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Healthy Teeth & Fluoride Alternatives

Posted by Sarah Stogryn on

Dentist: Do you floss?

Me: Yes daily.

Dentist: And of course you brush?

Me: Twice a day. Sometimes more. Very rarely only once. 

Dentist: Do you eat a lot of sugar?

Me: I eat sugar, but not excessively.

Dentist: Hm. I don't know why you have cavities then.

Me: I've been told in the past that my enamel is soft (hypomineralization). And my boys both have enamel hypoplasia.

Dentist: Hm. Your enamel looks great actually. Must be something genetic. 

When I got my numb-mouthed post-filling self into the car after the appointment I noticed my travel mug of lukewarm coffee sitting there and after 20 years of wondering, it suddenly hit me that oral hygiene practices aren't my problem. Let me explain.

What Teeth Are Made Of

Tooth Structure

Teeth are made up of 3 basic layers: enamel, dentine, and pulp (which extends into the root of the tooth) Enamel is 97% hydroxyapatite (a form of calcium phosphate) and is the strongest tissue in our body.  BUT it's also non-living tissue. No matter what we do, we can't grow new enamel because it isn't living tissue and dead things don't grow. Our saliva can however naturally deposit minerals onto our enamel to keep it strong. 

Saliva and Healthy Teeth

Healthy Smile. Flossing & brushing with fluoride isn't enough to prevent tooth decay
Healthy saliva is very slightly alkaline though the exact pH varies. Saliva coats our teeth and deposits minerals from our diet into the tooth enamel - allowing the enamel to naturally remineralize, keeping it solid, which prevents decay, sensitivity, and yellowing. Every time we eat or drink however the s.mutans bacteria in our mouth consume the sugars and metabolize them to acids. The pH of our saliva becomes slightly acidic which then leaches minerals out of our teeth, and our teeth become coated with plaque (a soft sticky biofilm made of food particles and bacteria). 

Of course not all foods and drinks are equal in this regard. Highly processed, sugary, and acidic foods take a high toll while many vegetables, water, or herbal infusions typically have a neutral or beneficial effect due to their low ‘stickiness’, alkalinity, and high mineral content.

If you're someone like me who takes 3 hours to drink a coffee with cream & sugar, and nibbles on snacks all day long as opposed to distinct meals, that means your saliva rarely has a chance to remineralize your teeth, leaving them highly vulnerable to decay. Nightly flossing and twice daily brushing with toothpaste (fluoridated or not) isn't going to counteract the damage that results from a mouth that is constantly acidic and not being given the conditions to remineralize. 

What About Fluoride?

Isn't it supposed to strengthen our teeth to prevent decay?

For decades experts have believed that fluoridating public water is essential and could reduce decay in the general population by 25-50%. In recent years we’ve learned that fluoridating water may in fact be ineffectual. Fluoridated toothpastes decrease dental decay by 24%, but they come with risks that not all are comfortable with. Some experts believe these risks are insignificant and that fluoride is safe but others consider the risks to be so substantial that the use of fluoride in public water is advised against or banned altogether (this is the case in most of Western Europe, China, and Japan). Some people differentiate as well between fluoride which is ingested via water and that which is topical via toothpastes or gels and varnish. I think it's important to keep in mind that really there is no such thing as a product that goes in your mouth which is purely topical, because there is so much mucous membrane in the mouth so things which are applied topically actually get absorbed into the bloodstream (hence the use of sublingual medications etc). 

Fluoride works by combining with saliva, calcium, and phosphate to form a substance called fluorapatite, which is deposited on the surface of the enamel in a very very thin layer. Once deposited, it attracts minerals present in saliva to the teeth, and new evidence shows it may be difficult for damaging bacteria such as s.mutans to adhere to the fluorapatite coating the tooth. The layer of fluorapatite is more resistant to an acidic mouth environment than natural enamel (hydroxyapatite), but still wears off by chewing and in an acidic mouth environment. Fluoride needs optimal levels of saliva, calcium, and phosphate to be effective. 

What About Healing Cavities Naturally?

Smiling mouth fluoride alternatives
Those who are not comfortable with the risks of fluoride typically look for safer &/or natural alternatives and stumble upon information claiming that tooth decay can be healed.
Frankly I would love it if my teeth were able to naturally regenerate. And we discover new things about the human body all the time so maybe one day we'll learn new things about tooth enamel that will allow us to stimulate natural healing. Unfortunately - - as I mentioned earlier - - enamel is non-living tissue. Dead things can't grow and things that can’t grow, can’t “heal”. Once your natural enamel is gone, as far as we know at this point, it’s gone forever.

HOWEVER - we need to take another look at remineralization. Because while we are not able to re-grow (heal) enamel, we can create optimal conditions in the mouth for teeth to remineralize. We do this by making intentional food choicesthat promote a healthy oral environment; byrinsing with water after eating or drinking; by using products that contain Xylitol or Luctatol to reduce s.mutans bacteria when we can't brush right away; by ensuring optimal levels of calcium and other minerals in our diet; and of course by brushing and flossing. 
DIY recipes and natural/remineralizing toothpastes usually include a combination of ingredients for killing bacteria (coconut oil, herbs, essential oils) and ingredients that are mineral rich (calcium carbonate powder and bentonite clay for instance) to assist in the body's natural enamel remineralization process. 

When all conditions are optimal, our saliva can deposit minerals into demineralized areas of enamel to prevent non-cavitous lesions (aka cavities/caries that aren't yet holes) from progressing. This process is what popular natural websites and the well-known book "Cure Tooth Decay" are referring to when they talk about naturally healing tooth decay. Once the enamel is completely demineralized however it breaks down and that's when we see it become a hole - a cavitous lesion/cavity/caries - which requires restoration such as a filling. Many cavitous caries actually need to be filled before becoming holes, if the demineralization has extended past the enamel. Waiting until you see a hole to seek dental care is not a good strategy ;)

Nano-hydroxyapatite: the unsung hero of tooth enamel

 In Japan they actually use something which - by all accounts I've found - is safer and more effective than fluoride. YES. You read that correctly. 

Nano-hydroxyapatite was developed by NASA for use by astronauts suffering from mineral loss in their teeth and bones due to extended time in gravity-free environments. It has been the gold standard for anti-cavity protection for more than 30 years in Japan but the first toothpaste using it was only approved by Health Canada in 2015. It is a synthetic version of the natural hydroxyapatite our teeth are made of and is highly biocompatible with an excellent safety track record and no known side effects EXCEPT for gum irritation if used in concentrations of 15% or more. Brushing with nano-hydroxyapatite toothpaste reduces the ability of plaque to adhere to teeth, fills in dentinal tubules to reduce sensitivity, fills in the microfissures on the surface of the teeth, and travels down to the bottom of demineralized areas of enamel, even partway into demineralized dentin which is 70% hydroxyapatite, to reverse non-cavitous/incipient lesions.

Because nano/medical hydroxyapatite fills damaged enamel in from the bottom up AND on the surface, teeth become whiter, smoother, less sensitive, and more resistant to decay.

Is it “100% natural?” No. But it IS a human-made version of what our body makes, is highly biocompatible, and is safe enough to swallow.  Toothpastes containing hydroxyapatite reduce decay by 36%-56% according to the existing research which is MORE than fluoridated toothpastes do.

Dental Caries Graph Remin
Oral Science Remin Toothpaste Caries Graph

Killing S.Mutans Bacteria with Luctatol and Xylitol

While learning about hydroxyapatite, I also discovered a product which has been clinically proven to kill the decay causing  s.mutans bacteria and inhibit plaque formation by 96%. Luctatol is made from human milk enzymes and licorice tree extract and can be found in many Splat brand products alongside nano-hydroxyapatite.

Then there is Xylitol. It's a sugar-alcohol derived from corn and hardwood trees. It has been clinically proven to kill s.mutans bacteria as well.

Putting All The Pieces Together For Optimal Oral Health

Sonicare toothbrush, Remin, Splat Kids
So. We've explored why standard flossing & brushing isn't the whole answer. We've figured out that “healing cavities” isn't really the answer. And we've talked about a lot of alternatives. 

What does optimal oral hygiene look like for my family in light of all this? Let me break it down.

We each have a water bottle that goes with us everywhere so we can rinse with water after eating.

We use non-GMO xylitol ‘candies' or gum after meals and snacks to kill cavity-causing s.mutans bacterial, aiming for 5'ish mg/day. Spry/Xlear, Pur, and X-Pur are the mints/gums we use depending on what's on sale.

If we are at home we brush our teeth* after meals as well. I let the boys (6 and 2) brush their own teeth with just a bit of guidance as needed during the day.

We each floss and brush before bed:
Our family uses a Philips Sonicare toothbrush (4 separate heads) because it removes plaque more effectively than a manual brush. For a lot of people an ultra soft bristled manual toothbrush is sufficient but if you're at high risk for decay, gingivitis, or periodontal disease a Sonicare brush is a worthwhile investment.It is wise to choose ultra soft or soft bristle brushes only, as firmer bristles than that can damage tooth enamel. We brush our kids teeth for them at night to make sure we really get everywhere. Kids struggle to do an adequate job so you can generally expectthey'll need help till around 6-9 but that varies widely from child to child.

My husband and I use Remin toothpaste. It's a Canadian toothpaste made by Sangi Co who are the industry leaders in Japan. Remin contains 10% xylitol and 10% nano-hydroxyapatite but no fluoride or parabens or SLS etc etc and is safe enough to swallow. At $20 for a 60mL tube it's not cheap but it's less than a filling!  It reduces cavities by 36%-56% vs fluorides 24%. You can order it online from yeswellness or in person from select Shopper's Drug Mart locations

My 2 boys won't go within 100 km of a mint toothpaste so for them we use Splat Kids which originated in Russia and has been studied extensively throughout Europe and Japan. It contains Luctatol and Hydroxyapatite as its active ingredients. It is 98.3% natural, no fluoride, artificial sweeteners, parabens, SLS etc and is safe enough to swallow. At $5.99/50mL in Canada it's pricey but less than Remin. It reduces cavities by 37%.

Splat Canada also carries a product called Maximum which feels more like a traditional adult foamy minty toothpaste but with an aftertaste of thyme. I want to love it but it contains methylparaben, sorbitol, and Peg-8. If that doesn't bother you though it's only $5.99 for a 100mL tube and reduces cavities by over 60%. 

Oral Hygiene for Infants

toddler brushing teeth with 3 sided silicone brush
A silicone finger toothbrush with a drop of Splat Juicy, Splat Kids or Splat Baby toothpaste is a great option for infants after meals and before bed up until they have enough teeth to warrant an ultrasoft toothbrush. You can also use a baby washcloth and wipe their gums with to help them get used to an oral care routine before teeth start to erupt if you prefer.

If you breastfeed through the night - carry on with confidence! Breastmilk is protective against infections including dental caries and nursing through the night is not at all the same as bottle feeding. Breastmilk has a ph of about 7 (neutral) and when breastfeeding the milk does not pool around the baby’s teeth. If your baby takes a bottle in the night of formula or dairy milk, rubbing baby's mouth with a bit of Splat on a soft washcloth or a silicone finger brush after their bottle is a really good habit to get into as you need to remove the food/liquids from their teeth that contribute to decay. Breastmilk doesn't cause decay itself and is protective in many ways, but it doesn't scrub off plaque from other sources so we still need to do that part for them.Mothers who use xylitol products themselves during pregnancy have been shown to have children with a lower level of s.mutans decay-causing bacteria in their mouths so that's another angle to consider.

To sum it all up....

You can't "naturally heal tooth decay" because teeth are made of minerals, which are dead. HOWEVER you can remineralize areas of enamel that have been demineralized but are not yet actual holes....which is *kinda* the same thing.

Creating a healthy oral environment is key to the remineralization process.

There are really awesome fluoride alternatives & complements that are clinically proven to work!

And so everyone is clear - I don't work for any of the companies mentioned in this post.This post isn't a paid endorsement.  I did NOT receive free products in exchange for a review. I'm also not a dental professional or a medical professional. Take what you've learned here as a starting point and dig into the research yourself so you can make an informed choice about what is best for your family. You'll find links sprinkled throughout the body of the post which will help you get started on this process. :)

Happy Brushing!

P.S. - still love/want/need/trust fluoride? That's okay! By all means use it if it's the choice you feel best about, and supplement your current routine with the products/information here if that seems like a good option for you or your family. :)


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