process
for a full minute—so that all these areas are bathed fully with this
mouthwash and then spit out and move on to Step 2, which is brushing
your teeth.
STEP 2: BRUSHING YOUR TEETH
To keep our gums healthy on a consistent basis requires two things: An
effective brushing technique; and the use of a bacterially clean and well-
designed toothbrush. Another important element to a healthier mouth
has much to do with when one starts to do things correctly—and when it
comes to brushing one’s teeth, the very best preventive move is to adopt
a good brushing technique just as the first adult teeth erupt into the
mouth during childhood. Fortunately, gum disease is not a risk for
children under the age of five.
Gum problems can, however, begin to be initiated as new adult teeth
enter a child’s mouth soon thereafter around kindergarten age—and this
is the time when parents should begin to pay closer attention, and when
they should teach their children good brushing habits and how to do
gum massage. It may take ten or more years for gum disease to become a
full-blown mouth problem, but early gum massage can protect your
child from problems by nipping this in the bud.
This is why the relevance of brushing teeth increases with a child’s age,
and the key for young children is mainly to establish an enjoyable habit
every night before bed. The use of toothpaste for young children is
optional—and we will discuss this further in Chapter Eight, where we
will look more closely at methods of care for children of different ages.
As adult teeth grow into the mouth, children can transition and begin to
use a small amount of sodium fluoride toothpaste—the same kind that I
recommend for adults. Most children will benefit from the entire system
of care by their teen years when most, if not all, of their baby teeth will
have been replaced by adult teeth. For children or adults with sensitive
mouths, it is a good idea to use less paste and shorten the length of the
two final rinses.
Next, let’s take a look at how to successfully brush one’s teeth—divided
into the following parts, which you will next learn about in this chapter.

1. Brushing Strategy
Brushing is a vital part of this system, as it allows us to apply toothpaste
to every tooth surface, to remove surface debris, and provide essential
gum massage—all key elements in one’s ongoing effort to keep the teeth
and gums healthy.
Massaging your gums may be a new concept, as many people continue
to believe that to brush one’s teeth is merely to smear toothpaste over
them. Most brushing habits among the general public have been found to
be consistently inadequate, and serially unable to maintain or improve
one’s oral health. Since our gums first become susceptible to disease in
our teenage years, it is ideal—for a successful long-term outcome—that
we introduce children to the benefits of gum massage early in life. That
said, it is never too late to begin your journey to better oral health—you
just need to get started.
When it comes to cleaning tooth surfaces, the goal is to brush actively
over every tooth surface and your gums—not only at the junction where
the gums meet your teeth, but across all the surrounding gum areas.
Your hygienist may be happy to help you learn how to brush better, so
take your toothbrush with you at your next appointment—and request a
personal demonstration (or learn from one of my online videos). Most
children unfortunately believe they know how to brush their teeth by age
four, and often they are never again instructed and therefore never learn
the real goals and aims of effective brushing.
It is good to be a conscientious brusher. You should always think about
what you are doing, as you work the brush around your mouth in an
organized sequence. Be sure to brush the inner and outer surfaces of your
teeth and gums. You should always target what you see as your more
problematic areas first, even if you end up brushing over and around
them twice. Gum massage also creates a steady movement of fluids in
the gums—a naturally occurring assemblage of lymph liquids (which
help to remove dead or unwanted cells from the mouth) and unwanted
toxins that flow away in this liquid. This applied stimulation also brings
a flow of blood to the gums and into the teeth that they support. The goal
is to stimulate circulation and generate a wound-healing response in any
area where your gums bleed, or where you have problems with gum
disease or pocketing.

2. Toothbrush Selection
Select a toothbrush that can easily apply toothpaste throughout the
mouth, but—more importantly—that will also help to keep your gums
healthy. Standard brushes are designed for spreading toothpaste on to
teeth, but you want to consider how well your toothbrush stimulates
circulation in your gums. Ideally, look for so-called flossing bristles,
which are designed specifically to help you access those areas between
your teeth. It is good to ensure that the brush bristles will not damage
your gums—to do so, look for a brush that is dense and outfitted with
bristles of differing lengths.
You should have a brush that is hopefully not too soft, yet resilient
enough to give your gums a good massage and remove debris from the
tooth surfaces. You may have to buy a small selection of different brands
and try them out yourself to get a better idea of what works best for you.
There is no standardization of brush firmness—which creates difficulty
for anyone who wants to determine if one brush is firmer than another.
Simply put, the only way to know the best brush for you is to try a few.
Some brushes may feel good for a few days, only to then rapidly become
softer—and completely ineffective.
In an echo of the different bowls of porridge at the center of the classic
fairy tale “Goldilocks and the Three Bears,” your brush should not be too
hard; too stiff; or too soft, since any of those qualities can render your
brushing process ineffective—and therefore, not just right.
I do not recommend a technique known as dry brushing, which is when
you massage your gums without any toothpaste or water on the brush,
because this spartan approach to your teeth and gums can be too harsh.
In fact, I suggest that if you feel that your gums or teeth are sensitive,
then you should use warm water on your toothbrush before you apply
paste. People who are lazy about brushing may find an electric brush
more effective, but nothing beats a well-designed manual brush in the
hands of someone who learns exactly how to use it.
Some people have developed a gag reflex that makes standard
toothbrushes feel too big in their mouths. These individuals can often
achieve success with youth brushes, provided that the bristles are as
resilient as for adult brushes—just with a smaller brush head. Some
people need longer handles or more angled heads, but generally look for
a brush with plenty of bristles of differing lengths. No scientific evidence
has yet shown that one type of toothbrush design is better than another,
so perhaps try a few different ones to discover the one that allows you to
brush most effectively.
Do your best to not select a brush for yourself that is too big, too small,
or that has an ultra-long head. In general, the toothbrush head should be
less than one inch in length with a handle that allows a firm grasp. The
bristles must have rounded ends to avoid damaging the gums—the more
bristles, the better. A brush with too few bristles will rarely be able to
give your gums adequate massage, which is one of the secrets to
generating gum growth and the perfect way to maintain one’s gum
health.

3. How to Clean Your Toothbrush

In recent years, people have begun to realize the hazards of using old
and infected toothbrushes—but reports still indicate that the average
American does not know how to clean a toothbrush, and only replaces it
once or twice a year. My suggestion is not definite because an answer has
not yet been scientifically proven. Some say you should change a
toothbrush after an illness, but it seems most sensible to me that one
should start to use a new brush after a cleaning, a periodontal treatment
of any kind—and especially after surgery such as a skin grafting, an
extraction, or a new implant.
Besides this, people with no dental problems who have a healthy
mouth may be able to use the same brush for a longer range of time. If
you have two brushes, and they dry for twenty-four (24) hours between
uses, then the replacement time may be extended. I consider six (6) to
twelve (12) weeks to be a reasonable interval, if you are using two
brushes and if you are an established student of my Complete Mouth
Care SystemTM. If, however, your brother—who has no interest
whatsoever in oral health—is asking how often he should change his
dirty brush, then “A new brush every month” is likely the most helpful
timeline to suggest.
It is important to keep toothbrushes sanitary and clean, because if you
use an infected toothbrush, you risk introducing aggressive bacteria that
can aggravate cavity and gum problems in your mouth. Any bacteria in
your mouth or on your gums are transferred to your toothbrush bristles
in a single use—and repeated use of an infected brush could replant
these bacteria into your mouth.
Be aware of hazards that exist around your toothbrush if/when you
travel; live in different spaces; or journey away from home while on
vacation. It may be good to take inexpensive brushes with you and throw
them away every few days—or disinfect them very carefully—especially
upon your return. You could experiment with something different, like a
Miswak stick, for use amid travel or temporary lodging. Brushes that are
stored damp or wet inside travel bags can swiftly become infected with
the kinds of bacteria that pose periodontal disease hazards. Studies show
that one of the best ways to clean a toothbrush is to allow the head of the
brush to air-dry completely between uses, and this can take up to
twenty-four (24) hours for a brush with dense bristles. Generally, it is
best to store a toothbrush head-up, in a cup, so that the bristles can dry.
Always avoid damp or wet conditions where mold or bacteria can grow
on your brush; for example, under a cover or inside a plastic bag—
particularly if you are using a hollow rechargeable, or sonic, toothbrush.
Brushes stored close to others may also experience a transfer of
bacteria, which is important to consider if you have cavities or gum
disease in your mouth. It is also a concern in schools, daycare, and
college dorms, where infected brushes can be a vehicle of transfer for
harmful germs from one mouth to another. Avoid sharing brushes
whenever possible—and if you doubt the air quality in your bathroom,
then consider storing your toothbrush near a sunny kitchen window
instead.

4. Choice of Toothpaste
People end up in trouble if they regard toothpaste as a “one-stop shop”
for all their dental needs. A good toothpaste should strengthen your teeth
(and thus whiten them naturally), just as it provides enough cleaning
power to remove surface and bacterial debris—without, of course,
scraping away a tooth’s surface or negatively changing the tooth’s
natural structure. Generally, I suggest you avoid pastes with the added
ingredient glycerin.
This area of concern was first raised in the 1960s by a chemist called
Gerald Judd, who suggested that glycerin or glycerol could attract
plaque to a tooth surface and become a barrier to successful tooth
mineralization. Dr. Judd created his own experiments, which led him to
record that it took twenty-seven (27) rinses to remove the film of glycerin
from teeth. It is interesting that glycerin is the mainstay, and even the
primary ingredient, in many commercial toothpastes—and yet, this
study has still never been repeated with a controlled trial.
In spite of the hyperbole often expressed in promotional language, the
promised benefits from so-called “miracle” toothpastes will not: cure
your dental problems; eliminate tartar; safely stop tooth and/or gum
sensitivity; or naturally whiten your smile safely, and for the long-term.
They may block porosity holes, kill bacteria, and strip away your mouth’s
protective barrier with chemicals that may temporarily appear to work—
but what more commonly occurs is that these inferior pastes will instead
sensitize your gums, causing the peeling and ulceration of your gums
and the skin of your mouth.
Abrasive pastes can thin or weaken the enamel in your teeth. So, what
you really need is a toothpaste that does not disrupt the mouth’s bacterial
balance or form a barrier layer on the outside of teeth, since this will
prevent or delay the natural healing processes. The ideal toothpaste
should safely clean all tooth surfaces, while it simultaneously speeds up
the remineralization sequence that naturally strengthens tooth enamel.
If you have read this far, then you must certainly be asking yourself:
What kind of toothpaste works best with this system? In answer to that
question, I would recommend the original Crest Regular Cavity
Protection toothpaste with no extras. This paste is 0.243% sodium
fluoride and hydrated silica—both useful ingredients that fit perfectly
into the sequence of my complete system of care. Never take your eye off
the ingredient list of toothpaste and be sure to avoid stannous fluoride, a
cheap tin/metal fluoride compound that kills oral bacteria and forms
barrier plugs in tooth enamel. If you are using my recommended system
but want to dilute the taste of the toothpaste, then sprinkle a quarter of a
teaspoon (1/4 tsp.) of xylitol crystals on top of the paste when applied to
your brush, and you will find that it changes the overall taste—without
changing the effects.

Benefits of a Good Toothpaste

For an adult, the amount of toothpaste you apply is not vitally important.
However, for a child or young adult you should use only one (1) or at
most two (2) small green pea-sized drops of paste on a damp brush head.
If you find the taste of toothpaste too strong, simply reduce the amount
of paste that you use. Target the surfaces of your front teeth, and then
work around to other areas where you think you most need to remove
plaque or food debris. If your hygienist has told you that your back teeth
collect tartar, then this would be an area to target early in your brushing
when you have the most toothpaste on your brush.
The kind of Crest toothpaste that I suggest (see page 107) cleans the
surface of teeth without being too abrasive. It was formulated before the
advent of the current whitening craze, but it will help to improve the
color of your teeth by helping to mineralize the enamel surface—thus
strengthening it, which makes it reflect light more completely. This paste
also gives the enamel adequate protection from the relatively low acidity
(pH level) of Listerine—the rinse that will now follow below as the next
step of my system. This is why, at the end of brushing, you should spit
out the toothpaste—but do not rinse the residual paste off your teeth with
water, which would diminish the synergy of this system.

STEPS 3 AND 4: TWO FINAL RINSES—LISTERINE,

FOLLOWED BY ACT
All liquid mouth rinses have their own unique chemical properties, and
each has a different effect on our teeth, gums, and overall mouth health.
The Complete Mouth Care SystemTM that I present here ends with a
sequence of two final rinses—Listerine, and then the Anti-Cavity
Treatment (ACT) fluoride rinse—which are used one after the other, a
tag team of mouth rinses that do more than clean teeth. By using these
specific rinses in the correct order listed above, they work in harmony to
clean away harmful plaque bacteria (while sidestepping the mouth’s
good bacteria) but then they set the stage for natural tooth
remineralization and gum support that will begin next.
This two-step ending is a robust way to stop cavities and help teeth
strengthen and mineralize, while simultaneously promoting gum growth
and setting up controls to stop plaque from forming—both above and
below the gum line. Used in this tandem way, these mouth rinses
enhance each other to leave your mouth feeling amazingly clean, and in
time, they can deliver remarkable benefits. You may like to think of this
duo in a similar way to the liquids used in skin care routines—where an
astringent or toner will clean the skin, right before a protective
moisturizer might be applied.
Listerine is used first, to rinse the toothpaste residue off your teeth
while targeting immature plaque bacteria that may be floating in saliva.
This rinse should be used by everyone—even those with a dry mouth—
who have lost enamel or have sensitive or acid-damaged teeth. The
Listerine rinse has effective cleaning power, but it is targeted to one kind
of bacteria—and despite the claims of social media influencers among
others, the formulations of Listerine that I recommend do not harm the
mouth’s microbial environment in any way. It is acidic, but this allows
for a unique interaction with the final ACT rinse that is going to be used
next. This duo creates a far more powerful mineralizing effect for teeth
than simply using a fluoride rinse on its own. When this specific
combination of two rinses is used in this sequence twice a day, they
achieve a more complete and effective mineralization than any of the
results achieved by using even strong prescription toothpastes, rinses, or
fluoride varnishes.

Listerine—Effective Essential Oils

Listerine is a liquid that is scientifically classified as an essential oil
mouthwash. Many people are surprised to find that the active
ingredients are oils of the eucalyptus plant, together with the naturally
occurring compounds menthol—from the peppermint plant—and
thymol, which is extracted from the herbs thyme and oregano. The
amount of ethyl alcohol in Listerine is 21.6%, and this is used to dissolve
the oils into the mouthwash formulation. Studies by the American Dental
Association (ADA) and the National Cancer Institute (NCI) show that the
aforementioned alcohol in Listerine is present at a completely safe level.
In this situation, the alcohol will immediately be diluted by saliva and
then it will be finally rinsed away by the non-alcohol rinse ACT—which
follows next.
Another concern that has been raised is the possibility of bacteria
developing a tolerance to Listerine after continuous use, but studies
show that the essential oils in Listerine do not result in bacterial
resistance of any kind. Today, Listerine competes with many alternative
choices, but it has survived all manner of online myths and many
unfounded fears. And so, I remain fully confident that Listerine and ACT
warrant their reputation as safe, and in the method that I suggest, you
will likely be amazed how quickly this effective combination of rinses
can improve your tooth and gum health to help you avoid the toxicity of
fillings or other consequences of mouth imbalance.

How Listerine Works

In 1931, Listerine was the first mouth rinse to receive the American
Dental Association (ADA) formal seal of acceptance after several twenty-
four (24) week studies proved that it was able to control a plaque-
induced gum inflammation known as gingivitis. Recent testing in
multiple studies has confirmed the effectiveness of Listerine and also
supported the company’s research that shows rinsing twice a day with
Listerine is five (5) times more effective than flossing, particularly when
it is used every twelve (12) hours—twice a day.
Thymol targets a few problematic bacteria, yeasts, and fungi in the
mouth, and the eucalyptus oil helps to promote gum growth. Listerine’s
effect is very specific toward immature plaque-forming bacteria such as
Streptococcus mutans. Thymol can dissolve their hard outer coating, and
because Listerine is a liquid, it intermingles with any plaque bacteria that
are floating in saliva. The eucalyptus in Listerine is effective at helping to
sooth gum problems, and this oil has been studied for its ability to help
regrow gum tissue.

Enjoy Listerine
When selecting from the modern array of flavor choices, look for the
original Listerine formula or the Cool Mint formulation. At the same
time, be careful to avoid any rinses that are advertised specifically for
plaque control or whitening, since many of these contain added
chemicals or zinc that can make your mouth feel uncomfortable and
make your teeth more sensitive to temperature changes that occur at
mealtimes when we eat and drink. Many people find the taste of
Listerine spicy, and if this happens to you—do not power through the
feeling, but simply use it for less time and spit it out as soon as you are
feeling a warm sensation in your mouth. A quick rinse is not
problematic, as you will derive benefits from even a second or two.
Notice the time you can tolerate Listerine and never go beyond sixty (60)
seconds.
If your mouth has been damaged by the use of artificial whitening
products, peroxide, baking soda, or frequent dental cleanings, then you
will likely experience trouble rinsing, and you may not be able to tolerate
Listerine for more than a few seconds. As your mouth health improves—
a consequence of all the other parts of this strategy—you will find that
you gradually work up to the thirty (30) seconds that are recommended
for most people. Adjust the final rinse time to match the Listerine time—
and when this duration with Listerine extends, increase the time you
rinse with the ACT to match. The volume of Listerine in your mouth is
not important—just use enough of it so that it remains a comfortable
(dare I say enjoyable?) experience for you.
Be sure, of course, that you do not rinse with any water between
having toothpaste on your teeth and the start of this Listerine step in the
system. This allows toothpaste residue both to mitigate the taste of the
Listerine and to offer your teeth protection from this rinse’s acidity while
it is in your mouth. Everyone will have their own personal tolerance
level, and never go beyond a comfortable time or after you register a
spicy signal on your tongue from the Listerine. The goal is thirty (30)
seconds, and never longer than sixty (60) seconds maximum, but if you
are uncomfortable or your mouth feels too hot—spit out the Listerine
and rinse immediately (even after a couple of seconds), and then move
on to the final ACT rinse.
Never forget to rinse Listerine off your teeth or the acidity of this rinse
will work against you, promoting plaque and allowing cavities to get
larger. It is with the last of these rinses that we turn possible problems
into the finale that will benefit your teeth and gums.

Dilute Fluoride—The Final Rinse

For shiny, strong, and healthy teeth, I recommend that you rinse with a
low-concentration sodium fluoride finishing rinse like ACT to protect
your teeth at the conclusion of this system. This is because sodium
fluoride supports, speeds, and stimulates the natural process of
rebuilding tooth enamel, commanding minerals from saliva to enter the
tooth and reconfigure the enamel crystals to make them more perfect,
which helps to create naturally stronger tooth enamel.
How ACT Works
Although I filter fluoride out of my drinking water (see the section on
fluoridation in Chapter Four from Part One of this book for the reason
why), I am a proponent of using a 0.05% sodium fluoride rinse called ACT
(anti-cavity rinse) as part of this system of adult tooth care, twice daily
and always right before sleeping. It is especially important if you have
damaged or weak teeth, lack natural protection (dry mouth), or are
middle-aged or even older (which places you at higher risk for dental
disease and damage).
A fluoride rinse is completely different from the undesirable idea of
drinking artificially fluoridated water. Rinsing with a dilute fluoride
compound will be helpful because it allows teeth to strengthen, and the
surface enamel to become smoother and more fully mineralized—which
is very helpful if your teeth are sensitive, if parts have broken or
fractured, or if you have cavities. A fluoride rinse will also help to build
weak enamel back to its former strength, which can also improve tooth
color—all achieved without consuming any fluoride as you would if you
were drinking it in your water.
A fluoride rinse will also help anyone with silver or white fillings in
their teeth, because the surrounding enamel often loses its strength,
which shortens the lifespan of fillings. This rinse can help you avoid
ongoing and expensive filling repairs, and the consequences of these that
may involve exposure to mercury or plastic chemicals as the fillings are
removed, or damage to the tooth nerves that often happens and leads to
tooth death and the need for root canals, crowns, or even tooth extraction
and implants.

The Benefits of ACT

The volume of this fluoride rinse is not important, but you do want to
monitor the length of time it remains in contact with your teeth. If you
keep both final rinses comfortably in your mouth for thirty (30) seconds
each, this will jumpstart your teeth to mineralize in the upcoming hour—
and that process will begin the minute you have finished cleaning your
teeth. If you can only use Listerine for a few seconds, you may also want
to limit the ACT rinse to a similar amount of time and gradually work up
to a longer time with both rinses simultaneously.
Always spit out well after the final rinses, and then rest your mouth by
not eating or drinking anything for at least an hour afterward. The longer
you wait before eating and drinking—after using my system—the more
benefit for your teeth and gums. If you can wait and avoid all food and
drinks for an hour or more, this action will enhance the benefits of the
Complete Mouth Care System™, because if we allow more time for
natural healing, more healing will occur. (This is something we have
discussed in earlier chapters.)

WHEN TO USE THE COMPLETE MOUTH CARE

SYSTEM™
Use this system twice a day, and a maximum of three (3) times a day. The
essential time to use this system is before you head to bed each day, so
that the strengthened tooth surface condition will protect your teeth
while you are sleeping. This is particularly important for anyone who has
a dry mouth, and especially those who breathe through their mouth at
night. The other time should be separated by about twelve (12) hours
from this session. If you can use the system after a meal—which I can tell
you works very well—you can design the timing of this system to
conveniently mesh with your daily routines.

The “Happy Teeth” Timeline

I like to encourage everyone to take selfie photos as part of how they
document their own respective oral health journeys. This may be the
only way you will remember how your teeth looked and felt when you
began using this system. There are scientific timelines that have been
documented in various studies. For example, we now know how xylitol
can help promote good bacteria while it also eliminates the bad. We also
know that it takes one (1) month to stop plaque from aggregating on
tooth surfaces, yet six (6) months before plaque will completely stop
landing on them. This means you must brush most carefully during these
first six months, but don’t be discouraged—with use of my timeline
provided below, you will be provided with a steady and dependable
path toward your very own set of “Happy Teeth.”

7 to 14 Days: If you have poor oral health, you may see and feel rapid
improvements as your gums stop bleeding and visible plaque no longer
forms on your teeth. This is the time when you need to work hard and
try to brush your gums and teeth more effectively. Consider the periodic
purchase of new toothbrushes and focus on how to do gum massage
consistently and effectively. This will help you to remove old plaque from
tooth surfaces and help prevent the stains that form when gums bleed
and inactive plaque gets stuck on the surfaces of teeth.

3 to 6 Months: This may be a good time to arrange a return visit to your

dentist for a thorough professional cleaning—in particular, to remove the
debris of dead plaque from your tooth surfaces. Ensure that you use the
system immediately before the appointment, and restart with some
xylitol at the end of your visit. Don’t expect accolades yet, and maybe
keep your thoughts quiet this time around. It will be during your next
visit when you should expect to be congratulated and hear about the
improvements you have always wanted to achieve.

6 to 12 months: You should now be able to appreciate the changes that

have occurred in your oral health, and you should feel empowered
knowing you have the power to protect and strengthen your teeth. You
can relax finally and enjoy this new confidence about your oral health.
Maybe this is a good time for a professional evaluation, or a time to take
photos, test your mouth bacteria, and maintain records of your
improvements, as a reference for yourself. At this point—six (6) to twelve
(12) months—your saliva should be free of new plaque bacteria, and any
stains you have been fighting should become progressively less of a
problem.
CONCLUSION
So, who can use the Complete Mouth Care SystemTM? I am happy to
report that this system is of great benefit for adult teeth (even for people
with a dry mouth or acidic saliva); for the elderly and young; and for
those who may think their situation is too far gone to correct or remedy.
Pregnancy is a difficult time for teeth, but this system will help maintain
and improve oral health during these months as well. It’s particularly
recommended prior to braces and orthodontic work, or when you are in
the process of aligning teeth with retainers—a time that can stress your
gums and teeth and lead to recession and tooth sensitivity.
There may be special situations, or in hospital or community settings,
when the use of this system is not practical. This is when the use of
xylitol may be all you can do, or perhaps just the toothbrushing with a
small amount of toothpaste, or some combination of this with xylitol
after meals, together with ACT rinsing.
In the next chapter, we will speak about what I consider one of the very
best things to happen to mouth care in the past one hundred years
—xylitol.
7. Xylitol—The Most Powerful Friend a
Mouth Can Have

Men judge us by the success of our efforts. God looks at the efforts
themselves.
—CHARLOTTE BRONTE

S ome years ago, a retired dentist friend of mine asked me how I use
home remedies to help people avoid cavities. He wanted the secret
because his wife’s teeth were, in his words, “falling apart.” Here was a
wonderful dentist, an expert in his field, who could not protect his own
wife from the plaque problems that were destroying her mouth. I
explained how xylitol, and my system of mouth care, work in harmony
to clean and protect teeth. Within weeks, my colleague told me with
great excitement about the positive effects on his wife’s oral health that
they had noticed.
These same remarkable outcomes have been repeated for decades,
consistently serving to amaze people with the benefits they quickly feel—
and see. They often cannot believe that something so simple, and
delicious, could make such an effective difference in the state of their
mouths. If you are searching for oral health changes like these, then
perhaps it is time for you to know more about xylitol—and how it can
become a pivotal part of your daily dental regimen.
Another “real life” story concerns three teenage brothers, each of
whom almost wrecked their oral health one summer as they enjoyed a
month-long family camping trip. Before their new school year started,
these boys would come together to visit me for their scheduled checkups
—and were shocked to discover just how many cavities had surfaced
since their last appointments. They admitted that consistent tooth care
had been neglected during the summer and that they had enjoyed soda
and snacks every day. Summer heat, and active lifestyles, had placed
these boys at increased risk for oral disease, and the older brother’s
seasonal allergy medications had additionally caused mouth dryness—
thus, creating even more potential for cavities to form.
I could see in each teen’s mouth that the central grooves of the molars
in their upper and lower jaws had started to decay—an alarming total of
twelve (12) cavities between them in total. Instead of merely filling these
cavities, I presented this family with another option—to go home and
make daily use of xylitol, along with my unique system of care, to control
their plaque infections and rebuild the lost tooth structure in each of their
mouths.
The most important part of that family’s decision, of course, was their
choice to act—to make use of xylitol in harmony with my prescribed
Complete Mouth Care SystemTM (as I have outlined previously in
Chapter Six). Changing the situation for these boys was vital, since
cavities simply progress if they are left alone and ignored. The boys
carefully followed my directions and came for follow-up visits to
monitor their progress at the three-, six-, and twelve-month marks. All
twelve of those boys’ cavities healed naturally, and never required
fillings.
Ready to learn more about this seemingly magical oral health aid? Let
me explain more about how it works and what it is.

XYLITOL 101
Xylitol (pronounced ZY-lih-tol) is a delicious granular health sugar that
was first recognized as being good for oral health in the late 1940s. There
had been a decade of sugar shortages in Great Britain, and so xylitol
became an alternative sweetener for all kinds of baking; for use in
beverages; and as a replacement for table sugar in most households.
Xylitol can be extracted from the wood of birch trees, and so it is not
surprising that The Finnish Sugar Company, located in a country where
birch forests are plentiful, was one of the first to commercially distribute
xylitol to other countries.
In Scandinavia (Norway, Sweden, and Denmark, specifically), xylitol is
found in many of their candies, and for over six decades, Finland has
managed a public health program for preschool and elementary schools,
offering xylitol dental gum during school hours, every day. Switzerland
also has produced xylitol and promoted it for oral health, launching a
certification program in 1982 for tooth-friendly candy made with xylitol
that meets their special regulation standards. Travelers to China, Asia,
Turkey, and Japan are usually surprised by the selection of xylitol gum
and mints in these countries—and how it has been promoted there, in
children’s playgroups and nurseries, for decades.
By the mid-1950s, European dentists and doctors had noticed—amid
this more generalized consumption of xylitol—that the oral health of
these populations had improved, and children in this part of the world
not only experienced fewer cavities but less ear infections. This was a
period of time when the first scientific research studies began to look at
why these changes had occurred, and if xylitol actually did promote
health. The benefits of this ingredient were gradually confirmed in
decades of study conducted across many countries around the world—
from Estonia to South America, and from China to Japan.
Xylitol first arrived in the United States in the middle of the 1960s,
when it was incorporated as an active ingredient in healthy chewing
gum. At this time in this country, however, there was comparatively little
interest in natural health products. This gum was flavored with licorice
and remained rated as a poor competitor alongside the tastier, longer-
lasting, but artificially sweetened gum that the American marketplace
had created for less health—and larger profits.
Today, xylitol can be purchased in granular form as well as in: tooth-
friendly candy, with many fun flavors; breath mints; tooth gels; mouth
rinses; baby products; and nasal sprays. Thankfully, xylitol-based
products are no longer found only in health stores—they can be
purchased nationwide, in a great many progressive grocery stores
alongside other organic and natural products, and online from a large
number of outlets (including, of course, Amazon.com).
WHAT IS XYLITOL?
As mentioned, xylitol was first produced from the fibers of birch wood,
but it can be derived from a variety of hardwood trees, and it is also
present in many popular fruits—including strawberries, raspberries,
plums, and blackberries—and fifteen (15) grams is even created daily by
the human body as a product of our metabolism. While this natural
sweetener is now produced in several other countries around the world,
using new techniques and processes (including fermentation—a process
that is similar to brewing beer), the extraction of xylitol remains sourced
primarily from fibrous plant materials like hardwoods, corn husks, and
oats.
Granular xylitol is a colorless white crystalline powder, that not only
looks—but also tastes—almost exactly like sugar, with perhaps a slightly
fruitier flavor. This is where similarities between sugar and xylitol end—
and enormous differences begin. Consuming xylitol creates an almost
opposite effect of sugar in the mouth—in addition to being tooth-
friendly, its benefits gradually promote oral health over time. In similar
opposition to sugar’s deleterious effects, consider the following: The
more frequently we consume small amounts of xylitol each day, the more
benefits we can achieve for our oral health. Consistent and frequent use
of xylitol can progressively change a plaque-diseased mouth into one
that is healthy and disease-free, with visible and measurable results, over
a period of six months. It has truly given me so much pleasure and
satisfaction over the years to see how quickly my patients have been able
to turn their dental health around—just by taking my advice . . . and, of
course, by taking xylitol.

THE BENEFITS
Many xylitol studies in the 1970s were centered upon populations of
pregnant women, a group of individuals at increased risk for gum
disease and cavity problems. These studies showed that when a mother
consumed a single piece of one hundred percent (100%) xylitol chewing
gum six (6) times per day, this small amount of xylitol—equal to about
six grams of xylitol—had the power to control cavity-forming bacteria in
these mothers’ mouths. Furthermore, this change impacted and
controlled the spread of the cavity forming infection to the newborn
babies who were followed for years and found at age six to have eighty-
five percent (85%) fewer cavities than the control group of children in the
study. A later study in 2022 conducted in the East African country of
Malawi showed that two pieces of xylitol-infused chewing gum—
consumed by thousands of high-risk pregnant mothers after lunch, and
before sleeping at night—significantly reduced their overall chance of
delivering a child prematurely.
These are the kinds of exciting studies that have illustrated the
attributes of xylitol for prenatal and family health. Many other studies
and clinical trials have shown the benefit of xylitol for cavity prevention
in early childhood. Research conducted at the University of Washington
Dental School by Peter Milgrom, DDS, indicated how much xylitol is
necessary to achieve these effects and looked at the timeline of how
plaque is gradually controlled over a period of six (6) months.
Meanwhile, Kauko K. Makinen, PhD—who has had an amazing career
at the Universities of Washington, Michigan, and Turku in Finland—has
led many studies and has shown how the frequency of xylitol use (even
in tiny amounts) affects the rate of decay in children’s teeth, and how
regular use of small amounts at the end of meals can lessen the chance
that a cavity will develop in a child’s mouth. Consistent use of xylitol
therefore appears to be one of the most effective ways to enjoy its
protective dental benefits. The results you get depend on your personal
discipline; but seeing improvement always makes this easier.

The Truth About Xylitol

There have been decades of studies on xylitol, showing its oral health
benefits and how it also provides a variety of positive health effects.
Throughout this chapter thus far, we have discussed how xylitol can
interrupt the family transmission of plaque bacteria; how it can help to
control tooth decay in children and adults; and how it has been shown to
reduce the incidence of premature birth for pregnant mothers. It is
therefore useful to consider what was discovered about xylitol according
to the following timetable—and be aware that all cited studies and
research below reflect a one-hundred percent (100%) level of xylitol:

In 2019, the Society for Global Health and Nutrition reviewed the
attributes of xylitol beyond mouth health, by exploring the positive
health impact of xylitol on the respiratory system for nasal, throat,
eat, and sinus health. This article also documented how xylitol can
help increase bone strength and reduce body inflammation—
positive effects that help to prevent cardiovascular events, arthritis,
and diabetes. In other studies xylitol was shown to support immune
health, and even more remarkable were the results of xylitol for
controlling a variety of viral and bacterial infections (especially the
influenza virus, when xylitol was combined with red ginseng). Xylitol
was also shown to be a benefit for weight management, and have
beneficial effects on metabolic health, with an ability to increase a
feeling of satiety after eating.
In 2020, more exciting results emerged from a Japanese study
reported in the scientific journal Chemico-Biological Interactions
that xylitol showed some anti-cancer effects, and how a
chemotherapeutic strategy combined with xylitol might improve the
outcomes for patients facing cancer.
Then by 2022, a meta-analysis—which is defined as the
scientifically deep and complete review of past studies—was
conducted to evaluate the effectiveness of xylitol for the prevention
of dental caries (tooth decay). The results were published in the
Journal of the International Society of Preventive and Community
Dentistry, and they showed—once again—that one hundred
percent (100%) xylitol is most effective in preventing tooth decay
when used three (3) to five (5) times a day, and when the total dose
is between five (5) to ten (10) grams of xylitol daily. The conclusion
of this analysis was that xylitol should be part of our overall oral
health strategy for children and adults.
 This is why it was so shocking in June 2024 to read media articles that
reported how xylitol could increase our risk for cardiovascular events.
The study at the center of this coverage, funded by private equity groups,
was hard to access as it was initially behind a paywall, and this
inconvenience was compounded by extremely misleading media reports.
The interested individuals who read the study from the source were able
to dispute these inaccurate media articles and explain that the study only
has relevance—and any possibility for concern—in elderly individuals
who are suffering from health conditions that included diabetes; high
blood pressure; and cardiovascular disease if they consume extremely
large amounts of xylitol as a drink after fasting.
In the study, there were no control groups taking smaller amounts,
which could have helped ensure the efficacy of the results—and the oral
health, diet, and smoking statuses of these subjects was not reported.
Furthermore, the group of ten (10) subjects in this study were given an
unusually large dose of xylitol—thirty (30) grams, in fact—as a drink,
immediately after fasting. None of the study group suffered any adverse
clinical reaction from this drink—but their blood was tested, and
researchers found a small elevation that averaged six percent (6%) in the
concentration of certain metabolites in their blood samples. Anyone who
is concerned by this statistic should consider that these percentages can
be elevated by one to two hundred percent (100–200%) in patients who
smoke cigarettes.
The report from the Cleveland Clinic, which was the study center,
specifically stated that this particular study had no relevance to the
insignificant amounts of xylitol recommended for oral health. This fact
was never mentioned by the media—instead, many outlets put images of
chewing gum, even toothpaste, as an attraction alongside their scary
headlines. Our body makes fifteen (15) grams of xylitol each day through
the processes of metabolism, but it is quickly and completely
metabolized, usually clearing away to baseline within an hour—and never
creating a buildup of xylitol in our body. It is unfortunate that media
reportage remains so focused on creating unnecessary fear by
disseminating inaccurate information.
Looking instead at statistics from countries where it has been
consumed commonly for over sixty years, it appears that even the elderly
should feel confident to follow sensible guidelines for the use of xylitol —
perhaps aiming for five (5) to ten (10) grams of xylitol per day and
spacing this consumption at the end of meals ideally with an hour
afterward when they do not eat or drink.

HOW MUCH SHOULD YOU USE?

The amount of xylitol required to protect the growing teeth of infants
and young children is less-than-half a teaspoon per day (2–3 grams). For
adults, the ideal amount is between one and two teaspoons daily (5–10
grams). In each scenario described above, the amount of xylitol needs to
make direct contact with teeth frequently each day, but the duration of
interaction can be short. This means we have a choice to either brush our
teeth with xylitol (by sprinkling the granular xylitol crystals on a damp
toothbrush) or to instead enjoy xylitol as mints or chewing gum at the
end of meals consumed during the day.
Xylitol loses some of its benefits when the crystals are dissolved in
water, but this application may be useful to brush or clean the teeth of an
infant or debilitated patient of any age. In every case, xylitol’s benefits are
multiplied when its frequency of use is increased, and when this xylitol
exposure is followed by a period of mouth resting, which is any time
when saliva in the mouth is allowed to remain without any change in
dilution. Put more simply, it is a time of “no eating or drinking”
whenever xylitol is consumed.
In 2006, the aforementioned Dr. Milgrom showed that adults need at
least three (3) grams of xylitol per day to create positive oral health
changes—while less than this may not create any visible oral health
changes, such as a reduction in plaque on teeth or improved gum health.
This is why it is suggested that one (1) to two (2) grams of xylitol be
consumed at the conclusion of every meal or snack, to create an ideal
frequency of ingestion about five (5) to six (6) times per day. When the
amount of xylitol consumed daily is above ten (10) grams, any effects in
the mouth will plateau—meaning that it does not appear to produce any
additional benefit to one’s oral health.
WHY XYLITOL? MY STORY.
My personal passion for xylitol grew to the point of starting a xylitol
mint and gum company in the 1990s. I had moved from the UK to live in
America but during this transition I had to wait to take the necessary
courses and for my dental license to be approved. This was an era prior
to Starbucks, and I was looking for a cup of cappuccino, so I decided to
open a coffee shop in Rochester, New York.
The first cafe was very small, but it quickly grew into a sizable
operation with over forty employees. I was aware that many of these
employees had poor oral health and inadequate funds for the dental
treatments they required, so I naturally introduced them to the benefits
of xylitol and made a peppermint flavored mint that we dispensed from
a gum-ball dispensing machine at the back of the restaurant. The
restaurant had a large bakery, and so it was common for employees to
snack on cookies, cake, and, of course, coffee and soda. Before serving
tables, the staff would regularly freshen their breath with a sugary breath
mint—the “icing on the cake” for placing them at risk for horrible
cavities and dental problems. The new breath mint I made was
formulated with one hundred percent (100%) xylitol—and flavored with
peppermint.

Something to Think About

It is important to note that xylitol is an expensive ingredient, which is why
many commercially available xylitol products contain percentages of
xylitol so low that they will not work effectively in my system of mouth
care. This is why it is so crucial to only select products that are made with
one hundred percent (100%) xylitol.

So, the new breath mints that I had created were embraced by my staff,
and soon became a daily routine in their lives—this simple substitution
for the sugary mints they were eating at their coffee breaks seemed to
have done the trick. Of course, they continued to enjoy sweet treats,
coffee, and some even smoked cigarettes—but now, by ending their
coffee break with xylitol, they suddenly saw stunning improvements in
their dental health.
This was also a time when I was working as Faculty at the University
of Rochester, under the guidance of a professor who had been involved
in the xylitol studies of the 1970s. I suggested that we should repeat these
studies, which had been conducted in South America, to prove the long-
term effects of xylitol. As the director of the outpatient pediatric clinic at
the Eastman Dental Center during this same period, I believed that we
could study how xylitol had the power to interrupt the transmission of
cavity bacteria from mothers to their babies. Furthermore, I maintained
that we could then use this research opportunity to help pregnant women
at the nearby maternity centers headquartered in Rochester, New York’s
Strong Hospital.
Using the normal protocol necessary prior to starting any research, I
tried to obtain funding for this study, but with no positive response or
show of interest from the funding authorities. I was told, in no uncertain
terms, that there was no money for a project that would not benefit
dentistry or the university. Mystified (and, frankly, shocked) by this total
lack of interest in finding a cure for cavities, I decided—there and then—
to further pursue the results of my discovery on my own. And so, I soon
resigned from my position at the university and drew out my retirement
savings to start my own xylitol company and teach the public directly
about the best ways to use xylitol.
As anyone with their own business knows, starting something new is
difficult. However, I ran into a lot of wonderful people—and a good
amount of luck—that proved invaluable to me on this journey. As I
pointed out earlier in this chapter, the mints that I had made for my
restaurant staff were made with xylitol (pronounced aloud as if the word
begins with the letter “Z”). The waiters merged this “Z” with my name
“Ellie,” and then simply added an “s”—thus giving an informal “in-
house” name to those little mints of mine, a catchy term that I would
soon elect to use as my new company’s name . . . Zellie’s.
Zellie’s was incorporated in 2004 and has grown steadily in production
and distribution over the years. This business has given me a wonderful
platform from which to continue teaching the science of oral health—but
I am no longer confined to medical and dental students alone. Instead, I
have elected always to educate anyone who is interested, and I have
continued to do so with: presentations in libraries, grocery stores tasting
tables, at various gatherings in hotel ballrooms and events, in groups;
through the production of an online video course; and, finally, on a near-
constant basis through all manner of social media.
To the immense frustration of anyone who cares about their teeth,
there still seems to be a hiatus in research around prevention of dental
disease—and a consistent failure to direct the knowledge and resources
that we have achieved at this point to eliminate this ongoing and
burdensome health issue. Considering all that we now know, it seems all
but certain that history will be especially harsh toward the profession of
dentistry if they do not soon start to accept this new paradigm of patient
empowerment—and willingly embrace a different and more patient-
centered approach to oral care.

HOW TO USE XYLITOL

For adults to fully maximize the benefits of using xylitol, the following
two basic steps are ideal:

1. Place one-eighth of a teaspoon (1/8 tsp.) of freestanding granular

xylitol crystals directly into your mouth or purchase a form of
xylitol that has been either compressed into a mint—chewing gum
is another suitable vehicle that can be sweetened with xylitol—to
then deliver a gram of xylitol directly into the mouth at the end of
meals. Most mints contain a half-gram of xylitol, so two mints—or
one piece of one hundred percent (100%) xylitol chewing gum—
will provide a gram of xylitol at the conclusion of meals and after
snacks.

As the xylitol dissolves in your mouth, it should be enjoyed for its taste
and then swallowed—like any other candy or mint. Mints can be sucked
or crunched up, and then swallowed. If you use gum instead, do not
chew it for longer than ten minutes—by which time the sweet taste
should be gone. Longer gum chewing will bring a different kind of
digestive saliva into the mouth, which will dilute and wash away the
xylitol-stimulated saliva that is most useful for healing the gums and
teeth.

2. It is ideal immediately after each xylitol exposure to have a period

when you do not eat or drink for at least an hour—something that I
call mouth resting. This allows saliva with xylitol dissolved in it to
interact with the mouth and teeth, and for xylitol to work in what
is called a prebiotic capacity, which serves to nurture the mouth’s
population of good bacteria.

Be forewarned, though, that if you snack on xylitol too frequently

(without giving the mouth adequate resting time between), you may
actually lessen its positive effects. Constant snacking on xylitol or trying
to orchestrate a way to keep it in your mouth for longer periods (as
opposed to just enjoying and swallowing it) may cause areas of exposed
root dentin to feel temporary sensitivity. This does not damage your teeth
or gums, but it is an unnecessary and painful sensation that is more
probable if you have thin enamel, exposed root areas from gum
recession, or an unfilled cavity in your mouth.

Something to Think About

Be aware that when it comes to the maintenance of a healthy microbiome
in the mouth, the use of probiotics—or living strains of good bacteria—will
not work in the same way as they function in the digestive tract. It is
important to distinguish carefully between digestive and oral probiotics,
since research shows it is very difficult to introduce any new strains of
bacteria into the oral microbiome. The best approach is to support oral
bacteria by giving them time to interact with saliva periodically throughout
the day, and support saliva health by a good diet that promotes digestive
health.

Xylitol’s beneficial effect happens because of its ability to pull saliva

into the mouth—a process known as a hygroscopic pull. The saliva that is
thus attracted into the mouth is the magical liquid that will help to heal
your teeth and gums, provided we allow time for this particular
interaction to occur. Success with xylitol is achieved most effectively
when you stop overthinking the “dental” nature of xylitol—and just
enjoy the taste and fun of eating it!
Many foods and supplements improve digestive health by nurturing
healthy digestive bacteria, and there are so-called digestive prebiotics—an
assortment of non-digestible fibers found in various vegetables, fruits,
and whole grains—that help to feed these good bacteria in our digestive
tract. It is wonderful to know that xylitol functions as this kind of fiber
and works as a prebiotic to support specific gut bacteria that produce a
health-promoting compound (known as a short-chain fatty acid called
butyrate).
New research indicates that butyrate may have an impact on blood
glucose regulation, and consequently a neuroprotective effect on our
brain. Butyrate also helps to strengthen the gut’s barrier lining, which
can aid in reducing the risk of deteriorative digestive conditions. When
the gut lining is damaged, this allows substance to leak from the inside of
the gut and migrate to the outside. This means that substances and
bacteria that should rightfully remain inside the gut walls instead begin
to “leak” elsewhere throughout the body, where they can initiate a severe
inflammatory response that can cause many more unpleasant symptoms
for the patient. These problems occur because there is excessive intestinal
permeability (known more popularly as “leaky gut”), and the most
common trigger for this—according to the Cleveland Clinic—is the
chronic overuse of antibiotics, alcoholic beverages, and/or popular over-
the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin
and ibuprofen.
After Antibiotics
Another opportunity for xylitol to improve oral health occurs during and
after any course of antibiotics that you may have had prescribed for you.
Antibiotics are used for all kinds of bacterial infections and each course
will exert a widespread effect on the body’s entire bacterial population.
No matter the reason for an antibiotic prescription, the effect will
simultaneously reach and potentially disable bacteria everywhere in
your body to some degree—often with the greatest impact on the mouth
and digestive bacteria. This is why, following a course of antibiotics, we
can jump on this and see it as an opportunity to refresh our digestive and
oral bacteria and improve them.
Digestive or “immune health” probiotics (defined earlier in this
chapter) may be useful following a course of antibiotics, but I suggest
you focus on eating foods that are supportive of your immune health and
high in fiber at the same time. This would be foods like mushrooms,
garlic, onions, green leafy vegetables, avocado, fruits, and salad greens
for a start. The goal is to support your digestive health and, in this way,
influence and improve the uptake of minerals from all the foods you are
consuming. These minerals will circulate around your body and find
their way into your saliva liquids, which then helps to support your oral
health. Taking an oral probiotic (as opposed to a digestive probiotic)
would be less important—and at the present time, there are not enough
studies to indicate specific long-term benefits from these expensive
supplements.

Ear, Nose, and Throat Infections

At first glance people are surprised by the link between mouth bacteria
and ear, nose, and sinus infections. You will recall that in Chapter Two
we looked at the anatomy of the throat; how it connects the nasal
passages to the mouth; and how tubes run from the back of the throat
and into our ears. Otitis media is an infection inside these ear tubes, and
children between the ages of six (6) months and two (2) years old are
frequently affected because, at this age, these tubes lie horizontally,
which allows saliva to access the entrance of these tubes.
The American Academy of Pediatrics (AAP) reported in 2000 that
doctors wrote more than 800 prescriptions for every thousand children
they treated for ear infections. The use of antibiotics can develop drug-
resistant bacteria and upset the child’s digestive health early in life.
Children with recurrent ear infections are at higher risk for learning
problems, not to mention the pain and suffering these children and their
families experience. By reducing sticky plaque bacteria in the mouth and
nasal passages with xylitol, this can limit the potential for sticky bacteria
to gain access to these ear tubes. Studies show that young children using
xylitol preventively in the form of xylitol mints or as a xylitol nasal spray
experienced forty-two percent (42%) fewer ear infections, especially
children prone to respiratory problems.

BAKING WITH XYLITOL

In the year 2000, I was asked to speak at a hygiene conference in
Syracuse, New York. To introduce these hygienists to the wonders of
xylitol, I provided coffee and brownies to them all. I explained the oral
and general health benefits of xylitol and then shared the xylitol treats
with my intrigued and excited audience. Many of those first converts
remain enthusiastic proponents of xylitol today.
Karen Edwards was the xylitol enthusiast who introduced to me the
idea of baking with xylitol. Karen is a nutritionist who wrote a book in
2003 titled Sweeten Your Life the Xylitol Way. She has baked with xylitol
for years and has developed a line of dessert sauces under a brand called
Karen’s Kitchen, Inc. The main problem with using xylitol for cooking is
that if people suddenly eat large quantities of xylitol—to eliminate sugar
from their diet—they can notice a laxative effect at first, because xylitol is
digested as fiber in the gut.
The best advice is to first experience xylitol gradually, especially if you
are replacing sugar in your diet. Personally, I believe there are many
healthy options for sweetening foods, including maple syrup, honey,
stevia, raw cane, allulose, monk fruit, and coconut sugars. For myself, I
prefer to enjoy lots of different sugars in cooking and use xylitol as a
tooth-friendly ending to meals. Granular xylitol is found in the baking
section of most health food stores, in bulk bags or teaspoon-size packs.

Warning—Not for Dogs!

The only warning I would give you about xylitol is that it should never
be given to pets—and dogs, in particular. Keep xylitol candies, mints,
gum, and other products out of the reach of pets. There are many
delicious human foods that are not good for dogs—grapes, chocolate,
raisins, and avocado––to name a few, and xylitol is yet another of these
foods.

SWEET CONFUSION
Most people who know the difference between natural and artificial are
quite confused in the world of sugar alternatives. Not all sugar
replacements are artificial and there are many naturally-occurring low-
calorie sugar alternatives derived from plants, and fruits like raisins and
figs—products like stevia, monk fruit, and allulose. Some of these are
intensely sweet, whereas others closely resemble the texture and taste of
sucrose sugar. Combining stevia powder with monk fruit, for example,
makes the intensely sweet stevia more manageable when mixed with the
less sweet and bulkier monk fruit sugar.
Be warned that naturally derived sugar alternatives can also be mixed
with one or more less expensive artificial sweeteners—products that often
have alluring, industry-created names like Truvia, EverSweet, Splenda,
Sweet ’n Low, or Equal. Artificial sweeteners have been promoted in the
United States for decades, allowing consumers to assume they are safe,
but in the world of sweeteners, names and appearances are deceptive.
There is also a confusing classification of products called sugar alcohols.
Xylitol lives within this group although it should really be set apart
because it has a different chemical structure from other sugar alcohols.
None of these sugar alcohols has any likeness to the liquid we call
“alcohol;” the name is a chemical description of their molecular
structure. Xylitol, for example, is a pentose or five-carbon molecular
structure. All other sugar alcohols have a six-carbon structure which is, in
fact, similar to the six-carbon structure of sucrose sugar.
Unfortunately, many dentists are equally confused by all these
different sugars and classifications, even though studies show there are
big differences in oral health impact between chewing xylitol gum and
chewing gum sweetened with the carbohydrate compound called sorbitol.
Xylitol is expensive and so many commercial gums and candies mix it
with cheaper variants––often sorbitol, or the sugar alcohols mannitol or
maltitol. Frequent consumption of sorbitol can, however—after several
grams have been ingested—start to feed plaque and cause stomach
cramps and digestive discomfort. This is why there is a big difference
between xylitol and sorbitol and why it is important to never give sorbitol
to children under the age of three, or to adults at risk for acid reflux.
The body utilizes xylitol in a way that is in total contrast to refined
sucrose (sugar), and different from the sweetener sorbitol mentioned
above. A small amount of pure xylitol each day can play an important
part in helping infants and young children grow up with healthy teeth—
and it is equally useful for healthy aging. Studies show xylitol’s positive
effects on the digestive microbiome, promoting communities of bacteria
that create a short chain fatty acid known as butyrate, a compound that
improves the health of our digestive tract lining to allow better
absorption of minerals from the foods we eat. The health of our digestion
often deteriorates with age; compromises our immune system; and opens
the door to new, or more severe, chronic health conditions, which can
become progressively more debilitating in later life—conditions such as
diabetes, arthritis, cognitive decline, cardiovascular events, and even loss
of bone density.

CONCLUSION
It seems an understatement to declare xylitol a revolutionary and
healthful product. Using xylitol is not only a pioneering idea, but it is the
first natural product poised to radically—and wonderfully—disrupt
dentistry’s old understanding of cavities and plaque. Initially, medicine
had no understanding of germs—for thousands of years, doctors
believed that disease was caused by imbalances in four body liquids
called humors. Medical treatments from this era appear cruel and barbaric
when we think about how illness is treated today, but physicians were
helping patients in the only way they knew at that time. Dentists have
tried to follow in the tailwinds of medicine, but they have been unable to
find pharmaceuticals to stop cavities or gum disease. This is why
dentistry clings to what it sees as its only apparent option: tooth
amputation (drilling), prosthetic replacement (fillings), and mechanical
dental cleanings.
Now is the time for a major shift in the way we care for our teeth; for
dentistry to embrace healthy mouth bacteria as allies for oral health and
to more deeply question its approach to cavities and gum disease. This
new vision empowers every individual to take charge of their personal
oral health, and xylitol becomes a precious resource in this endeavor. I do
not believe xylitol is a miracle health panacea. However, if we work to
develop healthy habits, offer our body adequate periods of rest and
regeneration, and work toward a diet that includes a wider diversity of
healthy foods, then I am convinced xylitol can be a solid partner in all of
our oral health efforts.
In the next chapter, we are going to explore how xylitol and my
Complete Mouth Care SystemTM can provide far-reaching and
potentially surprising benefits to anyone prepared to test the idea that
cavities and gum disease are not only controllable, but even reversible.
 8. When Your Mouth Goes South—
How to Stop High-Risk Dental Issues

We delight in the beauty of the butterfly but rarely admit the changes it has
gone through to achieve that beauty.
––MARGUERITE ANNIE JOHNSON (MAYA ANGELOU), PIONEERING AMERICAN POET

I t’s human nature to want a “quick fix” for our problems. In the dental
world, there has remained—since the late 1800s, in fact—the idea that
dentists provide a quick fix as they drill and fill teeth. Originally, fillings
had seemed to be a great alternative to tooth extractions. We now
understand, however, that each of us has the power to prevent tooth
damage, reverse early cavities, and avoid unnecessary dental drilling,
fillings, and other treatments.
If you are someone who has already experienced what has seemed like
a never-ending history of dental problems, failed procedures, and
extreme dental expense, then you know firsthand how frustrating it is to
hear that cavities can be prevented and even reversed . . . while you have
been seemingly excluded from these solutions. The first thing to know is
that it is never too late to gain control of your mouth health, and this
chapter is going to further explain how it can work for you (with the use
of xylitol, and the additional benefits delivered by my Complete Mouth
Health SystemTM).

“PERFECT STORM” DENTAL CHAOS

When it comes to oral health woes, the reality is that dental problems are
created by a confusing mix of circumstances that function as a kind of
“perfect storm” environment around our teeth. Despite so many
advancements in the world arena when it comes to new technology and
medical research, dentistry still has never found a solution to combat the
less-than-ideal conditions that cause tooth and gum damage—and so it
continues to focus on ways to repair the damage and dissipate any
accompanying pain and discomfort.
There is only one way to stop these ongoing issues, and that is to
address the underlying cause of dental problems. Since there is no single
product that can remedy a combination of perfect storm conditions,
dentistry considers these problems to generally be genetic in nature—and,
therefore, all the disease and damage lies outside, and beyond, our
control.
The truth is that, with the use of my Complete Mouth Care SystemTM
and the kind of consistent xylitol-based strategies first discussed in
Chapter Seven, you can forge a path out of all this dental health chaos.
Many of the solutions for dental problems that have been proposed by
traditional dentistry create a new cascade of unexpected consequences.
This is the dental dance you may have personally experienced—one step
forward, three steps back. A dentist fills a cavity in your tooth, but then
the enamel cracks . . . a gap opens up between the filling and the enamel .
. . liquids and infection travel under the filling . . . and now the filling
fragments and fails . . . and the cavity is so deep it has killed the nerve, so
now you have a dead tooth that needs a root canal . . . then a crown . . .
an extraction . . . perhaps then an implant. Then another tooth begins to
experience the same story—one tooth after another. Sound like a
nightmare to you? You’re right, it is!
All those who have experienced this sequence of events will surely
now be nodding their heads, relieved and comfortable in the knowledge
that I understand what they have suffered. On the other hand, I realize
there will be others who think this story is just alarmist. The fact is that if
you have a dry mouth, or are someone with acidic saliva, then this is
likely an exact replay of your dental misery—even if you are someone
who has flossed and brushed religiously and gone to every dental
cleaning. Why does this only happen to certain people? Of course, you
could believe it is your fate or that you have inherited these problems—
but this is untrue. The solution is entirely within your reach, and it lies in
balancing your mouth health with the strategies I recommend.
 Over the years, dentistry has looked for solutions and ended up being
compulsively attracted to a multitude of “shiny new things.” This slew of
new products and ideas became popular recommendations in dental
offices for a while—that is, until frustration and disappointment
inevitably arose. Do you remember fluoride gels, remineralizing pastes,
or maybe the charcoal method? Charcoal, it turns out, became the
“darling” of the dental world around 2018 as people began to search for
more “natural” ingredients in their oral care products. There was never
any evidence of an advantage from using charcoal, but the claims of
marketers created its fleeting fame. In the early 2000s, even toothbrush
filaments were coated with it; black toothpaste was made with it; and
influencers on social media seemed certain that charcoal was the best
“way” to whiter teeth.
In 2001, a study published in the Journal of Dental Research, and another
in the International Journal of Dental Hygiene looked at the abrasiveness
and whitening effect of charcoal-containing toothpaste. This was a time
when people began to complain that charcoal was making their teeth far
more sensitive to changes in temperature, and that their tooth enamel
was wearing away. The abrasiveness of the toothpastes on enamel and
dentin was studied and found to range broadly. Finally, after these
studies the American Dental Association (ADA) warned of the abrasive
nature of charcoal and the fact that toothpaste is more effective when it
contains a little fluoride. As one product exits the stage, the next enters in
an ongoing performance to introduce the next acclaimed “shiny new
thing.” Some of us view this as a cruel and senseless game of dental
hijinks that may give you hope for a while but will never actually
provide a solution that stops the painful, damaging, and expensive
problems of cavities and gum disease.

Xylitol as “Shiny New” Outlier

So, why hasn’t xylitol ever been introduced as a “shiny new” dental
solution? The reason may be that xylitol is not new and does not offer a
simple solution to dental problems. Xylitol is a unique tool that must be
used in a specific way so that it allows the mouth to heal itself. It requires
that we are consistent in our daily use and that we have a diet and habits
to support its actions. There is no way to promote xylitol as a dental
“miracle” product—and it does not perform as effectively in the form of
a toothpaste or mouth rinse as it does when it is consumed as an after-
meal candy or gum.
This message may have been too difficult in past years for dentistry
and was perhaps seen as too complex a concept for dental marketing. A
smattering of television advertisements from the 1990s can be found on
YouTube, in which xylitol was in fact promoted as being better than a
toothbrush and an accepted routine for adults and kids to enjoy before
going to bed at night. You can even find advertisements for xylitol
toothpaste made by the Colgate-Palmolive corporation during this
period.
The dental industry itself was, for a moment, frustrated by its lack of
control over cavities and gum disease. Any dentist in the early 2000s who
was interested to solve the increasing and serious problem of decayed
teeth in America may have participated in an idea proposed by the
American Dental Association (ADA). We were actively encouraged to
become accredited “evidence-based champions”—to learn more about
statistics and how to evaluate the quality of research, and to become
more fully aware of the system or processes with which to correctly
assess published studies.
Following participation in this course, we were then invited to attend
an evidence-based conference in Bethesda, Maryland, hosted by the
National Institute of Dental and Craniofacial Research. This professional
gathering was organized to closely examine groups of studies and, with
the help of top scientists, determine from the best evidence how dentists
should help prevent and manage cavities and tooth decay.
I can still recall the shock that there was really no evidence to support
brushing, flossing, or even fluoride supplementation. I also remember
just how strongly xylitol emerged as the biggest topic of enthused
conversation during that conference, and it was immediately introduced
by the US military to help deployed soldiers ward off cavities in a
program called “Look for Xylitol First.” Dr. Catherine Hayes, an
associate professor in the department of Oral Health Policy and
Epidemiology at Harvard University, ended the conference with her
comment that it could be perceived as unethical to deprive people of the
benefits of xylitol as it can “significantly decrease the incidence of dental
caries.”

WHAT ABOUT TOOTH SENSITIVITY?

Perhaps you are someone who is plagued by tooth sensitivity, an
uncomfortable sensation in your mouth that is a definite cry for help—
from your teeth. Trust me, you do not want to silence this alert by using
sensitive or mineralizing pastes designed to numb the sensation. Why?
Because this will not address the underlying cause of the problem . . . and
more damage may ensue. Sensitivity pastes can dull the pain felt in your
teeth, especially when this involves any root dentin that may have
become exposed in your mouth. These pastes frequently desensitize the
tooth by creating a plug made up from a tin compound that works as a
barrier substance over the exposed dentin. This will provide immediate
relief, but since the underlying problem has not been addressed, more
damage can occur and result in more problems elsewhere in the mouth.
This is good news for the makers of solution-based toothpastes—but if
you are concerned about your future oral health, these pastes are not
your friend. The other problem with desensitizing pastes is that they may
create a deposit or barrier that prevents natural healing—perhaps even
permanently.
This is why sensitivity is better addressed by using xylitol at the end of
meals, followed by a period of mouth resting (which will be explained in
detail in Chapter 9). This is really a time, after using xylitol, when you do
not eat or drink anything for an hour or two. This strategy allows your
own saliva to heal the defects in your enamel in a natural and permanent
way—not as a plug on the outside, but by helping to grow the enamel
crystals and making them a more perfect shape. This is a slower process,
and it may take a week or more for the sensitivity to go away—but it will
be a natural repair, not fake plugging of your porous dentin or enamel.
The use of my Complete Mouth Care SystemTM (described in Chapter
Six) will help to speed up this entire process.

SPECIAL CARE SCENARIOS

Adults who experience a lack of saliva flow in their mouths are normally
aware of an uncomfortable feeling of dryness. This condition, known as
dry mouth, can be the result of many things, including: a side effect from
medication; a response to prolonged stress or hormonal changes; any
form of sustained physical damage from chemotherapy and/or radiation
treatments; or perhaps even as the result of an autoimmune disease like
Sjogren’s syndrome or scleroderma, each of which can lead to
circumstances where the salivary glands become dysfunctional and can
no longer produce saliva.
Even those with low or absent normal production of saliva can be
helped by xylitol, and it is highly recommended for people with any of
these conditions—and with dosage recommendations that are the same
as for all adults. Studies show that when xylitol is used as suggested,
even for people with dry mouth, it can reduce their risk for tooth decay
(in that vulnerable portion of the mouth where the root of the tooth
meets the crown of the tooth) by a remarkable forty percent (40%).
Patients report significant improvements in their sensation of mouth
dryness when they start using xylitol, and particularly if they learn to
follow it with periods of mouth resting—in place of the intermittent
water sipping that we first discussed in Part One.
During the first four (4) weeks of xylitol use, you will likely notice a
cleaner surface on your teeth when you look in the mirror—the result of
an initial reduction in plaque. Over the next five (5) months, there will be
even less plaque-forming bacteria in your saliva. After a solid six (6)
months of xylitol use, there is normally a consistent ninety-eight percent
(98%) reduction in any kind of plaque in the mouth—either on teeth or
floating around in your saliva. And this can certainly be something to
smile about.

MOUTH ACIDITY
Any of us can encounter the complications that accompany the presence
of acid in our mouths. However, most women in particular have no idea
that their dental problems can begin when they are in their teenage years,
provoked by the unrecognized damage caused by mouth acidity.
Hormonal shifts can cause a young female mouth to be far more acidic,
and for much longer durations, than occur in healthy young male
mouths. During pregnancy, women frequently encounter a variety of
problems created by acidic saliva, which puts their teeth at risk for
cavities and their gums at risk for gingivitis. Mouth acidity and dry
mouth are the two main reasons underlying dental disease, and these
problems cannot be solved by brushing, flossing, or with dental
cleanings.
In addition, many people are shocked to discover how sugar-free and
so-called “diet” products can contribute to cavities and promote harmful
mouth bacteria, chiefly because of their acidity. Trust me when I tell you
to never believe that a sugar-free product is ever safe for teeth. Diet soda,
for example, can cause as much—and likely more—dental damage than a
sugar-containing drink, and that is because of soda’s extreme acidity.
Even children’s sugarless chewy vitamins or melatonin tablets can
contain a dentally harmful, non-digestible substance called an
oligosaccharide, which is classified as sugar-free because it has no calories.
The reason for concern around oligosaccharides is because they give
energy to harmful plaque bacteria—and, in this way, they can potentially
cause cavities.
Even carbonated water is problematic, whether sweetened or not.
Adding a citrus flavor to this water will make it even more caustic to
teeth, especially if it is sipped for over an hour, rather than being
consumed within five (5) to ten (10) minutes. To protect your teeth from
this kind of beverage damage known as erosive tooth wear (ETW), xylitol
can provide a simple and effective answer. The protection is achieved as
xylitol stimulates a flow of saliva that will be more alkaline than even
your resting saliva. This improved or raised pH combats this acidity and
neutralizes it, while also providing minerals that can help to heal any
damage caused by the acidic attack.
Many people assume that baking soda is a useful product to raise one’s
mouth pH level, but a pH higher than 7.4 is not helpful. Baking soda
creates a dissolved pH of 9—but it is baking soda’s own caustic nature
that strips the mouth’s natural protection from tooth surfaces, leaving
teeth more vulnerable to erosion, and the skin of the mouth to ulceration,
and the gums to recession.
A 1970s study showed that a paste of baking soda and peroxide could
eliminate an aggressive gum disease called Acute Necrotizing Ulcerative
Gingivitis (ANUG), but the study came with a warning that prolonged
use would cause gum recession and tooth sensitivity. Indeed, baking
soda may clean debris off a tooth surface and make teeth immediately
look whiter—but the long-term consequences of recession and tooth
sensitivity should be balanced against this benefit.
To remove tooth stains, a safer method is to add a half-teaspoon (1/2
tsp.) of xylitol crystals, sprinkled over the toothpaste on your toothbrush.
Target any tooth surfaces that are stained with this paste for a few days,
either used alone, or as a normal part of my Complete Mouth Care
SystemTM. (See previous Chapter Six for more details on my system.)
These xylitol crystals will act as an exfoliating scrub, but they will never
raise the mouth pH level above 7.4.

BACTERIAL COLONIZATION IN THE MOUTH

The tension between good and bad bacteria in the mouth is clearly seen
when we examine colonization, which is a formal term for a process
whereby teeth become infected and covered by bacteria as they enter and
grow as a new tooth in the mouth of a child or teenager. Hundreds of
kinds of healthy bacteria generally mix with plaque bacteria and form a
diverse bacterial collection, which floats throughout our mouth and is
carried around in the liquid we call spit or saliva. (See Chapter Three in
Part One for a fuller previous discussion of saliva.)
These floating—or planktonic—bacteria comprise around twenty
percent (20%) of the mouth’s total bacterial population, but this selection
of bacteria is easily sampled with a spit test, and it can provide a good
representation of the mouth’s overall bacterial mix. Plaque bacteria are
invisible as they float in saliva, but they become a dental problem if they
multiply into visible colonies—something that can only occur if these
bacteria become firmly planted on the hard, non-shedding surfaces of
teeth.
Infant teeth form in the jaw before birth, but they begin to appear in the
mouth around six (6) months after birth. The baby’s saliva will flow over
these teeth—and, consequently, any floating plaque-forming bacteria in
this saliva will immediately land on these teeth and colonize the tooth
surfaces. Plaque-forming bacteria latch tightly and multiply rapidly,
which puts teeth at risk for developing cavities. To prevent plaque
colonization from happening, it is important to clean new baby teeth as
soon as you notice them in your child’s mouth.

Clean Baby Teeth with Xylitol

Use a total of a quarter of a teaspoon (1/4 tsp.) of xylitol each day to
discourage plaque-forming bacteria from latching onto, and multiplying
upon, new baby tooth surfaces. You can dissolve the xylitol crystals in an
ounce of warm water and use this solution three (3) or four (4) times
during the day—possibly starting after the first feeding, or at another
time when your baby is awake and happy. Apply the xylitol solution
with a baby toothbrush, a soft cloth, a clean glove, or something called a
“finger toothbrush,” which is designed to fit directly on an adult’s finger
so that a baby’s teeth can be brushed softly and safely.
When you take this action on behalf of your baby, always make sure to
reach the areas where teeth meet the gums—particularly since plaque
can easily stick to the front surfaces of baby teeth, underneath the upper
lip. The process should take no more than two (2) seconds and should be
repeated three (3) or four (4) times daily. This will help protect baby teeth
from cavities during the first years of life—something that is especially
important if you are nursing your baby at night.
While xylitol works to defend baby teeth from plaque, it is also helping
to nurture healthy bacteria and encourage their colonization on teeth.
This becomes highly valuable, as baby molars grow and begin to break
through the gum during the second year of life. New adult molar teeth
will also become quickly colonized by the first bacteria to reach them, as
they typically enter the child’s mouth during kindergarten years. The
first bacteria to enter the surface grooves of baby or adult molars will
gain an advantageous foothold—and this will create a pronounced effect
on the child’s future oral health. This is why the earlier in time that
infants and toddlers’ teeth are exposed to xylitol, the better the chance
that their new teeth will be colonized by healthy bacteria—and this,
luckily, will only increase the child’s opportunity of enjoying future oral
health.
Anyone who caretakes infants or young children may also consider
“cleaning” their own mouths with xylitol, in a concerted effort to
decrease any chance of passing plaque-forming bacteria in saliva
droplets from their mouth to those of these children. Adults should not
be terrified of this risk or avoid interacting with a baby as a result.
Instead, parents, family members, and caretakers should all actively
consider steps to raise their potential for sharing healthy bacteria with
their children—and capitalize on this entirely natural process of bacterial
transfer, which will increase the diversity of oral bacteria in an infant’s or
toddler’s developing mouth.

CAVITIES FOR CHILDREN AND TEENS

A consistent daily regimen of xylitol during early childhood has been
shown to virtually eliminate the risk that cavities will occur in children’s
teeth. This has been reported in many studies but has been practically
applied for over sixty years in the public health programs of European
countries such as Scandinavia and Finland. Dentists have observed—and
microbiological testing confirms—that if a child’s mouth has cavities
(caused by harmful plaque bacteria) by the age of four, this child will
most likely have poor oral health as an adult. This explains the pivotal
importance of baby teeth in the fight to help a child avoid cavities early in
life.
A largely unknown (and often misinterpreted) fact is that harmful
cavity bacteria travel in droplets of saliva from person to person. This is
how parents with plaque, cavities, or fillings can unintentionally infect
their baby’s new teeth—and therefore greatly increase the likelihood of
early tooth decay. The movement of harmful mouth bacteria occurs
within an invisible cloud of microscopic particles that sprays out of our
mouths whenever we talk, sing, or kiss our friends, family, or children.
Teeth can never remain entirely sterile, so the goal is to nurture healthy
protective bacteria that will colonize and cover baby teeth as early as
possible in life.
Parents, grandparents, siblings, babysitters, and even caretakers with
healthy mouths can—and should—share their healthy bacteria with
infants and young children alike. If you are not sure about the relative
state of your mouth health, there is no sense in trying to avoid singing a
song or kissing your baby. Instead, you need only appreciate how
quickly, and easily, plaque-forming bacteria in your mouth can be
eliminated—and healthy bacteria nurtured—through the regular use of
xylitol.
Ideally, a xylitol program should begin at least a few months before a
baby begins to socialize widely with your family. This early preventive
approach appears to control bacterial transmission and can lower a
child’s immediate and future risk of decay (offering protection to
children even up to the ages of six to ten years old) by more than eighty
(80%) percent.
This is why developing a xylitol routine is so great—even before
pregnancy. If you want to know if xylitol is safe when you are pregnant,
a study presented in 2022 clearly demonstrated its potential benefits. In
that study conducted between May 2015 and October 2021—led by a
team of gynecologists from Baylor University in Texas—two single-gram
pieces of xylitol gum were given every day to more than 10,000 pregnant
women in the East African country of Malawi, starting either before or
within the first twenty (20) weeks of their pregnancy. (Pre-term birth is
the leading cause of death worldwide for children under five years of
age.) The women ate one piece of xylitol gum after lunch, and the second
piece before going to sleep each day. While the long-term oral health of
the babies was not a component of this study, the researchers did find a
twenty-five percent (25%) decrease in the number of babies born
prematurely—a major health challenge for the Malawi population. The
pregnant women also noticed improvements in their own collective oral
health—a result that the lead author of the study, Dr. Kjersti Agaard, has
maintained provides the closest thing to proof that a mother’s healthy
mouth is linked to a lower risk of premature birth.
Another way to control plaque (as described previously in this chapter)
is to brush or wipe a few xylitol crystals directly (or dissolved in water)
onto baby teeth, starting as soon as they emerge into the mouth. If you
have missed the chance to introduce xylitol into your family early in your
child’s life, don’t worry—there are more opportunities to do so.
For example, a good time is as a child begins to eat solid foods at the
age of two (2)—the start of what is known as the toddler stage. Soft xylitol
mints in child-appropriate flavors can be eaten at the end of meals, and
again before sleep time. It is safe and beneficial to have these mints after
brushing teeth, as this will ensure that your child’s mouth is protected
during the night—especially if tooth brushing becomes a struggle.
Studies show that the regular use of xylitol may also help to reduce the
risk of otitis media ear infections for a child, which is an especially
painful problem that can often occur during this stage of childhood.
The next window of opportunity to impact your child’s oral health is at
the kindergarten stage, around the age of five (5) or six (6), when new adult
molar teeth begin to grow—or erupt—into the mouth. Both baby and
adult molar teeth have a wide and crinkled biting surface. The grooves
and pits in these teeth are home to critical bacteria, so it is crucial to
ensure that these are healthy bacteria and not cavity-forming ones. This is
why it is prudent to introduce xylitol into your child’s daily routine prior
to the appearance of these molars—ideally, six (6) months before they
enter the mouth. When deep grooves of molars are populated by healthy
bacteria, this preferred state can help protect future adult teeth and help
promote a more permanently stable bacterial population in your child’s
mouth.
When children use xylitol early in life and consider oral care as
enjoyable and fun, this can be a wonderful foundation for future dental
experiences. The final adult teeth––the wisdom teeth––often find their
way into the mouth later in adolescence and teendom (9–19 years old), and
sometimes even later. This is a time when plaque transmission can be a
problem, shared between teens who have less than perfect oral care
habits. Wisdom teeth are hard to access, and they grow slowly and often
at a strange angle, making them difficult to clean.
This can also be a time when your teen may have less interest in caring
for his or her teeth. Gum disease can begin around any adult tooth, and
certain periodontal bacteria secrete a substance that dissolves in water to
make it taste foul. Stop your teen from spiraling down the road to
periodontal disease if they dislike the taste of water, and before they
become hooked on stronger tasting and more mouth-damaging energy or
soda drinks, which can make cavity and gum problems worse—and
potentially cause exaggerated issues that may involve their digestive
health or impact sinus, ear, and/or respiratory health.
Teens usually love the delicious flavors of xylitol gum and mints,
which will always be useful—although for ideal mouth health, it is better
(as discussed in Chapter Six) to combine xylitol with my Complete
Mouth Care SystemTM. What matters most, of course, is that they are
guided in the right way so that they come to regard oral health care as a
necessary—and even enjoyable—part of their life.

REVERSAL OF CAVITIES
Long-term studies undertaken in the Belize region of Central America
from 1989 to 1994 were able to document how cavities in some of the
study subjects had reversed during the study period. Careful
examination indicated that tooth decay stabilized in the xylitol group—in
both the outer tooth enamel and inner dentin—and, in some of the cases,
the cavities had completely healed.
Arguments from dental authorities in the United States claimed these
studies lacked a control group. This would have been a group of children
given sugar to eat, so as to show the differences between their teeth and
the xylitol group. Obviously, this was not a possibility, but many years
ago the University of Turku (mentioned earlier in Chapter Seven)
navigated the problem and created equipment called a caries model—an
artificial mouth with real teeth and saliva. Sugar was introduced and
cavities formed, as opposed to the other mouth that was contrasted with
the results obtained if xylitol was used to prevent cavities.
All of this should prove one thing to you—just because your dentist
hasn’t offered you a home-based solution to your tooth and gum issues
doesn’t mean that there isn’t one. There is, and I hope that now you feel
confident to explore xylitol in your own family.

CONCLUSION
Life and unexpected career choices have exposed me to an interesting
series of varied dental experiences. My compassion for phobic patients,
and the fortunate discovery of a solution to dental problems, has directed
me to teach this strategy for decades. My Complete Mouth Care
SystemTM allows people to experience a change in their mouth health
and a way to sustain this improvement day after day.
In the next chapter, we are going to explore what I like to call the Four
Keys to Preventive Mouth Care. To get an even firmer grasp on what’s
happening around and between the molars, canines, and incisors that
make up your smile, read on!
 9. The Four Keys to Preventive Mouth
Care—Unlocking All the Doors

The eye is the window of the soul, the mouth the door.
—HIRAM POWERS, NINETEENTH-CENTURY AMERICAN SCULPTOR

I magine that you find yourself in a barren corridor with nothing but
four doors—all locked against you. Desperate to break free from this
confinement, you reach into your pocket and discover a set of four
invaluable keys that can unlock all the doors . . . and provide you with
unencumbered access to the wonderful castle beyond that hallway. Now
consider the castle as a healthy mouth; the hallway as the isolated trap of
dental disease; and those four keys as the priceless steps toward better
oral care that I am now about to share with you.
The following four keys are valuable ideas that can improve your
dental health for the rest of your life. Does this sound like an exciting
opportunity you are eager to take, or does it scare you to consider that
you may need to make changes? If you are feeling unsure about trying
something new for your dental issues, don’t beat yourself up over this.
After all, new concepts often bring uncertainty, but that is why you have
already been presented in earlier chapters with descriptions of the way
teeth repair; the usefulness of good mouth bacteria; and all the whys and
wherefores concerning cavities and gum disease.
These four keys that follow are solutions to give you a way out from
ongoing dental treatments, and a pathway so that you can become
empowered to control the environment in your mouth—and achieve the
outcome you desire for your oral health.

WHAT ARE THE FOUR KEYS?

These keys are concepts that will assist you to stop, prevent, and even
reverse problematic disease in your mouth so you will have a life with no
more painful cavities or destructive gum disease—problems that have
affected people around the world since the dawn of civilization. You can
prevent cavities before they start, and you do not need to allow fillings to
fail, drilling to kill your teeth, or gum disease to fester in your mouth. And
it is entirely rational for you to be wary of the way our current dental
paradigm allows older citizens to experience increasing dental expenses
and worsening oral health as they age—issues that may contribute to
chronic inflammatory health problems and impact their overall
enjoyment of life.
Each key is one of four critical components that impact oral health.
Some of this advice may be in opposition to instructions you have been
given by your dentist or hygienist, and I know many people who love
their dentist too much to contradict them, question them, or take a
different approach on their own. If this is your situation, perhaps read
this chapter and simply take notes. You can then bring your findings with
you to discuss at your next dental visit.
My goal is to help you develop a strategy for dental health—making
simple changes that boost your success and that make the journey more
enjoyable. You will quickly notice how these puzzle pieces intertwine
and connect. I will not repeat information about my Complete Mouth
Care SystemTM or xylitol, since these have been described respectively in
Chapters Six and Seven. Instead, we will look at how to achieve oral
health in a more universal and—for those who live outside the US—
globally accessible format. This chapter will be useful for people in
countries where the products named in my system are not necessarily
available. The hope is that this advice will be useful for everyone who
wants improved mouth health.
This is why we are going to address:

How to clean your teeth (effective daily oral care);

The power of saliva to improve oral health (mouth resting);
What to eat (healthy diet and meals); and
 Body healing (digestion, immune health, and stem cell science)

THE FOUR KEYS

The following offers concepts and protocols that touch on areas of
science in general—and biochemistry, in particular—that will likely go
beyond what you may or may not already know. It is important,
however, to have an idea of these core concepts as they are part of the
reason why my strategy of mouth care works so effectively. After all,
what goes on in your mouth will be served even better by what you
understand and believe in your head—and I feel privileged to share
some of this interesting science with you here in this book.
So, here we go!

KEY 1—EFFECTIVE DAILY ORAL CARE

The products you choose for your oral care need not only to address
harmful plaque on the surfaces of your teeth—they should also target
plaque formation and the immature plaque bacteria that float in saliva. If
you can stop the sticky buildup that causes damage to teeth and gums,
that’s always a good thing. But it is really important that we preserve
and develop a population of healthy mouth bacteria during this process
—which involves a delicate balance that is not always easy to achieve.
The world of oral care is controlled mainly by large companies that
design toothpaste and other products to work like medications for your
teeth—formulated and sold to you as a one-stop-shop to deal with the
symptoms of dental disease, while doing nothing to combat the
underlying cause. For years now, people in America have seen
innumerable advertisements and toothpaste packaging with language
that suggests every different paste on the market is the only one needed
to end mouth sensitivity, whiten teeth, or help fight against existing
periodontal or gum disease. There are no products out there that suggest
they will help prevent problems—just products to reduce the pain and
keep you happy . . . for a time.
A well-designed toothpaste and/or mouthrinse should accelerate the
absorption of minerals into your teeth, no matter if you have sensitivity,
cavities, discolored teeth, or gum disease. You don’t want a putty-style
filler to block up open pores in your teeth or a whitening paste that
removes minerals and can change the protein structure of your tooth. As
I suggested in Chapter Six, try to look for a simple toothpaste made with
silica—and, ideally, one that contains sodium fluoride listed on the
product label at a low concentration of 0.24%. (This kind of weight
percentage is normally reported on the label to describe how much
sodium fluoride there would be in a hundred grams of this kind of
toothpaste.)
Try to avoid glycerin, if possible, since this may interfere with
mineralization and reversal of cavities. A good mouth rinse should also
not contain glycerin, and I recommend a rinse with a dilute concentration
of sodium fluoride around 0.05% (which, like the toothpaste, indicates an
amount of sodium fluoride in the liquid). Keep in mind that sodium
fluoride is a relatively expensive ingredient, so you must pay attention
and look for its presence in oral care products—and, of course, always
avoid stannous fluoride, a much less expensive tin-based compound that
I do not recommend.
An excellent toothbrush will do more for bleeding gums, and to help
heal gum pockets, than any aggressive toothpaste you may find
marketed for gum disease. Look for a toothbrush with plenty of resilient
bristles of different lengths (often called a flossing brush). This kind of
brush will make a difference, especially if you use a proper and
consistent technique of gum massage following the directions that I
presented in Chapter Six. A top-quality toothbrush will help to stimulate
circulation in your gums and initiate the healing response that will make
the difference between periodontal success and failure.
I also advise that you reconsider any expensive electric brush that you
think is helping you—it is highly likely that it isn’t. Test one or two good
manual brushes and see if they feel better for your gums. You may be
surprised to discover that a well-designed manual brush is far superior
to the more expensive sonic varieties.
 KEY 2—MOUTH RESTING
In general, the biggest problem for teeth is our culture’s incessant habit of
sipping beverages—and snacking between meals. The trouble at play
here is the elimination of the time when saliva would normally repair
teeth from the damage that acidity causes whenever we eat and/or
drink. Generally, you will want to give your mouth a rest for at least an
hour after every meal—avoiding the sipping of anything, even water—so
that your mouth can recover and restore a healthy balance. The quality of
our saliva matters, and there are several ways to improve it.

Exercise and Mouth Health

Any body movement—whether it is yoga, walking, pickleball, dancing,
running, or rowing—will help generate improved saliva production in
the mouth. When we are happy and relaxed, it appears that a tranquil
state of mind also benefits the quality of saliva to some degree, and there
is also an impact from things we eat, read, watch, consider, and do—
even an impact from our social circles and experiences of love. Our saliva
dries up or flows more under the direction of many influences, and many
studies have shown that simply being grateful for food can alter the
composition and flow rate of saliva as we look at food.
Studies from both Kings College in London, England and the
University of Miami in Florida—conducted between the years 2017 and
2020—have shown some interesting things about saliva. For example, it
was discovered that the more rapidly our saliva flows, the better we will
sense the aroma of the food—and the more ability we each will have to
enjoy its taste.
Stress and anger can create a variety of negative health outcomes, and
these emotions can also decrease salivary flow and increase tooth
damage. A dry mouth environment—especially one that is acidic—will
promote more damage and disease. In Part One, we discussed the value
of the saliva (or “spit”) in our mouth—in particular, we established that
the longer we can allow it to interact with our mouth after meals, the
better it is for mouth health. And based on what we examined in Chapter
Seven, saliva that is stimulated by even one or two grams of xylitol will
lead to a far healthier mouth bacteria—so I advise you to again consider
xylitol as a great benefit at the end of meals, and before periods of mouth
resting.

The Salivary Circle of Mouth Health

Many people feel challenged to resist eating and drinking for an hour
after meals, especially when they first adopt this habit. In light of this
struggle, I need to explain why I will next suggest that—for ideal health
—we double this period of mouth resting. To understand why, we will
explore a specific interaction that occurs between certain mouth bacteria,
healthy saliva, and nutrients absorbed by the body when we eat green
leafy vegetables. This chain of events is something I call the salivary circle
of mouth health.
This interaction will not occur well unless the mouth is populated by
healthy oral bacteria, and only if saliva carries these special nutrients—
called nitrates—that are absorbed from foods. (These nitrates will be
absorbed best when you have a healthy gut, and only when we consume
specific foods such as fruits, like strawberries, and vegetables, including
celery, lettuce, red and green spinach, and beets.)
When nitrates leave the gut, they are then carried by the blood
circulation to the salivary glands and into saliva—a coordinated event
that requires management by a healthy immune system. When you have
a healthy body, this complex circle of events occurs smoothly, and this
allows the saliva in the mouth to become a valuable resource for our
gums and teeth. For those who employ mouth resting a little longer, one
additional reaction can turn these nitrates into an almost magical
compound for our body health—extending saliva’s healing benefits to
help our breathing, heart, and brain health. Let me next explain how this
happens, and why you can only derive these benefits when you provide
saliva with sixty (60) to ninety (90) minutes of mouth resting, after meals.
Denitrifying Bacteria
A large international study called the Human Microbiome Project of 2007
(which we already first discussed in Chapter One) showed surprising
things about human bodies that shocked many doctors and dentists. The
results illustrated an enormous variety of previously unrecognized
bacteria on and inside the human body and revealed that a healthy
mouth can house over eight hundred (800) different kinds of oral
bacteria. An elite group of these bacteria appear to form a central
community on our tongue surface, and they support and appear to
organize other healthy bacteria. The total population of bacteria in our
mouth will vary in type from tooth to tooth, and from location to
location, with specific kinds found in niche areas—but together, if they
create a diverse and well-functioning microbiological ecology, this is
called a healthy oral microbiome.
When you have a healthy oral microbiome, the bacteria on your tongue
will have a special ability to interact with those compounds in your
saliva called nitrates. An hour or so after we have eaten nitrate-containing
foods, these bacteria on our tongue interact with nitrates in saliva and
turn them into new compounds called nitrites. This community of
bacteria on our tongue are not only important for mouth health but for
changing nitrates into nitrites. And this is why they are known
collectively as denitrifying bacteria––because the term describes
specifically their ability to denitrify any nitrates in saliva.
The next stage of this process occurs when we swallow these nitrites
that form on the tongue. When these compounds reach our stomach, they
react with our stomach acids to form a gas called nitric oxide. The key
reason that this interaction is important is because nitric oxide has a
direct effect on our lungs, heart, and brain health. It is absorbed into the
nearby body areas, causing the walls of important breathing tubes and
blood vessels to relax—a reaction that allows more blood to flow through
them. Within seconds of this absorption, nitric oxide directly benefits our
breathing and goes on to improve our heart and brain health. Studies
show that nitric oxide also has a powerful and beneficial effect on our
nervous system, our daily sleep-wake cycle, and our hormone health.
Nitric oxide gas is also produced in the nose, where it is stored in the
small and large sinus caverns that wind throughout the bones in the
front and middle of our face. Healthy sinuses release nitric oxide every
time we breathe through our nose, while chronically infected sinuses can
instead cause a depletion of nitric oxide. This, of course, leads to an overall
imbalance in the body—and, once again, this is why I recommend the
use of a xylitol-based nasal spray, which will help keep your nasal
passages as healthy and clear as possible.
To check your own nitric oxide levels, you can use nitric oxide test
strips. When you coat these paper sticks with saliva, a color is generated
that you can match with a related chart intended to help indicate the nitric
oxide levels in your mouth. Be aware, however, that these levels should
be measured at least an hour or two after eating. If you cannot generate a
very pale color on the test strip, which indicates a low level of nitric
oxide, consider how nitric oxide production is affected by poor mouth or
digestive health, diet, and/or by chronic sinus problems. Nitric oxide
will also be reduced if you happen to take any medications that may dry
out your mouth, such as allergy and/or blood pressure medications.
Nitric oxide production is also affected by chemotherapy and radiation
treatment, and it is prevented by acid reflux medications (like, for
example, proton pump inhibitors) since too little stomach acid will shut
down nitric oxide production. Talk with your doctor about foods that can
jumpstart stomach health; foods rich in zinc and vitamin B12 (red meat,
fish, soy, dairy, seeds, and whole grains), and also in iodine (seafood,
tuna, eggs, and the already-mentioned dairy). Fermented foods like
sauerkraut and pickles can also be useful.

Something to Think About

This is a good moment to point out that there are still some “myths” on
the Internet that suggest how nitric oxide production is reduced by using
mouthwash because it reduces denitrifying bacteria on the tongue. This
assertion is, as you might already have guessed, incorrect and does not
apply to the oral care products and strategies that I recommend.

Harnessing the power of saliva for mouth health is a new concept for
many, but we should now be able to see how nutrients in foods work to
protect vital body functions through an extraordinary oral pathway. We
can begin to appreciate the importance of our dietary choices, and how
crucial it is to give our mouth an adequate amount of resting time after
meals. Hopefully, the remarkable salivary circle of health that I have
described for you here can help you to enjoy nutritious meals that offer
many health benefits, including a boost for our breathing, circulation,
and cognitive function.

KEY 3—HEALTHY DIET (AND MEALS)

Most people know sugar is bad for teeth, but few people understand how
it negatively impacts teeth. Sugar does its primary damage by feeding
any plaque bacteria into our mouth, and it supplies them with energy to
damage our oral health. Many people try to eliminate sugar from their
diet to prevent cavities, and this is rarely a pathway to success.
The problem is that if plaque bacteria exist in the mouth, then decay
and gum disease will always be possible consequences. In addition,
many foods that we do not think of as sweet contain hidden sugars.
Lowering our intake of sugary foods may be a good overall strategy for
health, but completely excluding “sugars” from your diet is close to
impossible—and this total restriction is not my recommendation, either
for health or as a practical way to change your oral health.
Carbohydrates, for example, are instantly digested and broken down
to form sugars in the mouth—even before they are swallowed. This makes
all carbohydrates—from potatoes to bread—possible sources of sugar,
hidden or not. More surprising sources of carbohydrate or sugars will
include an array of vegetables; additives in vitamins (substances known
as oligosaccharides); and a confusing list of sweeteners, even some that are
billed as “zero calorie” but that still support plaque acid production. This
particular list of occurring sugars encompasses most everyday
condiments, like mustard and ketchup; many commercially available
varieties of canned and fresh fruit products; most processed and
prepackaged foods (even those created for kids and babies); yogurts;
and, of course, the typical assemblage of chocolates, chewing gums,
crackers, baked goods, and cookies that most of us would assume is a
direct source of danger for your teeth and gums.
What makes this sugar equation such a consistent and uphill battle is
that you only need a few grains of sugar to jumpstart the harmful activity
of plaque in your mouth—or, said another way, the quantity of sugar you
consume is not as important for mouth health as the frequency and
duration of time during which sugar is in your mouth. This is why a more
successful approach is to plan healthy meals, and then end every meal
with a tooth-protective food or—you guessed it—xylitol, which will
negate any drop in your mouth’s pH level generated by the sugary foods
and/or beverages in question.
This said, certain foods can certainly be classified as the worst for teeth,
and they are any foods that have a texture that causes them to stick onto
—or into—the crevices of teeth. Many crackers and breakfast cereals can
stick around or on teeth, and these are often treats that we give to the
young children in our lives.
Remember that most of these crackers do not seem sweet or look, at first
glance, like a tooth-decaying danger. Carbohydrates, as mentioned,
quickly turn into sugar in the mouth—and if a piece of food attaches
itself to a tooth or is squeezed into the grooves of teeth, this gives
harmful plaque bacteria a long duration to feed . . . and create damaging
acids all the while. This is why sticky or highly processed foods,
especially soft cereals and crackers, are particularly dangerous for teeth.
If you and/or your children tend to snack on cookies, cereal, or crackers
—especially late in the evening, when your saliva flow is reduced—you
need to be aware that this habit can ruin teeth.
The speed at which you will notice positive change in your mouth will
depend on how well you keep to this routine of meal “times,” which will
drastically limit how much damage your mouth experiences each day.
Other factors—such as smoking cigarettes; having a dry mouth, either
from allergy medications or as a side effect from prescribed drugs;
treatments for hormone deficiency; chronic sinus infections; or continual
stress—can work against you and slow your progress. Our mouth
chemistry ultimately ends up being as unique and individual as we are
in life—but there are certain foods that can help us overcome these
unwanted effects . . . and also help our saliva become more beneficial to
fight this fight.
The following are foods that should be included in an ideal diet to:
improve saliva quality; augment and support our immune system; and
positively impact the speed of tooth and gum repair, even as it promotes
overall healing within your body.

Water-rich Foods
Carrots, celery, cucumber, apples, and melons are all water-rich and
fibrous foods that help to keep the mouth hydrated while they also boost
saliva production. Tomatoes and pink grapefruit contain special
nutrients called bioactives, which can protect the DNA of cells from
damage that may occur during X-rays, provided that they are consumed
prior to any radiation. Medical imaging of any kind can deliver radiation
with the potential to traumatize the DNA of healthy cells in the body—
and also to cause a malfunction if these genes are repeatedly damaged.
Fresh apples are a great example of a food rich in probiotic properties
(together with the aforementioned bioactives) that help to speed up the
repair of DNA damage to reduce damaging effects. This is why apples
are useful when they are consumed after one has undergone X-rays, or
for patients with disrupted salivary glands who are following a course of
radiation and/or chemotherapy. Apples can also help anyone who
develops a sore tongue and/or mouth after long dental treatments—and
I will sometimes suggest that these patients first shred an apple into fine
slivers with a kitchen grater, to make it softer and easier to consume.
 Key Foods for the Health of Your Teeth and
Mouth
Water-rich Foods
These foods all help to keep the mouth hydrated, boost saliva production,
and contain high levels of special nutrients called bioactives that are able
to protect the DNA of cells from any damage that may occur during X-
rays (provided that they are consumed prior to any radiation).
Apples
Carrots
Celery
Cucumbers
Melons
Pink Grapefruit
Tomatoes
Calcium-rich Foods
These foods are good for bone and tooth health, and contain many
nutrients (including vitamins A and B12, potassium, magnesium, and
iodine) that can also help improve saliva health.
Cheese
Kefir (see Yogurts)
Whole Milk
Yogurts (see Kefir)
Foods Rich in Vitamins and Antioxidants
All these delicious natural foods contain various levels of the vitamins A,
B6, C, and E, together with health-promoting beta-carotene and
magnesium. Working as powerful antioxidants, they help to boost
immune and mouth health in a variety of ways.
Bananas
Blueberries
Leafy salad vegetables (and greens)
Nuts
Papaya
Pineapple
Raspberries
Seeds
Strawberries
Sweet Potatoes
Foods for Dry Mouth and/or Bad Breath
Garlic and onions contain a naturally occurring compound called allicin
that aids in saliva production, nourishes our immune system, and
supports the bacteria that help to ward off bad breath. Both ginger and
mushrooms can help with dry mouth and remain a great source of
immunity-stimulating dietary fiber along with bioactives (mentioned
above) for an overall improvement of digestive health.
Garlic
Ginger
Mushrooms
Onions
Anti-inflammatory, Anti-viral, and Anti-bacterial
Turmeric (which contains curcumin) and green tea can help to lower and
control body inflammation by virtue of certain plant compounds they
contain that are called flavonoids. These flavonoids provide a number of
beneficial health effects that protect our body and reduce our risk for
disease. Meanwhile, many types of shellfish can boost our immune
health, and oyster, crab, and lobster are especially high in zinc—an
element that supports our immune function, which helps the body fight
viruses and bacteria.
Crab
Curcumin (see Turmeric)
Green tea
Lobster
Oyster
Shellfish
Turmeric (see Curcumin)
Calcium-rich Foods
Cheese and whole milk are rich in calcium and phosphorus, minerals
that are both good for bone and tooth health. Dairy-rich foods also
contain many nutrients (including vitamin A, B12, potassium, magnesium
and iodine) that can also help improve saliva health and help to heal
teeth. High-quality yogurts (including a variety of yogurt referred to as
kefir, usually consumed as a drink because its consistency is thinner than
that of more conventional yogurt products) are also rich in calcium
alongside their probiotic properties—and this helps not only to improve
a body’s digestive and immune health, but also aids in balancing oral
health and production of saliva.

Foods for Dry Mouth and/or Bad Breath

Onions (along with its close cousin, garlic) contain a naturally occurring
chemical compound called allicin, which boosts saliva production and
benefits immune health—and goes on to have a positive impact on gum
health. Consider the following: Researchers at the University of Florida
have conducted a variety of studies looking at the benefits of foods on
health—and in 2016, they showed the effect of aged garlic on the immune
system of healthy men and women during the cold and flu season. Blood
analysis showed a supercharged response in the immune cells of those
who ate the garlic.
In addition, the natural spice ginger stimulates saliva production
directly and can be helpful for people with a dry mouth while it also
supports the immune system. Mushrooms, meanwhile, are a great source
of immunity-stimulating dietary fiber along with certain nutrients called
bioactives (mentioned earlier) for an overall improvement of digestive
health.

Vitamins and Antioxidants for Healthy Biofilm

Leafy salad vegetables and greens are rich in vitamins A, C, and E, all of
which are powerful antioxidants that help to boost immune health. (They
also provide nitrates that improve saliva quality.) Nuts and seeds offer a
source of valuable nutrients for oral health, including proteins,
antioxidants, magnesium for salivary health, and vitamin E. Sweet
potatoes are especially high in the pigment-producing element known as
beta-carotene, which can be converted into vitamin A that has been shown
to support skin and mouth health. Bananas are rich in magnesium and
vitamin B6, which can help improve sleep, while this popular fruit’s fiber
also supports immune health. Papaya and pineapple are two unique
fruits for digestive health, each contributing enzymes that can be a help
to those who experience acid reflux. Small amounts of these fruits can be
eaten right before a meal as an appetizer—which allows these enzymes
to help support improved upper digestive health.
Why is this important? Because the process helps to reduce the
unpleasant and painful symptoms of acid or gastric reflux—a problem
that negatively influences mouth health in many ways, especially as it
can cause erosion of teeth and promotion of unhealthy mouth conditions.
Berries of all kinds—blueberries, strawberries, and raspberries among
others—are rich in antioxidants and vitamin C, and they all contain some
naturally occurring xylitol. Studies have shown that berries have a
particularly useful impact on mouth health and help to develop
protective biofilm over teeth.

Anti-inflammatory, Anti-viral, and Anti-bacterial

Turmeric (which contains curcumin) and green tea can help to lower and
control body inflammation by virtue of certain plant compounds they
contain that are called flavonoids. These compounds provide a number of
beneficial health effects that protect our body and reduce our risk for
disease. One way this occurs is through the antioxidant properties of the
flavonoids, which enhance our immune system and mouth health—and,
consequently, our gum health.
Shellfish can boost saliva health, while oyster, crab, and lobster are
each high in zinc—and these all support immune function, while helping
the body fight viruses and bacteria.
Food Pairing
The nutrients in foods can be better absorbed by the body through the
application of a relatively new concept called food pairing. This involves
the discovery that we can enhance our nutrition by eating certain foods
in combination with other foods, and in patterns that extract more benefits
from these foods. Generally, we will have optimal absorption when these
partner foods are eaten or paired as a meal since they interact and trigger
reactions that provide us with maximum absorption of the nutrients in
each.
There are many examples of this kind of food pairing—for example,
eating banana with some dairy product (like yogurt, milk, custard, or
kefir) can allow the fiber in the banana to support the gut bacteria that
digest dairy, and the outcome will be enhanced calcium uptake. This
method allows us to increase the nutritional value of our diet to a level
that is higher than the sum of eating each food individually—and this
allows us to reap additional health benefits.
The possibilities are endless and most combinations on a dinner plate
will be a balanced mixture of colors that taste good together, which
should encourage us all to opt for meal-style eating. There are also
benefits in high fiber and fermented food diets that help more minerals
to be absorbed by the and it appears better if we consume sugary foods
at the end of meals, to allow fibrous foods (vegetables, grains, and
legumes) to be digested first, as the fiber-utilizing bacteria will gain
energy and promote improved digestion and absorption of all the
nutrients. A practical application of this kind of food paring would be to
eat an apple or some kiwi fruit (each high in fiber) before a sugary cookie
or muffin.
The types of foods—together with the order in which we consume
them—remain important to our mouth health. However, the daily
process of eating should never become overly complicated by science.
For instance, let’s consider the work of Erica and Justin Sonnenberg,
senior researchers at the Stanford Center for Clinical Research in
California. This married couple have studied how different diets affect
our general health for more than twenty years. Erica passionately teaches
how foods are a powerful lever to fight disease and improve health—and
in 2021, colleagues of theirs at the Stanford Nutrition Studies Research
Group published the so-called “FeFiFo” (Fermented Fiber Foods) study.
Thirty-six (36) individuals ate diets with more fermented, or fiber-rich
foods, added to every meal. The results showed rapid changes as their
gut bacteria adapted—in some cases, within twenty (20) minutes.
Erica Sonnenberg says we can enjoy so many benefits by consistently
adding some active-culture, or fermented and fiber-rich foods, to our
meals—perhaps with a side of sauerkraut or colorful veggies. In service
to that concept, here below are some food combinations to consider:
Tomatoes with Olive Oil
When tomatoes are consumed with olive oil, the healthy fat in the oil
encourages the release of a compound called lycopene from the tomato. Its
release then makes the combination of these two foods more effective at
reducing unwanted chemical toxins throughout the body.
Citrus Fruits with Spinach
When vitamin C-rich foods (such as citrus fruits like lemons and/or
oranges) are squeezed onto a vegetable dish like spinach, more of the
iron in the spinach will more readily be absorbed.
Avocado and Carrots / Salad Greens with an Egg
When an avocado is eaten alongside carrots, more of a specific
carotenoid molecule called beta-carotene will be absorbed from the
carrots, and certain carotenoids can also convert into vitamin A. When an
egg is consumed alongside carotenoid-containing salad greens,
researchers at Purdue University in 2015 discovered in their study that
three (3) to nine (9) times more carotenoids were absorbed into the body
from the salad greens with an egg . . . as opposed to when the greens
were eaten alone.
Other Food Pairings
There are many other food pairings that also offer health benefits, and
you may wish to access any number of free online videos and webinars
(some by Erica Sonnenberg or Dr. William Li, who teach about nutrition
for health) or draw from any/all available Internet searches to discover
food combinations that you may enjoy. Wonderful examples of culinary
pairing include: Oatmeal and berries; broccoli and mustard; beans and
rice; salmon and broccoli; eggs and spinach; chickpeas and lemon juice;
and let’s not forget the famous combination found at the Wimbledon
Tennis tournament tea gardens, fresh strawberries with cream. Yum!

KEY 4. DIGESTION, IMMUNE HEALTH, AND STEM CELL

SCIENCE
In this section, we will explore a new way to think about disease and
wellness, and how they exist in a kind of perpetual tension within the
body. Disease—and its associated damage—can position itself to tip our
health balance, but with the help of delicious foods and a few smart
lifestyle choices, we can tilt this scale back to our favor—toward the side
of repair, regeneration, and optimal wellness. This process of balance
mirrors the way teeth and gums are protected from damage and disease
by preventive daily care and habits. In the same way, our body will be
healthier if we limit damage and support our body’s amazing self-
healing system. Good daily habits make a difference, but toxins and
infection will burden our body’s repair machinery; the essential
mechanism by which we maintain and improve body health.

New Molecular Medicine

Molecular medicine is a branch of medicine that studies how diseases,
medicines, and foods either help or harm us—by looking at how they
interact with different cells in our body. This approach helps to discern
more clearly what is occurring inside us at a molecular level—something
that has been impossible until recently. Molecular science has witnessed
remarkable cell interactions and capability—some that must have been
an experience as awesome as that encountered by Dutch scientist
Antonie van Leeuwenhoek in 1674, when he first saw plaque (collected
from his own teeth) under a microscope and noticed little animals in the
lens . . . particles that were, in fact, plaque bacteria scrutinized under
magnification. New discoveries can be astounding, but so is the fact that
today—more than three hundred years later—most people still don’t
know that tooth plaque is a seething mass of bacteria.
Perhaps this is the first time you have heard of molecular medicine,
and you may be in for some surprises. Molecular medicine has helped
scientists learn how the body can rid itself of disease, and how the
nutrients called bioactives (see earlier in this chapter) in certain foods can
stimulate the body’s own repair and regeneration systems. Scientists
have watched the movie-like process that occurs as new blood vessels
grow into transportation systems, fully equipped to deliver ready-to-help
cells to areas of the body that need healing and repair . . . and this
process is how your gums can repair in your mouth. You may not be
excited by science, and perhaps you want to know if it is necessary to
learn about mouth acidity and bacteria, or can you simply follow the
directions and heal your teeth and gums. This is a good question, and the
answer is yes—the results will be great––whether you know the science
or not.

Wound Healing
When a body part is injured, it sends out an emergency chemical—a kind
of distress signal that then triggers a wave of coordinated reactions that
together are referred to by science professionals as a healing response. This
highly coordinated pattern of events allows the body to clean up and
build new tissues in a wounded area. If, however, a bodily infection
blocks this signal or the healing response is compromised, then these
events cannot occur as nature intends.
You may have been told by your dentist that your gums or the bone
around your teeth cannot heal or regrow—and this is correct
information, if you have plaque or an infection in the gum pocketing
around your teeth. These infections from plaque and periodontal bacteria
will prevent the transmission of the signals and healing response that
result in regrowth of your gums.
Here’s the good news—xylitol eliminates plaque, and my Complete
Mouth Care SystemTM will help your gum pockets heal. If you have had
gum problems for some time, it is reasonable to assume that your body’s
warning signals are not being received—and that this infection is
preventing repair. Our body tires of chronic or ongoing signaling when it
is unable to properly respond, as this creates a challenging and
frequently chronic health condition known as inflammation.
The first stage of gum healing involves the growth of new blood
vessels through a process called angiogenesis. These new blood vessels
allow transportation of special cells to regrow your gums—and these are
known as stem cells.

Stem Cells and Angiogenesis

Stem cells are part of an organized healing system housed within our
body. Just as the development of a baby in the uterus is a coordinated
dance that involves the development of body parts from stem cells, so
also, from the first day we are born, stem cells travel throughout our body
to repair any organs or part of our body in need. After birth, humans have
a supply of about seventy (70) million or more of these cells held in
reservoirs around the body, and they serve us throughout life. What we
must realize is that as we age, these stem cell reservoirs can become
depleted. The good news is that specific foods and lifestyles energize
stem cells—and even stimulate the formation of new ones.
The stem cells involved in gum healing can be summoned by gum
massage to contribute to a healing response that can regrow new gums,
periodontal attachments (the fibers between teeth and the jawbone), and
even new bone around teeth. The main thing stem cells need is a
circulating fluid to carry them to the location of need. If a blood supply is
missing, this is when the complex and miraculous mechanism known as
angiogenesis kicks in.
Angiogenesis is the growth of new blood capillaries from existing blood
vessels. The new blood vessels are then able to carry the needed stem
cells to the area that has been damaged. In the first step of angiogenesis,
cells push themselves through the wall of the blood vessel that housed
them, and in the process, they are flattened. Once outside the wall of the
blood vessel, the cell curls into a tube shape and become the first part of
a new blood capillary.
As one cell after another joins this sequence, the blood vessel grows
and becomes a functional transport for the stem cells to move into an
area of need. Once stem cells have reached the wounded area, they
change again, but this time into the tissue that the body requires. This
phenomenon can occur after a heart attack, to heal a broken bone, a skin
wound and, more to the point of this book, as and when you need new
gum or bone to grow around your teeth.
You may now be asking yourself, Why is a knowledge of stem cells so
important when it comes to your oral health? The answer is that we need
stem cells to heal our gums and the skin of our mouth every day. Natural
wear and tear happens whenever we eat and drink, but any problems
from these activities will be avoided if we can compensate for this
damage by proactively engaging stem cells to heal our gums and
regenerate them daily.

Foods to Support Wound Healing

Specific foods stimulate an improved wound response, and some of these
foods include: Dark chocolate (which can stimulate stem cells); black and
green teas (which can mobilize stem cells); grains (especially barley); and
seeds (including flax, sunflower, pumpkin, and chia), all of which can
speed up the process of angiogenesis to bring a needed blood flow to the
gums. Herbs like rosemary, peppermint, and ginseng can be useful, as
well as the fruit and peels of fresh apples and plums, which help the
repair process. Capers and onions, dried cherries, sultana raisins, and
blueberries are similarly beneficial for wound healing.
The problem, of course, is that quantifying the amount of food for this
beneficial effect on wound healing has not yet been completed—and in
many cases, there is no absolute confirmation of their effectiveness. We
have studies, however, that show a higher number of circulating stem
cells in the blood of people with a lower risk for developing heart and
other health problems. Conversely, a low level of stem cells in blood is
linked with arthritis and chronic diseases. So, you can decide whether
you want to wait for confirmation of these studies or decide—like me—
that if eating some chocolate with a cup of tea can activate healing stem
cells . . . then why wait?

CONCLUSION
As we have established throughout this book, the human body has its
own amazing inbuilt ability to heal. Xylitol, coupled with my Complete
Mouth Care SystemTM, stand as powerful partners to boost the outcomes
for your gums and teeth. If, however, the products named in my system
are not available, the four key strategies described in this chapter will be
good companions for you.
It is time for you to take charge of your oral health and stop any
ongoing craziness of the never-ending dental fillings or treatments that
you may up to now have merely accepted as your lot in life. Instead,
appreciate how our bodies are amazing healing machines, and how they
have the power to rid the body of the bacteria, viruses, and nasty
chemicals that try to derail us. With benefit of what you have learned
here in this chapter, you now have an open door—and the keys—that you
will need to turn things around both for your mouth and your overall
body health.
Even with all the knowledge that has been provided in these pages,
you may still find yourself in a place where you and your mouth are on
one side of the fence—and your dentist is on the other. What follows in
the next chapter are some steps and strategies to help you reinvent a
better relationship with dentistry—and suggestions about how to
maintain a healthy connection with your current or a new dentist; to
enjoy future dental appointments; and to reap the benefits that these can
offer.
My hope is that you will overcome fears and use this new knowledge
of what is possible for you to do for yourself . . . to feel empowered, to
dispel any dental angst, and create the opportunity for dental visits to
become periodic evaluations that are informative and interesting. There
are so many reasons for oral care to be a positive and meaningful core
health value, and my hope is that we can welcome a new era of patient
empowerment, drill- and injection-free dental offices, new ways to limit
fear, improved patient attitudes, and a more open and enjoyable access to
dentistry. My preventive program has helped so many people achieve a
new level of confidence and oral health, with cleaner-feeling teeth,
fresher breath, and fewer, happier dental visits. These are important
achievements that have often elevated patient attitudes to dentistry—
even for those who admit they once truly wished to kiss their dentist
goodbye.
 10. You and Your Dentist—Can You
Ever Be Friends?

Friends are those rare people who ask how we are, and then wait to hear the
answer.
—EDWARD CUNNINGHAM, AMERICAN ENTREPRENEUR AND AUTHOR OF RECIPROCITY

A s this book has already established by now, you do not have to rely
solely on a dentist to keep your mouth healthy. On the other hand,
it is important to monitor all these dynamic changes in your oral health
so you will be sure that it improves and then remains in great shape.
Remember that most people either think they were “born” with good
teeth, or that they somehow deserve to get cavities because they may have
missed a dental cleaning or canceled an appointment. Through a series of
perpetuated narratives, dentistry continues to offer its own misleading
“myths”—many of which have caused patients to feel all manner of
unnecessary guilt, worry, or fear. Those days are over—it’s time for you
to STOP letting someone (even yourself) carry the burden of self-directed
blame.
The strategies offered throughout this book are likely to be radically
different from the advice you have been given by your dentist. Facts
being facts, you now need to consider that although you may love your
dentist, his or her dental school education was most likely built on what
should be called a “drill and fill” approach to tooth care. New technology
has certainly improved treatments—indeed, the field of dentistry now
benefits from all manner of computer-generated cavity design, crowns,
fillings, implants, and even “fit in one day” dentures. The travesty is that
this restorative work only remains necessary because of damage caused
by a disease—one that could have been halted by small changes in habits
and healed naturally with correct strategies.
Most people have never considered the importance of taking
responsibility for their own oral health—by reading this book, of course,
you already recognize its value. You will quickly feel improvements and
positive changes, but to move forward, you need your progress to be
truthfully evaluated by a dentist who understands the bigger picture.
Once you have scheduled a dental evaluation, prepare yourself to listen
carefully during the appointment—and do your best to try to absorb and
understand the meaning of the findings. In that way, you can ask
questions and contribute to any discussions about treatments that you or
your family may want or need. These action-based decisions could be
about how often to go for assessment visits, which treatments to accept,
and which ones you want either to delay—or to refuse.
To monitor your oral health, and to ensure you feel confident that you
are headed in the right direction, you will need professional advice from
a supportive dentist who will understand your side of any decision-
making processes. My hope is that this chapter:

Will help guide you to find such a dentist;

Will steer you toward the kind of evaluation scenario that ensures
better oral health;
Will provide you with the best and most important questions to
ask at an appointment;
And, if necessary, will equip you with what to do if things are not
working out between you and your dentist.

HOW TO FIND A DENTIST

Selecting a dentist takes effort and it is not easy, but it is arguably an
even more important decision than the choice of contractor to renovate
your home. Our mouth’s “contractor”—yes, this is how we will refer to
your dentist for the purpose of this example—has the power to help you
enjoy a lifetime of sustainable mouth health . . . or to precipitate an
opposite sequence of calamitous events. A builder who doesn’t care
about the quality of the materials used, or the way they are applied, is
more than partially responsible for structural flaws that may occur over
the years to cause a house to slowly crumble and fall.
Underlying problems created by poor dental treatments can be hidden
for years, but their long-term health effects are now being recognized as
more serious than we previously imagined. Inferior or toxic dental
materials can have a negative impact on overall health, and chronically
infected teeth or gums can cause potential damage to our heart, body,
and brain—outcomes that may only become obvious later in life, when it
is too late to turn back the clock.
Dentists have different ways of treating patients. At this point, most
oral health professionals still subscribe to the training and practice
protocols espoused by the American Dental Association (ADA)—which
is to say a non-personalized, “one size fits all” approach to dentistry.
These dentists will ordinarily take charge of your situation, “drill or fill”
your teeth to get you out of any painful circumstance, and then work
over some period of time to make your teeth as functional as possible—
for as long as possible. Their goal is not to save you from treatment—
instead, it is to make your mouth comfortable so that you can go about
your life and be able to eat and chew without too much harm or fuss.
This is the kind of dentistry that most people have requested—or is
what they believe to be the only plausible kind that is available to them
and their family. Today, many dentists operate their offices under the
umbrella of far larger business corporations—ones that frequently
possess allied and interconnected associations with dental insurance
companies. These “big box” dental chains are always busy by design and
are specifically appointed to do as much restorative dental work as
possible. Because more is their motto, you should not expect them to favor
—or want to treat—anyone who wants the least treatment possible.
On the opposite side of the spectrum are oral health professionals who
are not trained in a specific dental specialty, but they choose not to follow
the routine practice protocol of the American Dental Association (ADA).
These dentists have usually attended training courses in methods for the
“safe” removal of silver amalgam fillings with techniques, equipment,
and even protective clothing to shield patients and staff from any toxicity
during a filling—something that is generally not a concern for
mainstream dentistry. Patients may also be offered intravenous and
supplemental vitamins as support during treatment, and biological
dentists promote far more personalized and holistic (or “whole-body”)
care.
Biological dentists are also sometimes referred to as “natural” dentists,
yet surprisingly their offices are usually extremely busy with the removal
and replacement of all the silver amalgam fillings you may have in any of
your teeth. They disapprove of fluoride and reject any fluoride-
containing oral care products, which is why I believe that the guidance of
a biologic dentist can frequently lead clients to require ongoing treatment
and an incessant need for fillings to be repeatedly and frequently
replaced, often culminating in the eventual death of these over-treated
teeth. The biological practitioner treatment choice for a dead tooth is
usually to extract it, since they also believe that root canals are unsafe.
This means biological dentists also do a lot of implants, bone grafting,
and other surgeries, and patients can spend thousands of dollars for an
elegant style of treatment, yet the outcome often does not reflect a
naturally healthy mouth and minimal treatment that I believe is both
possible and ideal.
So, which kind of dentist do you want? Everyone needs a dentist who
values pristine (uncut) teeth; who wants to avoid drilling, when possible;
and one who has been trained in techniques of tooth repair that mimic
the structure of nature’s original design—through use of a minimally
invasive approach. Most of us want to keep our own teeth in a healthy
condition for life, with no unnecessary treatments. You may be lucky to
have such a dentist—but if you are looking, you may gather some names
from a group of specialized care professionals referred to as biomimetic
dentists.
There are only a few such-trained dentists in America, with a
smattering of others located elsewhere around the world. These
biomimetic dentists spend hours learning specialized techniques to
correctly fill teeth with fiberglass materials, all of which help to care for
the overall integrity of your teeth. You may not find one near your home,
but perhaps you can find one in a city you visit, or at a vacation spot
where you could start with a comprehensive dental evaluation.

“BAD” DENTISTRY
There is no way for a patient to evaluate the techniques or materials
being used during their dental treatment. Even if a dentist notices
previously performed and shoddy dental work in your mouth, he or she
may not divulge it to you. Too often, patients will accept the blame if
food gets stuck between their teeth—something that may, in fact, result
from one or more dental mistakes; a poorly shaped filling; or a roughness
or ledge that can form if an edge of the filling does not align smoothly
with the adjacent tooth surface.
Sometimes, a dentist may inadvertently cut an adjacent tooth surface
with his drill and expose this area to decay by removing its protective
enamel surface. These are accidental incidents that should never happen,
but they do—and as an untrained layperson, you will likely never know
or discover when or if they have happened to you. Fragments of fillings
can end up in your mouth and be swallowed, especially as old fillings are
removed, or when new ones are being put into teeth. Both silver and
plastic particles can affect the health of your gut, as their toxins can
damage gut bacteria or affect your hormones.
There are also times when a rough cleaning, an unnecessary crown, a
retainer, or a poorly designed night guard can create long-term
consequences that could be easily classified as “bad” dentistry. This is
why you need a caring, thoughtful, and experienced dentist.

DENTAL ETHICS
The professional training and direct experiences of every dentist
eventually combine—and when these are mixed with an individual’s
personality, it creates a unique approach to dental care. A dentist’s career
experience matters. Most who have spent time treating the elderly or
patients with physical or mental disabilities; worked in clinics for the
underserved; or in countries where dental equipment is not available will
understand there is a realm beyond dental school and decision making in
the real world that is different from the formulas and standard protocols
they may have originally been taught. Integrity is doing what is right,
even when there is no glory or money in the outcome. If you have an
experienced dentist with integrity, be thankful and enjoy the benefits.
An American-trained pediatric dentist often has no practical
experience between dental school and entering this field of
specialization. This can narrow their long-term view and blur their
selection of treatment choices for their young patients. For example, a
dentist may not realize when treating a child how critical is her or his
decision to drill a ten-year-old tooth, which can impact and potentially
precipitate a lifetime of future treatment needs for this tooth. Why seal or
drill if you could reverse this cavity and improve the oral health
trajectory for this child? Traditional pediatric dentists may be satisfied
with the look of nickel-metal crowns on root canal-treated teeth, plastic
coatings, strong fluoride gels and sealants, done as the child is sedated by
a general anesthetic. From a global perspective, however, this can seem
barbaric, dangerous, and unnecessary—especially when there are other
options.
A more compassionate kind of “no drill” dentistry is called an
Atraumatic Restorative Technique (ART) approach, an effective and
respected approach to children’s dental treatment and care.

The ART Pediatric Approach

“ART” stands for Atraumatic Restorative Treatment, and it has been my
personal choice as a valid approach to solving the problem of decay in
children’s teeth for decades. The use of silver and fluoride used together
in a varnish that stops decay is used as a way of treating cavities in baby
teeth, and it is gaining acceptance in America with entrepreneurial
dentists who have bucked “the system” and refuse to give in to ridicule or
dismissal.
 Baby teeth are vulnerable to decay, and cavities in baby teeth do not
reverse, as they do in adult teeth. Stopping decay is critical, and xylitol is
useful, but if the cavity needs to be filled, ART dentistry helps to avoid the
use of a dental drill and is structured to provide treatment without pain;
that requires no hospital visits; and, in most cases, can be achieved
during a ten-minute “in and out” low-cost visit that prevents ongoing
dental damage.
This ART technique allows cavities to be gently cleaned with hand
instruments and then varnished with a silver compound (silver diamine)
mixed with fluoride (to stop the decay)—and finally topped with a glass
type of filling (glass ionomer) that helps to seal up and fill the cavity. It
has been evaluated extensively and used successfully in remote areas
around the world where decay is an urgent concern and dental
equipment is lacking: namely, in parts of Africa, Mexico, and a number of
regions in South America.
It has also been endorsed by the World Health Organization (WHO) as
an effective method for managing decay, while also preserving tooth
structure. Furthermore, the International Caries Consensus Collaboration
—a group of dental professionals from twelve (12) countries who review
strategies for dealing with tooth decay and promote their opinions to
dentists across the world—also recommend ART as a treatment option
for decayed teeth.
It has not yet, however, been embraced by the American Academy of
Pediatric Dentistry (AAPD). Instead, the AAPD endorses a style of
treatment known as Interim Therapeutic Restorations (ITR). This
technique exactly resembles the technique of ART—using hand
instruments to clear the decay and the application of silver diamine
fluoride and a glass filling—but the AAPD protests that this a temporary,
and not a permanent, solution. Combined with the preventive use of
xylitol and improved oral care, these temporary fillings may be all your
child needs until new permanent teeth come into the mouth. Meanwhile,
do not confuse this approach with the use of a plastic sealant—
something heavily promoted by the AAPD, but which may not be useful
or even necessary.

WHEN AN EVALUATION IS NEEDED

Once you are confident that you are able to manage your dental
maintenance effectively at home, then you will likely wish to discontinue
any unnecessary bi-annual cleanings. After all, you now know that these
professional cleanings present no magical power to combat the daily
damage that your teeth experience. Dental cleanings cannot stop cavities
or gum disease, although it is correct that they help people—to some
degree—who are unwilling to help themselves.
The problem with these visits is that many of us have been
brainwashed by marketing messages through voicemail and text for so
many years. As such, the majority of the public are easily persuaded that
these cleanings are a vital component of oral care. The intention of these
reminders may be a legitimate effort to get you to the dental office for an
evaluation of your teeth and gums—but the question to ask is whether
you actually need this “one size fits all” bi-annual cleaning.
Yes, everyone needs an in-depth check of their oral health periodically,
but this does not necessarily involve (or it may go far beyond) those
routine X-rays and the so-called dental cleaning. This is why I encourage
you to find an ethical, caring, and knowledgeable dentist, rather than
look for one who merely “takes your insurance.”

PREPARE FOR YOUR DENTAL VISIT

To gain the most benefit from dental visits, you want to feel comfortable
when you get ready to go to the appointment with your goal of as little
treatment as possible. To achieve this, it is best to prepare prior to a
dental visit and do your best to reverse as many potential problems as
you can. In other words, work to improve your oral health before the visit.
My special Complete Mouth Care SystemTM (see Chapter Six) may take a
year or two to help heal your gums and spruce up your teeth, but even a
few weeks can help you to create a better impression during your mouth
examination. Taking these active steps prior to the time when you sit
down in that dental chair will give you sharper focus and clarity when it
comes to your next step(s).

What to Eat Before (and After) a Dental Visit

Obviously, you don’t want to have food around your teeth as you go into
a dental visit—and I suggest that the best time to use my system is within
a few hours of your appointment. In Chapter Eight, we talked about how
saliva health is improved by diet and digestive health. Consider this
prior to your dental visit and let saliva that has been boosted by good
foods play a part in enhancing the condition of your teeth and gums.
Eating certain foods are also useful prior to and following any X-rays
that you receive, as they contain nutrients that help protect our body
from possible radiation damage. Vitamin C-rich foods, like oranges and
lemons, will help the nerves in your jaw to recover more quickly after an
anesthetic-numbing injection, and many foods (again, described in
Chapter Eight) serve to stimulate skin and gum healing—particularly if
your mouth is sore after your visit.

The Best Time for a Dental Visit

The timing of your visit is also something to consider. Particles of tooth
and debris are sprayed into the air above every dental chair as a dentist
drills, or when the hygienist works to clean a patient’s teeth. This
invisible cloud floats in the air for about twenty-four (24) hours and,
following treatment of multiple patients, the office air could carry
considerable amounts of unwanted bacteria. This is why dental teams
gear up with goggles, masks, and sometimes even shielded helmets to
protect themselves from this potentially infectious spray.
You, however, are expected to lie down on the chair with your mouth
open, which is why it is good if your dentist covers your mouth with a
protective latex square sheet referred to as a dental dam. (If your dentist’s
office has a high-powered vacuum exhaust system to keep the air cleaner
and try to purify it, so much the better.) I also suggest you wear
protective glasses—and for examination appointments when there is no
way for you to shield your mouth, it is always a good idea to make an
early morning appointment (ideally after a long weekend) when the
circulated air in the treatment room has had time to settle.
Do You Even Need a Dental Cleaning?
Anyone who has used my system of care for a year should begin to reach
the point when they no longer form plaque and do not need “routine”
cleanings every six months. As you initially phase into my system, a little
dead plaque may accumulate as dark deposits in nooks and crannies,
and even on porous flat surfaces in some mouths, but they are more
generally found in places that are difficult for you to clean. You may
have used a brush that was too soft, or perhaps you were afraid to brush
vigorously. A cleaning appointment can quickly deal with this superficial
debris and prepare you for moving forward with less chance of this build
up on your teeth. Some hygienists may be confused, but you should
know that these surface shadows or stains do not reflect negatively on
your mouth health—they occurred because your mouth became healthier.
After this debris has been cleaned off your teeth, you will be pleased
with the way your teeth look and feel because this was simply “left-over”
remnants from the unhealthy mouth you had before starting my system
of care. Be sure to continue with this routine, but bear in mind that you
may also need a new or better toothbrush, or to more actively target those
stained areas on your teeth as the first step in your daily brushing
routine. In the future, you can ask your dentist how often you need a
cleaning—and it is perfectly acceptable to ask for the reasons why.

WHAT IS A DENTAL EVALUATION?

A dental evaluation is different from those old twice-a-year “checkups”
that have usually always taken place alongside those obligatory X-rays
and routine cleanings. We have already discussed at length the
connection between body and mouth health—and this is why your entire
head, neck, and systemic health should be considered part of a good
dental evaluation. Some dentists will take your blood pressure, examine
the health of your carotid arteries, and do a thorough examination for an
array of problems—for instance, looking for ulcerations, a misaligned
bite, or any hint of oral cancer. Usually, an examination will begin with a
check of the outside of your head and neck, then your mouth, and finally
a visual examination of your gums and teeth, followed by necessary X-
rays—and, finally, any tests and/or treatments that you may require or
want.

A Head and Neck Evaluation

An experienced hygienist or dentist will perform a head and neck
examination by massaging and feeling around your neck, face, and lower
jaw. This is done to determine if you have enlarged salivary glands or
nodes (small glandular masses), which could indicate inflammation
draining from an infection or other problems in your mouth.

Visual and Tactile Evaluation

A soft tissue examination is performed to evaluate the texture and color of
your tongue, the skin on the inside your mouth, and the area that
stretches down further into your throat. The dental examiner may move
your tongue to look underneath it, or on the sides—places where
ulceration may be a sign of so-called pathology, something which could
suggest the start of an oral cancer. This kind of screening is valuable
every few years, at a frequency related to your personal risk—for
example, you may need this annually if you smoke; vape; drink alcohol;
are diabetic; have a dry mouth from disease or medications; have had
radiation and/or chemotherapy; have been exposed to the herpes virus;
or have a family history of head and neck cancer.
During the visual examination, a pointed dental probe called an
explorer (a kind of thin, “L”-shaped instrument normally comprised of
metal) is gently trailed over your teeth to determine if there are any
rough areas—and this tactile assessment is then matched with the visual
one. If all the tooth surfaces look and feel smooth and hard, this is a good
sign.

TOOTH HEALTH EVALUATION

In the 1950s, it was common for dentists to force this sharp pointed
explorer against the surface of teeth to search for so-called sticky spots
that were believed to be the early onset of cavities. Every suspicious area
was poked or probed to see if the sharp point could break the surface—
something that was interpreted as a tooth in need of a filling.
By 1966, research indicated that these soft areas could heal themselves
completely with correct care, and that a potential cavity could disappear
if minerals went back into the area. Pushing a metal point into a weak
spot on a tooth could make this repair more difficult—sometimes
impossible.
In 1992, a study in The Journal of Caries Research reported on one
hundred teeth that were examined with an explorer point—and were
then found to have sticky spots. The teeth were extracted, cut open, and
examined under a microscope to see if this diagnosis of a cavity was
accurate. Only twenty-four (24) of the teeth had signs of decay, showing
how unreliable the explorer is for finding a cavity.
Today, a dentist should only examine teeth with a blunted explorer
and only to feel for rough areas, which should then be allowed to
remineralize. No dental professional should ever push any kind of sharp
or pointed instrument into a tooth or grooves on the surfaces of teeth to
test their hardness. Change your dentist if he or she uses a “pointy”
explorer in this inappropriate way.

A PERIODONTAL EVALUATION
A periodontal or gum health examination should technically be a
continuation of this soft tissue evaluation. The goal is for your gums to be
tight against your teeth with no bleeding, with a somewhat indented
appearance that gives the surface an almost pin-pricked texture—which
should be pink, rather than red, in color—and with no loose pockets of
periodontal disease. This is a good time to listen to the dentist or
hygienist’s evaluation and the numbers that they report on your dental
chart.
At the conclusion of this stage of your appointment, you can ask for a
printed copy of these numbers, or you can simply write down in a small
notebook which of your teeth have been diagnosed with problematic
pockets. You need to know if the pockets are on the inside or outside
surfaces of your teeth, so that you will be confident which areas you need
to target with your home care.

BLEEDING GUMS
Your hygienist may find an area that bleeds during his or her
examination with a dental probe. This may happen if you are in the first
months of improving your mouth health with my system. Bleeding is
possible, even if you have worked hard to improve your oral health, and
no matter if your mouth feels cleaner and healthier than ever before.
Some hygienists consider this a signal that you need to floss more
frequently, but often the problem is caused by the fragile state of new
gum tissue—like any wound in the process of healing. Perhaps you have
not used the correct brushes, are not confident enough to do vigorous
gum massage yet, or you forgot how important diet is for gum health. A
little more work at home could likely resolve this so-called bleeding on
probing (BOP)—so don’t be dismayed, and maybe give yourself a few
more months before re-evaluation.

GUM POCKETING
If areas of gum pocketing are discovered by your examiner, the depths of
these pockets will be recorded in millimeter measurements at six
separate spots around the root of each tooth. Ideally, you will want to
know where any pockets are in your mouth, so you can target these
specific spots with vigorous gum massage. As described in Chapter Six,
my Complete Mouth Care SystemTM can usually help to heal pockets
within six (6) to twelve (12) months, and you should expect to achieve
zero pocketing around your natural teeth.
Be aware that implants cannot be evaluated with a probe in the same
way as teeth, since there is no attachment of gums to an implant. Some
hygienists probe implants, but there is disagreement about the usefulness
of this. If pocket depths have improved since your last evaluation, even if
a few continue to measure a few millimeters, try a few more months of
slightly more focused gum massage; use good toothbrushes; ensure that
you give your mouth more resting periods; and consider modifying your
diet (strategies that were all explained in Chapter Eight).
Your dentist may offer laser treatments or deep cleaning to help reduce
these gum pockets and remove any hardened debris found under the
gums. This treatment may be helpful for some people, but the Complete
Mouth Care SystemTM has allowed many to avoid this treatment and
heal the associated pockets. This can even occur in situations where there
is an accumulation of a crusty layer of plaque below the gum line. This
so-called tartar or calculus can build into a sizeable plate of mineralized
plaque, but the regular use of my suggested home care strategies can
often dissolve it away—and gum massage can help resolve the pockets
completely.
Never allow gum pocketing of more than seven (7) millimeters to
linger more than a year—and if you have tried using my system for
twelve (12) months and have not healed such a deep pocket by yourself,
then a deep cleaning or surgery may be better for your mouth. In-office
stem cell regenerative therapy is a way to promote gum and bone
growth, in a similar fashion to the gum massage that I recommend. This
treatment injects stem cells (see Chapter Eight for more on this topic) into
your gums and uses lasers to excite these cells into a regrowth of healthy
tissue in and around your gums. The outcome from this kind of therapy
appears to be superior to other techniques that include bolstering the
gums with collagen and dermal fillers or using bone and gum grafting.

GUM RECESSION
Gum recession can cause pain and tooth sensitivity, but it is not an
indicator of poor mouth health. In fact, recession often occurs in healthy
mouths from overuse of the wrong kinds of products (like baking soda,
whitening pastes, or peroxide) or an excessive amount of flossing. This is
why it is important to recognize the difference between gum disease
(where you may need to do more) and gum recession (where you may
need to do less). Knowing the cause of recession is important so it can be
controlled—especially if you have enamel loss along the sides of your
teeth, which makes it impossible for your gums to grow back across this
empty (even-filled) enamel erosion space.
Filling the erosion grooves in enamel is often a recommendation, but if
the area is temperature-sensitive, you may prefer to wait and use my
system to reduce the sensitivity first, so you give the tooth time to protect
the tooth nerves. This type of filling on the sides of teeth is called a Class
V (five) filling, and they often fail and need constant replacement—which
risks the health and vitality of these teeth. Ask your dentist why he or she
recommends the filling of these eroded areas, and maybe discuss what he
or she thinks about the idea of a delay in treatment.

Bacterial Testing
Cavities and gum disease are the result of an imbalance in the
proportions of bacteria in your mouth. A sample of your saliva can be
used to measure the number and kinds of mouth bacteria it contains, and
also to help determine if you have an overabundance of harmful ones
(periodontal pathogens or plaque-forming ones) or too few that are
healthy (often a cause of bad breath).

How Often Do You Need X-Rays?

A visual inspection used to be the best way to judge the overall health of
a mouth, but this is not possible if the biting surfaces of teeth have been
sealed or filled. Molar grooves are usually the first places in the mouth to
decay, which means we can make a relatively accurate interpretation that
if someone has healthy molar grooves, they likely have a very healthy
mouth. When these grooves are covered with a plastic sealant or have
been otherwise masked or filled, then it must be understood that these
treatments will have eradicated the most important signal for visual
mouth assessment.
With an inability to check tooth groves, we can no longer rely on a
visual examination and therefore need more frequent X-rays to monitor
mouth health. This is another critical reason to avoid sealants and
unnecessary fillings, since they considerably increase your lifetime need
for—and dependence on—X-rays. The more dental work in your mouth,
the more you will need X-rays—and the less fillings, crowns,
bridgework, sealants, and implants that you have, the less X-rays you
will need.

X-Rays for Evaluation of Progress

X-rays are also useful to find unexpected things, to determine if your
teeth and jawbone look healthy and normal, and to investigate the
ongoing health of specific areas. However, X-rays can also be a tool to
show if your mouth care routine has successfully mineralized your teeth.
When X-rays are aimed at a mineralized surface, they bounce off
minerals they encounter—and the more X-rays bounce back, the whiter
this area appears in an X-ray picture.
Examine an X-ray of a tooth and you will see that it has a white outer
shell. When you compare X-rays taken from the same angle, targeted at
the same tooth, and after an interval of time, it is possible to compare the
brightness of this shell. Every year—if your teeth are in fact becoming
healthier and more mineralized—this area of your teeth should look
clearer and whiter. A dark area on an X-ray means this area is not
mineralized, because there are no minerals to bounce the X-rays back.
The center of a tooth always appears black because it is an empty space
full of liquids, nerves, and live cells. The dentin of the tooth (see Chapter
Two earlier in this book for more on this topic) has a few minerals, so it
always appears as gray in color.
If your dentist sees a black shape in part of a tooth that is supposed to
be gray or white, this indicates that there may be a loss of minerals in this
area. These black shapes on an X-ray can easily look like a hole in your
tooth, but this is not necessarily the case. A cavity takes some years to
form, and it begins as a softened area where minerals have disappeared.
If you decide to remineralize your teeth, then this black hole will likely
brighten and whiten in color. Bear in mind that it can take months for a
demineralized area to show up as fully mineralized on an X-ray.
Improvement should be encouraging, and if you see progress, you
should continue for longer to see if you can completely reverse this loss
of minerals.
Bitewing X-rays are still the best type to show this kind of change, both
in tooth density and mineralization. If your dentist needs to look closely
at the area around the root of a tooth, he or she may take a periapical X-
ray to see this unique view. A periapical X-ray can also be used to help
determine if a tooth is dead or alive. More expansive and complete jaw
X-rays are called panoramic X-rays, and they capture an image of your
entire jaw—upper and lower—on one piece of film. This helps a dentist
notice things that are unusual—a cyst, a buried or extra tooth, a left-over
root from some previous extraction—or anything else that would be
considered unexpected in the jaw area of the mouth.
Sometimes a dentist will use a panoramic X-ray to check the carotid
artery blood vessels in your neck, if only to more fully ensure that there
are no signs of a calcification blockage inside the walls of these arteries
(which would appear on the X-ray as a white area or calcified mass).
Other dentists may offer ultrasonic scans of these arteries—to similarly
check the health of this important blood vessel that takes blood through
your neck and into your brain. Cone Beam Computed Tomography (CT)
scans are now used more commonly in dental offices. They are less
expensive for the dentist, are said to create less radiation exposure, and
can produce improved 3D images to help your dentist better evaluate the
position and health of tooth roots or possible fractures. Fortunately,
technologies are being developed to make no-radiation scans a
possibility in the near future.

UNNECESSARY TREATMENTS
You need a dentist who will talk with you and explain how you could
improve your oral health at home. In the summer of 2006, the New York
State Dental Journal published an editorial examining the “biological
price” of fillings, compared with the option of no treatment—that is, the
comparison between the cost to health created or caused by a filling (in
the form of possible harm to the mouth and body, and the potential risk
for a filling to precipitate a cascade of future treatment requirements)
compared with an outcome achieved by stabilization of mouth health if
the patient chooses to reverse this cavity (which could potentially
eliminate any need for a filling).
Consider carefully that some dentists do not believe that cavities or
gum disease are preventable or reversible. You should also remain aware
that there is another available treatment that flows a thin plastic sealant
material into the open porosities of a cavity. This is not a good solution,
since it can act as a kind of plaque magnet to attract decay in this area of
the mouth—so don’t be fooled by this sealant treatment for early cavities.
We have already explored how a small cavity in a permanent adult
tooth can naturally reverse in a few months, which is why any motivated
patient should weigh the risks of sealants and “small” fillings, and
consider carefully that any treatment will be irreversible, especially if
you allow a tooth to be randomly drilled. Patients often want to have a
conversation with their dentist and be given options—including a non-
treatment choice. Why put a filling into a tooth that could repair itself
naturally? This is a question that must be asked, especially when this is a
choice for young patients.

Toxicity of White Fillings and Sealants

Statistics show that more than fifty percent (50%) of silver amalgam
fillings eventually need repair, and that the lifespan of an amalgam or
white filling is about thirteen (13) years. Consider how many times one
filling could be repaired over a lifetime and multiply this by the number
of teeth in your mouth. There is always some damage and danger to the
life of a tooth when a dentist removes or puts in fillings. Remember as
well that there is always some impact from almost all dental materials, as
mercury can escape from silver amalgams and plastic chemicals can
leach from sealants and white fillings.
This is why I suggest you consider carefully if your dentist suggests
that you change your silver fillings to white ones. White fillings attract
plaque and can quickly develop cavities around their edges. All filling
replacements have the potential to kill the nerve of a tooth, although this
damage may occur slowly and not be obvious for five or more years. The
fact that many teeth die and need a root canal after an amalgam has been
replaced by plastic makes this replacement decision important.
White fillings and sealants are materials with ingredients that have the
potential to cause what is called a bisphenol toxicity, which is a reaction
that occurs when plastic molecules (with a specific chemical structure)
are absorbed by the body or swallowed into the digestive tract. These
chemicals confuse the body signaling systems as they mimic the
important female cycle and growth regulating hormone called estrogen,
and this can raise the overall impact and effects of estrogen everywhere
in the body.
These toxic side effects could be a serious issue for a child or someone
of reproductive age, or if you have a history of hormonal dysfunction or
estrogen-related cancer in your family. You have been empowered by the
material in this book to refuse unnecessary fillings, and you would do
well to always remember the option to delay and wait for confirmation of
the safety of white fillings and sealants on the gut microbiome—
especially for children, young adults, and women of all ages.

Toxicity of Silver Fillings and Gum Disease

Silver amalgam fillings are banned in Norway, Denmark and Sweden,
and many dentists in America refuse to use this material in their offices.
The International Academy of Oral Medicine and Toxicology has
established safety guidelines for the drilling and removal of amalgam
fillings, and there are many dentists who offer the safe replacement of
amalgam fillings, removing most of the danger posed by amalgam
toxicity. I encourage patients to protect their existing fillings and maybe
wait before they decide to exchange a silver filling for a white one, since
in a healthy mouth, silver and white fillings should remain stable for life.
If you are worried about toxicity, know that our body has many ways to
detoxify and remove the poisons from dental materials, but the first way
is to avoid any more fillings that would add to the toxic burden on the
body.
On the other hand, it is vital to know that certain gum disease bacteria
can release hydrogen sulfide—a gas that reacts with mercury (the
compound that is found in silver amalgam fillings). When this gas reacts
with the mercury from fillings, it can form a toxic compound called
mercuric sulfide. If you have amalgam fillings in your mouth, it would be
wise to take a salivary test and be assured that you do not have high
levels of periodontal pathogens or chronic periodontal disease, since this
has the potential for the formation of a highly toxic compound, which if
released into your mouth has the potential to cause kidney and nervous
system damage—if mercuric sulfide is absorbed or inhaled. A metallic
taste in your mouth is a sign of this problem, and my recommendation is
to immediately start using my system of care to reverse periodontal
disease as rapidly as possible.

Smile Design
People want attractive teeth and although a nice smile is definitely a
beauty asset, the alignment and color of your teeth does not define your
mouth health. Front teeth are visible to others, and there is an interesting
but illusionary line (created by the contrast in color between the white of
your teeth and the pink of your lips) that creates your smile line. Look in a
mirror and follow the tips of your upper teeth from the front to the tip of
your last visible tooth when you smile. This smile line shape affects how
others perceive your smile, with a gently upward-curved line associated
with a wide, friendly smile.
If you now want to enhance your smile, there are specialists in
cosmetic dentistry, prosthodontics, and orthodontics who suggest a
variety of ways to build with crowns, veneers, bridges, or implants, or
move teeth with orthodontic appliances to formulate a new smile. This is
not easy to achieve so be cautious of online marketing that promotes “do
it yourself” tooth movements—this is one case when you must have
expert advice from an experienced specialist to move teeth safely.
One consequence of incorrect tooth movement is that gums can move
down the roots—a problem we call receding gums. The way teeth bite
together matters for the health of the gums and bone. If your teeth have
been incorrectly moved, it can have long-term effects on your gums—
and this can lead to eventual tooth loss and leave teeth without an
appropriate bite, which could compromise your oral health for life.
Before you worry about straightening your teeth, ensure your mouth is
healthy. You will notice that a healthy smile naturally appears brighter
and more attractive, anyway.

WHAT TO DO WHEN THINGS ARE NOT WORKING OUT

How do you find a dentist with high standards and who values teeth?
The best dentist is surely one who does an ever-diminishing amount of
work on your teeth. My advice is to be cautious and realize that
descriptions can themselves be a marketing strategy. Many new dentists
consider selecting a field of dentistry that will maximize their work goals,
which may not be your goals. Cosmetic skills and whitening, or the idea
of being holistic, are some of the strategies to set dental offices apart.
You may simply want an honest evaluation by a caring professional
but even when you find such a dentist, be aware that there may still be
some difficulties to overcome. You cannot change dental offices every
time you and your dentist disagree, so I encourage you to be empowered
with as much understanding of oral health as possible. You should ask
questions and take your time to agree on any treatment plan. Below are
some of the decisions that you may find easier with a little more
knowledge.

Ten Ways to Empower Yourself Before a Dentist

Visit
It is one thing to learn about all the best and most proactive things one
should do for your teeth and gums in between dental visits—it is
something else entirely when it comes to being—and feeling—adequately
prepared for that next scheduled appointment. The following are ten
surefire ideas you may want to consider before you go to your next dental
visit.

1. Confidence can help you glide through a dental appointment,

which is why you will want to take headphones and some favorite
music. But you also want your teeth to look as good as possible,
so know mouth health can improve in a few weeks and be sure to
clean your teeth immediately before your scheduled visit.
2. Resist pressure or coercion by dental office staff who may
suggest you should whiten your teeth. Bleaching treatments
weaken teeth and ultimately make them more porous, so they will
stain more easily if you decide to stop using whitening products.
Improve your daily home care to naturally whiten your smile.
3. You may be told that you need dental work, or that your gums are
not healthy. Don’t allow this to make you sad or anxious. Avoid
signing treatment agreements quickly, unless your problem is an
emergency. You may want to consider options—even the option
to reverse a cavity or gum disease yourself—or see a specialist
for a second opinion. These are your teeth, and you do not need
to commit to anything you do not want to have done—especially
in a hurry.
4. You may not want to buy the products that your dentist
recommends. Never allow yourself to feel pressured or purchase
an expensive toothbrush or other device when there may be
equally or more effective––and less expensive– options.
5. Knowledge is power, so I encourage patients to ask lots of
questions at dental visits. A patient’s responsibility is to provide
the dentist with a good medical history and as much information
as possible about any dental symptoms. Then be sure to listen
and ask more questions if you do not understand your dentist’s
evaluation of your teeth. You may want to know more about your
periodontal charting and the urgency for treatment. With a clear
 picture you can be in a better position to decide what you want
your dentist to do in your mouth.
6. Dentists may recommend that you, or your child, be referred to a
specialist—maybe an orthodontist who specializes in
straightening teeth, or an endodontist who specializes in
evaluating sensitive teeth and has the skills to do a root canal on
a dead tooth. This may be a good idea, but always take time to
consider if you want to accept the procedures recommended and
ensure you understand which treatments can wait and which
ones should begin immediately.
7. If you are told that you have a small cavity or two, you can ask if it
is possible to delay treatment for a few months. You can use my
strategies and ask if they see improvement at your next
appointment. Cavities generally take several years to form, and
many cavities can be reversed—often within ten to twelve
months. You may amaze your dentist when your improved oral
care is able to heal those cavities.
8. A good time to take charge of oral health and make changes is
before your next dental appointment. Mouth health can improve
rapidly and make your teeth cleaner and healthier—especially
when you use the strategies introduced in this book. If you need a
dental cleaning, you will have less plaque—and if you need a
filling, the tooth enamel will be stronger because of your efforts,
so this new filling will be surrounded by healthier enamel and last
longer in your mouth.
9. The air in most dental offices is contaminated by particles that
spray out of mouths as teeth are drilled and cleaned. Your dental
team wear masks and eye protection, but you lie in the chair with
your mouth open. The best time for a dental appointment is early
in the day—so you are the first in the treatment chair—ideally,
after a long weekend (when the air has settled).
10. Last, if you take your child or children to the dentist, be sure to
give them support by discussing and providing them with the
same empowerment strategies listed above. They will thank you
for it later.
Should You Extract a Tooth?
If a tooth nerve dies, what should you do? Some dentists tell you to
extract the tooth, while others may advise you to have the tooth treated
with a root canal. If you extract the tooth, you may find your dentist
wants to make a bridge to fill the gap, while others suggest bone
replacement surgery and an implant (which is a screw that carries a fake
tooth). Extraction of any tooth is serious business, because there may be
other options and health implications to consider. Extractions, even for
children, is an option that should be weighed with the utmost of care. It
is usually best, whenever possible, to save teeth rather than extract them
too quickly—even if a smile is crowded—because there are a number of
things about teeth that you may not know.
There are special nerve connections between adult teeth and the brain
that cause the release of a substance called orexin, which may be a benefit
for eye, digestive, and brain health. This is one good reason to try and
save every possible tooth—including wisdom teeth. The jawbone around
wisdom teeth will only grow to accommodate the tooth if there is one
there—and although it may look as if there will never be room, consider
waiting if your child has a healthy mouth and good oral care habits. If a
tooth is extracted, the jawbone will stop growing, and this can shorten the
jawbone and potentially impact the shape of a face and the size of nasal
sinuses—which could impact breathing efficiency in later life. It is
therefore crucial that you do not have any teeth extracted—unless there
is an associated acute infection or tooth abscess, without the clear-
minded consideration of these long-term effects.
Extractions themselves can be complicated, with serious potential to
cause chronic nerve damage or a loss of taste or feeling in the tongue or
lower jaw. A lost tooth creates a space, and if an upper tooth loses
contact with its opposing lower tooth, this can allow the upper tooth to
overgrow—and come loose—from the upper jaw. Implants also have
drawbacks, while root canals have experienced a considerable amount of
bad publicity on social media.
Implants are frequently sold as an easy dental fix, but they are always at
high risk for periodontal gum disease—although when this so-called
periodontitis infection is discovered around an implant, it is called
implantitis. This is why it is so important to develop a healthy mouth
before an implant.
Regular dental cleanings are also riskier for people with implants, as
particles of titanium from the screw can be shaved off by hygiene
instrumentation and cause tissue reactions that are similar in nature—
and impact—to an exaggerated auto-immune response. If you already
have implants yet continue to need dental cleanings, you may want to
ask your hygienist if she or he will use what is referred to in the oral
health industry as a special dental implant scaler to avoid this kind of
implant scratching or possible complications.
So how can one decide the best dental treatment to select? In view of
all these choices and considerations, my advice is to empower yourself
with as much knowledge as possible—and to always seek out counsel, or
at least a second opinion, from a specialist like an endodontist or
prosthodontist.

THE STATUS QUO

Your dentist may tell you to use a soft brush and to avoid brushing your
gums, but my recommendation is to practice consistent gum massage
with a dense and relatively firm-textured brush. Some dentists say
cavities cannot be reversed, but this book has suggested already how to
do this. You may wish dentists would agree, but this is unlikely to
happen in the foreseeable future.
Why? Well, a big part of the answer is because most are trained in the
aforementioned “drill and fill” approach that fits the protocol structure
of most dental offices, whereas you are now looking for personalized
home care to avoid unnecessary dental treatments.
Unfortunately, financial reimbursement generally maintains the status
quo in America, and student training is to fit the paradigm where
dentists are paid a fee for service—and this means that the more
treatment a dentist does for you, the more he or she is compensated with
money. If your dentist has never seen a cavity reverse, then she or he will
unfortunately be unable to offer you the kind of support that you now
seek. If your dentist does not believe periodontal disease can be reversed
without a cleaning, then you may need to consider following my protocol
for a few months before you return.
Remember something, as you continue on this oral health journey:
Your mouth’s environmental conditions cannot go in two directions at the
same time. If your teeth and gums feel cleaner and healthier, then keep
going with my Complete Mouth Care SystemTM. If you see some surface
stains on your teeth, they are likely superficial and may even be
successfully brushed away with a little more vigor. Don’t make the
mistake, though, of interpreting a temporary cosmetic flaw—which can
easily be cleaned away by your dentist—as something to worry or
redirect you. It is not the sign of a problem—rather, it indicates that
plaque is being addressed and that your oral health is changing and now
going in the right direction.

No Instant Decisions
Second opinions can be useful, and it is always best to try not to feel
pressured or make any instant decisions. You should never give your
consent to a treatment plan until you have had the time to consider it
—carefully. If you are told that you need a cleaning or surgery, find out as
much as possible about it and perhaps ask how long you could
responsibly delay this appointment. Remember the story of journalist
Helen Rumbelow (see Chapter Four), who defied warnings and achieved
amazing improvement in her oral health? Your dentist may have been
trained to believe the only solution for periodontal disease is achieved
through antibiotics and cleanings. The problem is that these repeated
deep cleanings may not solve your problems, and they have been shown
to carry a special risk for anyone with gum disease.
Consider the following: Gum disease may increase your risk for an
ischemic stroke, and the more severe the periodontal disease in your
mouth, the higher this risk appears to be, particularly for young adults.
The Journal of Dental Research published the results of an international,
multicenter study in April 2024 that investigated 348 people with
periodontal disease and how their risk for stroke increased after a deep
cleaning. This case-controlled study of adults ages 18 to 49 years old
compared the experiences of first-ever stroke victims who had a
Cryptogenic Ischemic Stroke (CIS), and this group was matched with
adults of similar sex and age who were stroke-free. Invasive dental
treatments, like deep dental cleanings three months prior, were found to
be associated significantly with an increased risk for stroke. The
participants in this study were recruited at Helsinki and Turku
University Hospitals between 2013 and 2019 and it appears more studies
are necessary to better understand these risks and dangers.
My suggestion, if you are diagnosed with gum disease, is to ask if your
dentist would at least consider a delay. You can then look to make
immediate use of my Complete Mouth Care SystemTM, if only for a few
weeks, to try and improve your oral health and limit this risk on your
own—prior to a deep cleaning appointment.

CONCLUSION
At this moment, you may be ready to adopt the strategies in this book,
even before your next visit, or maybe you are too nervous to do things
that are contrary to the advice you have been given by your dentist. If
you feel this way, or simply want to learn more, I have already created a
number of online videos, teaching programs, and video interviews with
dentists, doctors, and scientists where we discuss this new paradigm of
dentistry, in a way that I hope will make you feel more comfortable and
confident.
One vital nugget that I hope you have taken from these chapters is that
oral health success is possible. Although the ideal moment to start using
these strategies is before or between visits, it is never too late—and
remember that most of these positive changes will occur largely in the
comfort of your own home.
Don’t buy into the excuse that you have a “cracked” tooth, or that your
teeth are “aging,” or the idea that you cannot control dental damage and
must resign yourself to ongoing dental treatments. If you have any
dental problems, immediately consider a change to your daily home care
since healthy enamel does not crack, and a healthy mouth preserves
fillings so that they do not age. You already know how to turn your
mouth health around before your dentist makes that crown or refills that
tooth. You have learned the power of stem cells and the process of
angiogenesis to repair gum and bone, and how diligence with the
Complete Mouth Care SystemTM can help you to reverse dental
problems. The ideal is to prevent dental disease early in life and establish
healthy habits in children so that they can enjoy a lifetime of perfect
teeth.
I have always worked to help patients improve the quality of their
dental visits. To do this, you must know how to control mouth health
and how to avoid unnecessary treatments. My hope is that you have
been empowered by this book and that you are now ready to enjoy your
own future dental experiences—more than you may ever have believed
possible.
 Conclusion

All truth passes through three stages: first it is ridiculed, second it is

violently opposed, and third it is accepted as self-evident.
—ARTHUR SCHOPENHAUER, NINETEENTH-CENTURY PHILOSOPHER

T he medical and dental professions of today do not seem adequately

aware of the simple things that patients can do for themselves to
avert dental disease and suffering. This is why I believe it is important
for patients themselves to be empowered about the dangers of commonly
offered procedures like sealing tooth grooves, artificial tooth whitening,
implants, and inappropriate straightening of teeth. Your body health,
cognition, and longevity depend on interactions with your teeth and a
healthy mouth. Powerful dental organizations seem focused on their
financial stakes, while teaching institutions prepare dentists for general
practice without concern for the long-term consequences of unnecessary
treatments.
This is why I wanted to demystify oral biochemistry—and help you
learn how to heal and strengthen your teeth with simple at-home
strategies. My deep hope is that this book has served that purpose for
you. In fact, nothing would put a bigger smile on my face than knowing
that Kiss Your Dentist Goodbye has refreshed your mindset about
dentistry, improved your oral health, and offered tangible nuggets of
encouragement. For all who have dared to take a healthy bite into this
book, I congratulate and thank you.
 Glossary

Abrasion. The wearing away or loss of tooth enamel that occurs when
the mouth is acidic, when teeth have inadequate lubrication and
protection from mouth’s liquids (dry mouth), and a signal to dentists to
investigate for an underlying airway/breathing problem.
Aggregatibacter actinomycetemcomitans (AA). A type of bacteria that
proliferates in mouth conditions associated with periodontal gum
disease. AA is also associated with chronic sinus infections, and the
bacteria can enter the bloodstream to negatively impact body health by
evading and attacking immune cells.
Amalgam. A silver-colored metal material used to fill cavities in teeth.
Half of the material is liquid mercury mixed with powdered silver, tin,
and copper metals. Concerns about mercury toxicity have eroded its
popularity, and many dentists use plastic or ceramic as filling materials
instead.
Ameloblasts. These special cells are involved in a complex process that
results in tooth formation inside the jawbone—before teeth enter the
mouth. These cells release proteins and minerals that mix to create an
enamel shell on the outermost part of a tooth.
Anaerobic. This refers to organisms that can exist in the absence of
oxygen.
Angiogenesis. A process by which new blood vessels form from pre-
existing ones, something that plays a vital part in wound and gum
healing. The new vessels bring blood, oxygen, nutrients, and stem cells to
support and accelerate the natural repair mechanism.
Biofilm. A community of resistant bacteria that adhere to surfaces and
create a self-produced protective matrix, usually made from simple
sugars called polysaccharides and proteins and with the inclusion of other
bacteria.
Biomarker(s). Substances in blood that can be used to measure body
reactions to medical interventions.
Biome. A diverse community of organisms in specific locations on or
inside the body and comprised of bacteria, viruses, fungi, and other
microbes. The composition can be shaped by diet, lifestyle, genetics, and
interactions between bacteria. (See also Microbiome.)
Bisphenol toxicity. Harmful endocrine-disrupting effects associated with
exposure to chemicals in plastics and resins, including white dental
fillings and sealants. The most well-known is bisphenol A (BPA) toxicity,
but there are variants called Bisphenol S (BPS) and Bisphenol F (BPF) that
also block or mimic hormones (particularly estrogen) and create a range
of adverse effects on reproductive, neurological, cardiovascular, and
immune health, which may promote cancer and metabolic conditions
such as obesity, and type 2 diabetes, and impaired glucose metabolism.
Brachiocephalic vein. A large vein found on the left and right side of the
head that collects oxygen-depleted blood from the head, neck, arms, and
upper chest to channel into the heart for re-oxygenation in the lungs.
Bruxism. An involuntary grinding or clenching of teeth during the day
(or night) that causes tooth wear and damage, jaw pain, headaches, and
loss of gum attachment. A serious underlying cause may be some kind of
restriction in the airway from the nose or mouth into the lungs.
Butyrate. Also known as butyric acid, this is a beneficial compound
essential to maintain the integrity of the gut lining that may help to
prevent a condition called “leaky gut.” (See also Intestinal permeability
and Leaky gut syndrome.)
Calcium. A mineral that is essential for building and maintaining strong
bones and teeth, but it also plays a key role in muscle, nerve, blood and
overall body health.
Calculus. (See Tartar.)
Canine (tooth). A pointed, cone-shape tooth at the corner of the upper
and lower jaws and located directly under the eyes (which is why they
are sometimes called “eye teeth”). These strong teeth guide others into
the mouth and provide support for our face and lips.
Capillaries. Small blood vessels that form a network that connects the
body’s oxygenated blood vessels with the blood vessels carrying
deoxygenated blood back to the heart. They allow for the exchange of
oxygen, nutrients, and other products between the blood and tissues at
every location around the body.
Carotid artery. A major blood vessel that supplies oxygenated blood to
the brain, face, and head, running up each side of the neck to further
supply the outer parts of the head and the deeper parts of the brain, eye,
and other areas in the skull. Carotid artery health is vital, and plaque
build-up in carotid arteries can reduce blood flow and increase the risk
for stroke.
Cariostatic. A substance or action that can halt or inhibit the
development of tooth decay (dental caries).
Catalyst. A substance or other similar agent that provokes or speeds a
reaction or change in the body.
Cavity. A damaged area of a tooth that is formed by the caving in of its
structure, following the progressive weakening and erosion that results
from the acidic attack of plaque bacteria.
Chlorine-dioxide. A solution used to sanitize food and produce. In
mouthwash, it can disrupt anaerobic bacteria without producing harmful
byproducts.
Circadian rhythm. A natural process that cycles over a period of twenty-
four (24) hours. The rhythm can be influenced by environmental factors,
hormones, and lifestyle, and related disruptions can then lead to health
imbalances.
Citric acid. An organic acid found in citrus fruits like lemons, limes, and
oranges, and which has a sour taste. It is used to flavor foods and
beverages but can also play a part in the body’s metabolism to create
energy in our cells.
Collagen. A protein that provides strength, structure, and resilience to
body tissues, including the gums and teeth. Collagen also forms
attachment points where fibers connect the tooth to the jawbone and is
also a part of these same attachment fibers.
Colonization. The process by which bacteria establish themselves to
become stable communities suited to a particular environment within the
body.
Crown. Dental crowns cover damaged, decayed, or unattractive teeth to
restore function and their appearance—or to protect weak teeth from
further damage. A crown is made by shaving away the outside layer of a
tooth and replacing it with either metal, ceramic, porcelain, or plastic.
Curcumin. The root (or rhizome) of the South Asian plant called Curcuma
longa provides a yellow-orange spice called turmeric, which is used in
cooking and for medicinal purposes. The active compound in turmeric is
curcumin, which has powerful anti-inflammatory and antioxidant
properties.
Demineralization. A loss of minerals, which weakens a tooth’s structure.
Dental caries. A progressive and destructive disease that attacks teeth.
Dentin. A porous, creamy white layer that is the principal mass of a
tooth, within an outer protective layer and encasing live tissue in the
center.
Dilute. The process whereby particles in a liquid become spaced out as
more liquid is added. Since the thickness of a substance decreases by
adding liquid, this process of dilution then makes the substance less
concentrated and “weaker.”
Electrolyte. A substance that, when dissolved in a liquid, can conduct
electricity. Electrolytes are involved in many bodily functions, as they
help to regulate water distribution and balance the fluids inside and
outside our cells. They also play a role in nerve and muscle function.
Enamel. The hard outside layer of a tooth, packed with minerals to form
a protective coating.
Endodontist. A dentist with additional training to diagnose and treat
problems that occur on the inside live part of a tooth. These experts
perform root canal treatments that can allow you to save a tooth from
extraction.
Enzyme. Since our body needs certain proteins to speed chemical
reactions—especially for digestion and wound repair—enzymes have a
shape that allows them to attach to molecules, which thereby helps to
achieve the process. For example, amylase (a mouth enzyme) speeds the
breakdown of starchy foods into digestible sugars.
Erethism. A disorder that affects the nervous system and is often the
result of long exposure to heavy metals and particularly mercury vapor.
Symptoms include irritability, anxiety, loss of memory, hand tremors,
and impaired brain function.
Erosion. The act of teeth wearing away, following a softening from
prolonged exposure to acidity.
Essential oil(s). Highly concentrated extracts that release a plant’s
unique natural scent, flavor, and beneficial compounds. They can be
made from various parts of a plant, including the leaves, flowers, stems,
roots, or bark but they must be carefully diluted for use in any therapy or
personal care product.
Estrogen. A sex hormone that plays a critical role in the regulation of the
female reproductive system, influencing hormonal cycles and the
development of a female body shape. This hormone is also important for
bone, cardiovascular, and brain health—while imbalances of this
hormone can lead to health deterioration in general (and cancer, in
particular).
Eustachian tube(s). Each ear has a narrow tube connecting the middle
ear to the throat. The function of this tube is to equalize air pressure on
both sides of the eardrum for hearing and balance.
Explorer. A pointed instrument that dentists use to check for cavities and
tooth decay.
Extraction. A procedure to remove a tooth from its socket—usually as a
last resort when other treatments have failed or are not possible.
Filling(s). A dental treatment used when a tooth has been severely
damaged by decay or fracture. A filling is designed to control dental pain
and protect the tooth from further damage. White plastic and silver
amalgam fillings are common, but ceramic/glass and gold are preferable.
Fluoridation. The process of adding extra fluoride to drinking water or
oral care products, in an effort to strengthen teeth and help them resist
decay. (See also Fluoride and Fluorosis.)
Fluoride. Fluoride is a mineral found in soil, water, and certain foods
(such as brewed teas, along with certain fruits, vegetables, and fish)
around the world. (See also Fluoridation and Fluorosis.)
Fluorosis. Mottling of the teeth caused by fluoride as it interferes with
enamel formation in a child before the age of six, to result in a speckled
or mottled appearance of enamel. (See also Fluoridation and Fluoride.)
Floss (Flossing). A thin strand of material promoted for cleaning teeth by
rubbing it between teeth to remove stuck food particles.
Fusobacterium bacteria. Rod-shaped bacteria that thrive in low-oxygen
conditions found in the gut, breathing tubes, genital areas, and the gums
around teeth. These bacteria can invade the body and may be involved in
colorectal cancer.
Gingivectomy. A procedure that cuts gum tissues around teeth in an
effort to make it easier for someone to clean their gums.
Gingivitis. A reversible inflammation of the gums most often noticed as
“bleeding gums.”
Glycerin (or Glycerol). A sweet, colorless, sugar alcohol commonly
added to foods and cosmetics to help them retains moisture. Glycerin is
derived from animal and plant fats by hydrolysis, and some from
petroleum.
Graft. A surgical procedure that takes skin from one area and attaches it
to another area where skin is needed. Gingival grafts are usually
removed from the roof of the mouth and attached where gums are
missing or receding.
Halitosis. A medical term for bad or “stinky” breath.
Human Papilloma Virus (HPV). A group of over 200 kinds of viruses,
with some being able to infect the skin and mouth to cause warts or
cancer. HPV is transmitted through skin-to-skin contact during sex, and
these risks can be reduced by safer sexual practices and vaccinations.
Hydrogen peroxide. A chemical compound normally mixed with water
to disinfect, bleach, and kill bacteria, viruses, and fungi. It can also
change tooth color when used in artificial whitening products.
Hydroxyapatite (crystals). A naturally occurring mineral found in
human bones and teeth, where it gives these structures strength and
resilience.
Hygroscopic pull. Hygroscopic substances attract moisture from their
surroundings, drawing or “pulling” water to themselves.
Implant. Used to replace a missing tooth, titanium or some
biocompatible component is screwed into or attached to the jawbone,
where it goes through a process of fusing with the bone. Once this has
occurred the implant can support a replacement tooth.
Incisor. Eight thin, flat teeth that are located at the front of the mouth—
four in the upper and four in the lower jaw. These teeth help us bite into
food, and also help us talk and look friendly as we smile.
Interproximal cavity. Dental disease between two adjacent teeth occurs
in a space known as an interdental or interproximal area. These cavities
are often the result of microfractures in the enamel surface, that happen
when biting forces are re-routed by a filling. Plaque bacteria enter the
microfractures and begin to form a cavity.
Intestinal permeability. The ability for water and nutrients to pass
through the intestinal walls into the bloodstream. When this permeability
increases, it can allow other particles to pass through as well. When this
occurs, it can cause leaky gut syndrome, potentially creating some
gastrointestinal diseases. (See also Butyrate and Leaky gut syndrome.)
Invisalign®. A brand of transparent plastic and removable dental
appliances used as an alternative to traditional metal braces. These
aligners are customized using 3D-imaging technology to generate
gradual tooth movements over a period of one to two years.
Knoop Hardness Test (KHT) and Knoop Hardness Number (KHN).
This measurement was developed by Frederick Knoop at the National
Bureau of Standards (now NIST) in 1939. A precise force is applied to the
sample material by a diamond indenter with a specific shape. The
material is examined under a microscope and the hardness number
calculated from the result. This is a test used for brittle or thin materials,
such as ceramics, glass and tooth enamel.
Lattice. Tooth enamel has a microscopic structure described as a lattice. It
is a highly organized arrangement of crystals packed in a prism-like
pattern, which gives enamel its remarkable strength and resilience.
Leaky gut syndrome. When too many substances are able to pass
through the intestinal walls into your bloodstream, this may create a
condition referred to as leaky gut syndrome. Symptoms may include aches
and pains, bloating, cramps, gas, and sensitivity to certain foods. (See
also Butyrate and Intestinal permeability.)
Lichen planus. A chronic condition that can affect the mouth, skin, nails,
and sometimes the scalp. It is like an itchy rash and in the mouth may
form white patches on the cheeks, gums, tongue and lips. Dental
materials and medications can trigger the problem, which may have
periods of flare ups and remission.
Litmus paper. Specially treated paper is used to measure acidity and
record it as a pH number, by matching the color of the paper with a
graded scale. The dyes in the paper change when they are exposed to
different levels of acidity and the results are from pH 1 to 14, with a
neutral pH registering as pH 7.
Lymph. A clear fluid that circulates in the body to help maintain fluid
balance, remove waste, and support immune function.
Maltitol. A sugar alcohol derived from starches like corn. It is less sweet
than table sugar and contains less calories. (It does not have the same oral
health benefits as xylitol.)
Mannitol. A sugar alcohol that is naturally found in fruits and
vegetables, including strawberries, mushrooms, and seaweed. It is a low-
calorie sweetener commonly used in pharmaceutical products.
Mercury. A unique metal that is liquid at room temperature, with a
silvery appearance. It has been widely used in dentistry and other
industries, but its toxicity can have serious health and environmental
impact.
Meta-analysis. A powerful tool for research to improve precision and
accuracy in assessing study results by pooling data from multiple studies
to look for patterns or trends that may not have been visible in individual
studies. The reliability of meta-analysis depends on the quality of the
studies and poor studies cause a bias in the results.
Metastable. A physical or chemical system that is temporarily stuck in an
unstable condition, until something triggers its transition to become
stabilized.
Microbiology. The scientific study of tiny, single-celled organisms that
can only be seen under a microscope. These organisms include bacteria,
viruses, fungi, and algae.
Microbiome. A diverse community of organisms living in a specific
location on, or inside, the body. Every microbiome has a unique mix of
bacteria, viruses, fungi and its composition is dynamic and shaped by
factors such as diet, lifestyle, genetic traits, and other bacteria. (See also
Biome.)
Microorganism. A living organism of microscopic size which makes it
too small to be seen with the eye. Examples are bacteria, viruses, and
fungi.
Miswak stick. A traditional, tooth-cleaning tool cut from twigs or roots
of certain trees like the Salvadora persica—known as the “toothbrush
tree.” Miswak sticks contain silica, essential oils, and fluoride to offer
antibacterial, plaque-removing, and teeth-whitening properties.
Moh’s scale. A measure of mineral hardness generated by the ability of a
mineral to scratch or be scratched by other substances. The scale ranks
from 1 to 10 with 10 being the hardest, and enamel with a hardness of 5
and steel 4.5.
Nano-hydroxyapatite (NHA) toothpaste. A toothpaste that contains
extremely small particles of hydroxyapatite minerals. The idea is these
small particles fill microscopic cracks and block demineralized pores in
the tooth enamel surface.
Neuropeptide. A small protein-like molecule that plays a crucial role in
transmitting signals to the nervous system. Some neuropeptides help
reduce the sensation of pain and others regulate stress, emotions,
appetite, and the immune system. (See also Orexin.)
Night or mouth guards. Sometimes a guard is made to protect teeth from
sports injuries, but more often they are made to protect teeth and jaw
joints from wear and damage that causes pain and sensitivity after
clenching and tooth grinding during sleep. The underlying cause of
clenching and grinding may be a misaligned bite or an obstructed
airway. This means night guards do not address the cause—which should
be addressed.
Nitrate(s). Naturally occurring compounds found in foods, especially
green leafy vegetables and in drinking water in agricultural areas where
nitrogen-based fertilizers get into the water supplies.
Nitric oxide. In the body nitrates are converted to nitrites, which then
form nitric oxide—a molecule that helps reduce blood pressure, and
improve breathing, heart efficiency, and blood flow to the brain.
Nitrite(s). Chemical compounds that are known as food preservatives in
cured meats, but they are also produced in the body by certain bacteria
that live in the mouth.
Nitrous oxide. Commonly known as “laughing gas,” this gas has been
used in dentistry to relieve pain and for its mild sedative effects. When
inhaled nitrous oxide creates a feeling of relaxation and reduces anxiety.
The effects wear away rapidly as inhalation stops. Nitrous oxide has an
environmental impact three hundred (300) times more potent than
carbon dioxide.
Oligosaccharide. A complex carbohydrate found in vegetables, legumes,
and grains. They provide energy to beneficial gut bacteria and support
immune function.
Oral epithelium. A layer of cells that forms a covering over the lips,
cheeks, gums, tongue, protecting these surfaces from mechanical,
chemical, and bacterial attack.
Orexin. A substance (called a neuropeptide) secreted by the brain that
affects and regulates wakefulness by its effects on our eyes, cognitive
function, balance, and appetite. (See also Neuropeptide.)
Oropharyngeal cancer. Cancer found in the middle part of the throat,
back of the tongue, or on the soft palate. It is often associated with
smoking and alcohol consumption or following an HPV virus infection.
Otitis media. Inflammation in air-filled spaces behind the eardrum after
a bacterial or virus infection that causes earache and fever—also known
as a middle ear infection.
Pathogen. A kind of bacteria, virus, fungi, or parasite that can causes
disease by invading the body and disrupting normal body functions.
Pentose. An important sugar that has a unique structure composed of
five carbon atoms. These sugars are essential building blocks for DNA
and RNA, and they are also involved in generating cellular energy,
which is vital for cellular function. Xylitol is a pentose sugar. (See also
Xylitol.)
Peptostreptococcus bacteria. An aggressive bacterium that thrives in low
oxygen conditions and is often associated with infection in the mouth
and nasal sinuses.
Periodontal disease. A more severe progression of gingivitis that occurs
when the fibers of tooth attachment become infected and disrupted
below the gum line.
Peroxide. (See Hydrogen peroxide.)
pH scale. A system to measure the acidity or alkalinity of a solution. The
range is from zero (pH 0) to fourteen (pH 14), with seven (pH 7) being a
neutral solution. Any number above seven is alkaline and any number
below seven is acidic. The scale is designed so that each number
represents a tenfold change in acidity: for example, a liquid with a pH of
3 is ten times more acidic than a solution with a pH of 4.
Phosphate. A chemical compound that is important for energy
production in the body, to maintain the body’s acid/alkaline balance,
and for bone and tooth mineralization.
Phosphoric acid. Used in industry to produce fertilizers and remove
rust, this acid is frequently used for its sour taste in a number of
carbonated soft drinks. In dentistry, this acid is used to dissolve minerals
from teeth and create microscopic holes in the enamel surface. Plastic can
flow into these pores, and this is how the filling is attached to the tooth
surface.
Planktonic (bacteria). Free floating bacteria that drift independently as
opposed to existing inside surface biofilm, which makes them more
susceptible to the effects of antiseptics and antibiotics than bacteria that
are protected within biofilm.
Plaque. The soft sticky film that coats the teeth and contains bacteria. If
left untreated, it can harden into tartar. (See also Tartar.)
Polyfluoroalkyl substances (PFAS). A group of industrial “forever”
chemicals used for their resistance to water, oil and heat. They are used
in non-stick cookware, many kinds of packaging and to make dental floss
glide between teeth. These chemicals are toxic to the environment and
can accumulate in the human body over time, being associated with
hormone disruption, immune system impact, and a higher risk for
cancer.
Polymerase Chain Reaction (PCR). This is a lab technique which can
amplify parts of a DNA molecule to make billions of copies and allows
scientists to perform genetic testing and disease diagnosis as part of a
science called molecular biology.
Polysaccharides. Carbohydrates made up of long chains of sugar
molecules bonded together. Starch and cellulose (found in plants) are
two examples.
Porous. Permeable to liquids.
Porphyromonas gingivalis (PG). A kind of bacteria found in the mouth
and associated with periodontal gum disease. It can evade the immune
system and produce enzymes that cause gum inflammation and bone
loss. Studies have linked it to cardiovascular disease, rheumatoid
arthritis and Alzheimer’s disease.
Prebiotic. A group of nutrients that selectively support beneficial
bacteria in the mouth, promoting a healthier balance of bacteria for
health. Xylitol is an example of an ideal oral prebiotic food. (See also
Probiotic.)
Prevotella bacteria. A group of bacteria that live in low oxygen
conditions and are found in the mouth, gut, and female reproductive
tract. Some species are associated with periodontal gum disease and
systemic infections, whereas others contribute to a healthy digestion by
breaking down carbohydrates and proteins in the gut.
Probiotic. Live bacteria or yeasts that may be introduced in supplement
form to balance or enhance the natural mix of bacteria found in the gut.
These same bacteria may also be found in fermented foods like yogurt,
kefir, sauerkraut and kimchi. (See also Prebiotic.)
Pterygoid plexus. A network of small veins in an area deep within the
face, and with connections to veins near the brain—where blood from the
nose, face, and teeth drain into the larger veins of the neck. It is through
this pathway that dental infections can sometimes travel to the brain.
Pulp. The soft innermost part of a tooth that contains the tooth’s nerves,
blood vessels, lymphatic fluids, and cells that can detect and transmit
pain sensations to the brain.
Recession (gum). A condition where the gum around teeth moves down
the root of the tooth exposing sensitive dentin, an area that can feel
sensitive to temperature because it is not shielded by dental enamel.
Recurrent decay. Continued damage to a tooth from decay-forming
bacteria in plaque that may attack the edges of an existing filling and
even travel around and under the filling.
Remineralization (tooth). The rebuilding of minerals back into enamel to
repair and replace missing minerals so that the tooth regains strength.
Retainer. A dental appliance made of plastic or metal and designed to
keep teeth in a specific position—often after orthodontic movement.
Retainers can be permanently fixed in the mouth or removable, which
allows them to be taken out for cleaning.
Root canal. A dental procedure to save a tooth that has suffered damage
or infection in the central area. Any damaged or diseased parts are
removed, and then a special filling seals the area completely, even to the
tips of the roots. This technique requires skill and experience for success,
so it is best performed by a specialist called an endodontist.
Saliva. A watery liquid produced by salivary glands to keep the mouth
healthy, mineralize teeth, fight gum infection, keep the mouth moist, and
aid in the processes of digestion, chewing, and swallowing.
Sealant(s). A coating, usually made of plastic, applied to the grooves and
crevices in the chewing surfaces of teeth to prohibit entry of bacteria.
This concept was developed before the understanding that these areas
are an important habitat for beneficial bacteria.
Silica. One of the most abundant naturally occurring minerals on Earth.
It is found in sand, glass, ceramics, certain foods, and in certain
toothpaste products to support enamel health.
Sorbitol. A sugar alcohol used in many sugar-free foods, which occurs in
some fruits but is generally manufactured for commercial use. Sorbitol
should not be consumed by children.
Stannous fluoride. One of the least expensive fluoride compounds
available and fabricated by a reaction between fluoride and metal. The
metal is tin, and it gives stannous fluoride antibacterial effects and an
ability to form plugs in the surface of teeth. This is claimed as an
advantage, but stannous fluoride can stain teeth and create toxic
reactions, thus causing skin sensitivity in the mouth.
Stem cell(s). Unique, undifferentiated cells able to change into many
types of specialized cell and renew themselves. They play a crucial role
in growth, organ repair, and wound healing.
Streptococcus mutans. A type of mouth bacteria that contributes to
plaque formation and tooth decay because it can stick to teeth and
produce acids that erode tooth enamel. S. mutans can process sugar and
carbohydrates but is unable to process xylitol as an energy source.
Sucrose. Most people use this as a table sugar, and it’s valued for
sweetness. Sucrose is naturally found in fruits and vegetables, including
pineapples, peaches, sugar cane, carrots, sweet potatoes, and beets. It is a
carbohydrate that can be broken down into glucose and fructose and
used by the body for energy or stored.
Sugar alcohol(s). A group of carbohydrates with similar chemical
structure. They have less calories than sugar and are commonly used in
low calorie or sugar-free foods and drinks.
Sulfide(s)/Sulphide (British spelling). A chemical compound that
contains sulfur—often in combination with a metal or hydrogen—iron
sulfide (pyrite), for example (which is called “fool’s gold”), and hydrogen
sulfide—a gas with the smell of rotten eggs.
Super-saturation. A state when a liquid contains more dissolved
particles than normal. This makes the solution unstable and ready to
release these extra minerals or particles.
Tartar. Sometimes called calculus and formed when plaque crusts into a
hard substance on the outside of teeth. (See also Plaque.)
Thorax. The area between the neck and the abdomen housing vital body
parts including the heart, lungs, diaphragm and major blood vessels: all
protected by the structure of the rib cage.
Thrush. A creamy-white infection of the tongue, cheeks, gums, and
tonsils, caused by an overgrowth of candida albicans—a yeast that is
naturally present in the body in small amounts. The areas can be sore
and will bleed if scraped.
Triclosan. A synthetic compound that can kill bacteria and fungi and
formerly used in personal care products until it was found to be a
hormone disruptor—affecting thyroid and reproductive health, and
polluting the soil, water, and environment.
Turmeric. (See Curcumin.)
Venous. The blood vessels that carry de-oxygenated blood to the heart,
where it is pumped to the lungs and re-oxygenated.
Voussoir arch. An arch created by arranging wedge-shaped stones in a
curved design so that downward forces are distributed outwardly and
the stones interlock to resist collapse.
White spot lesions. The first stage of a cavity, seen with the naked eye as
minerals are lost and the tooth surface weakens and becomes porous.
Xylitol. A health sugar found in trees, fruits, and made by the human
body. It has a unique molecular pattern with five carbon atoms (while
sugar and sugar alcohols have six). This pentose structure allows xylitol
to control plaque’s ability to grow and multiply. (See also Pentose.)
Zinc. A metallic element that is essential for human health, supporting
immune function, growth, and wound healing. It occurs naturally in
meat, shellfish, and dairy products.
About the Author
Ellie Phillips, DDS, received her specialty qualifications in pediatric and
advanced general dentistry from the University of Rochester, New York.
Dr. Phillips is also a graduate of Guy’s Hospital Medical School in
London and licensed as a dentist in Switzerland. She has worked in
many fields of dentistry, including oral surgery, community and general
practice, in geriatric, special needs, and cosmetic dentistry. She was
faculty and pediatric clinic director at the Eastman Institute for Oral
Health in Rochester, NY, where she was worked with professors who
were involved in many xylitol studies. Her lifelong interest has been the
impact of mouth health on general health and wellness, and this led her
to be a founding member of the American Academy for Oral Systemic
Health (AAOSH) and a leader in creating a multidisciplinary dental
practice at the University of Rochester.
Dr. Phillips has been interviewed extensively by various media outlets
and publications both in the US and abroad—including The Times of
London, The New York Times, The New York Post, First for Women, The Daily
Mail (UK), and FOX News. She also has an active social media presence
that extends to popular apps such as TikTok, Instagram, Facebook, and
YouTube, where she has brought her inspiring message of health
empowerment to millions of fans and followers throughout the world.
Dr. Phillips lives in Austin, Texas, and continues to share her expertise
as a speaker, consultant, and author of articles on topics related to the
value and importance of dental health at every stage of life. In addition to
being the author of her previous book Mouth Care Comes Clean, Dr.
Phillips is the founder of the popular dental health company Zellies.com.
Those who wish to learn more about her various experiences with dental
excellence and her ongoing efforts to change the world one healthy smile
at a time, feel free to visit her website at https://drellie.com/.