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Nutrition and Oral Care

I had the honor of being invited by Dr. Salahudeen to his dental clinic, Pearl Dental clinic, to talk about the importance of nutrition in oral health (and vice versa) on his first podcast. It was a first for me as well, and first times are always a bit stressful: you stumble over your words, you forget to mention important things, you mix up your notes, and sometimes you even glitch 🫣. But in the end, I loved doing it, which confirms to me that I would like to teach... I just have to take the plunge 😅. Here I share with you a glimpse of the podcast without stumbling and with a few extra bits. You'll discover how to keep your teeth beautiful, and why (beyond aesthetics) it's important for your health 😁.




1/ Why nutrition is an important factor in maintaining good health?

I think everyone has heard the phrase “we are what we eat”. There is nothing more representative (genetic polymorphism aside). The food we eat influences our metabolism and all biochemical reactions in the body. It’s a truly fascinating world. This ranges from energy production thanks to mitochondria (factories that produce energy in the nuclei of cells) to protection against oxidative stress, the effectiveness of neurotransmitters, the health of the microbiota... All this is the result of biochemical reactions which involve enzymes, hormones, cofactors, etc. which come from raw materials: macronutrients (proteins, carbohydrates, lipids) and micronutrients (vitamins and minerals) from our food. I'll give you some examples to be a little more concrete:


  • Quercetin, found (among other things) in red onions, is a polyphenol with antioxidant properties, which is also beneficial for a healthy microbiota and for immunity.

  • Zinc, a very important mineral as a cofactor for many enzymes (immunity, insulin resistance, oxidative stress...) that you can find in large quantities in shellfish, especially oysters.

And I have more than one example like this!


We also find in food “bioactive compounds” such as polyphenols, fibers, omega 3 for example which beneficially influence our metabolism and your health.


Conversely, a diet too rich in sugar and bad fats, an industrial diet is a vector of inflammation and oxidative stress causing type 2 diabetes, cardiovascular disease, obesity, depression, etc.


Food can truly be your health ally or your worst enemy!




2/ How does nutrition directly impact teeth and gums?

I would say that the direct relationship between oral health and nutrition is the oral microbiota, quality of saliva and acidity (oral PH). All of them influence each other. The balance between demineralization and remineralization is continually affected by the virulence of the oral bacteria and the host (=ourself) defense system. However, the composition of the microbiota is influenced by what we eat, as is the quality of saliva. As acidity which can comme from food or reflux/stomac increase the demineralization process of the teeth.



The oral microbiota consists of bacteria (also viruses and fungi) that form an ecosystem with important roles such as

  • digestion,

  • protection against the entry of pathogens,

  • maintaining optimal PH to protect teeth against inflammation, acid attacks, and ensure that enzymes are active (salivary amylase for the digestion of sugars).


A diet rich in sugar or bad fats, for example, will tend to disrupt this balance and promote the proliferation of pro-inflammatory or acidogenic (acid-producing) bacteria to the detriment of good bacteria.


Food also has a mechanical role: chewing plays an essential role in digestion but also ensures self-cleaning of the teeth. This is particularly the case for hard-to-chew foods such as raw vegetables and fibrous foods which help eliminate impurities. It also stimulates the production of saliva, the role of which is also very important both for digestion and for the protection of teeth and gums.


3/ Are there specific vitamins or minerals that play a crucial role in dental health and how do they work?

There is not really vitamine or minerals which are "crucial" but to build the structure of tette and gums we definitly need calcium, phosphorus, vitamins A, K and D, and fluoride.



The tooth is made up of dentin covered by dental enamel. Dentin is made up of 70% calcium phosphate crystals (=hydroxyapatite) + collagen and proteins. Enamel is composed of 96% hydroxyapatite + a small portion (which nevertheless plays an important role in the formation of enamel) of proteins. We therefore understand the importance of calcium and phosphorus in dental health. The balance between calcium and phosphorus (= phosphocalcic balance) is influenced by acidity and vitamin D as well. That why vitamine D is also involved. Vitamine D (I should say hormone D because it is an hormone, not a vitamin) reach the cell thanks to a transporter which require vitamine A. Furthermore, vitamin A prevents enamel malformations. Severe deficiencies can lead to enamel hypoplasia and disturbances in tooth formation. However, becareful because excess of vitamin A can be bad for your health.


Vitamin K (more precisely vitamin K2, MK7) allows the fixation of calcium in the tooth.


Fluoride is more controversial. It contributes to dental health and protection against cavities but it is also toxic in excess. The maximum daily quantity is 4 mg per day for an adult but unfortunately we quickly exceed this. There is not only fluoride in toothpaste... fish, tea, tap water, table salt, not to mention the soils which are contaminated with fluoride which is there fore found in our fruits and vegetables. And I personally think this is more the issue with the fluoride than to use toothpaste with fluoride. Because of this controverse, I decided to do my toothpaste without fluoride inside. One month later, one of my tooth was broken. The dentist explained to me that is probably because I missed fluoride.

Anyway, it is a very personal opinion and I don't want to go into the controversy. I can advise then to put only a small amount of toothpaste on the teeth brush, to not swallow the toothpaste and rinse your mouth well after brushing.


4/ What does a balanced diet for optimal health look like?

The so-called “Mediterranean” diet is, in my opinion, the best compromise. In any case, it is the most used and studied in scientific studies. Concretely and a little bit revisited by myself:


- Vegetables at every meal

- 1 to 2 fruits per day, berries regularly

- 1 handful of ground oilseeds or seeds per day

- Have several meat-free meals during the week

- 1 yogurt per day

- 2 times minimum during the week of legumes unless sensitivity to it

- Small fatty fish 3 times a week (sardinas, makerel, hereing)

- Good oils: olive, walnut, rapeseed, flax, avocado.

- We avoid industrial products as much as possible

- We replace the salt with spices as ginger, tumeric, cinnamon, cardamom, garlic and red onion.

- Varie the type of cervelas you: Barley , buckweat, , oat, millet, sorghum...




5/ Can you discuss the importance of incorporating various food into our diet to support our teeth and gums?

It is an indirect link. To make it simple:


Various foods = a healthy gut = protection against dysbiosis, stomach acidity, and SIBO--> healthy digestive system to protect the teeth and gums from acidity, better oral microbiota.


Various food = good antioxidant barrier and balanced immune system--> improve the defense system from acid attacks.


6/ Which food are particularly beneficial for promoting strong teeth and health gum?

Difficult to say because basically a balance diet is good for the body in general.





Dairy products are often mentioned. In fact, they immediately come to mind when we talk about a source of calcium. I would recommend a yogurt (or better a kefir which is a fermented yogurt), for example, rich in probiotics beneficial for the microbiota. But, I would like to highligh that calcium is not only found in dairy products but also in quantity in green vegetables. Also, it seems that certain milk proteins such as casein have an inhibitory effect on bacteria such as Streptococcus mutans as well as other cariogenic species. In addition to that, casein forms micro complexes with calcium phosphate on the tooth surface, thus creating a sort of reservoir for calcium and phosphate ions. Lactose, on the other hand, tends to be cariogenic (cariogenic =lead to tooth decay/cavities).


Raw vegetables and fresh fruits (except bananas which have a small cariogenic power) are low in carbohydrates, rich in water, vitamins, minerals and polyphenols. The fact that they are raw means you have to chew more, which stimulates salivary flow. In addition, they are rich in fiber and therefore provide physiological brushing. In short, they have everything you need!


Foods rich in vitamin A or beta-carotene (precursor of vitamin A). Vitamin A is found in meat or fish livers (cod liver) and beta-carotene in orange fruits and vegetables : sweet potato, pumpkin, pumpkin, carrot. Be careful, excess vitamin A can be toxic.


Vitamin D is not really found in food, fatty fish (such as salmon, mackerel, and sardines), egg yolks, cheese, a little in mushrooms. But it's not enough to cover the needed.


Vitamin K is found in quantity in natto (fermented soybeans) but also green vegetables. Our intestines contain a bacterium that produces 80% of our vitamin K needs. To promote strong bone (like is the case if you have osteoporosis or osteopenia), it is usually good to combine vitamin D and K.


Vitamin B deficiencies can also be involved in oral health and promote inflammation (periodontitis, gingivitis...).


Vitamin C is involved in collagen synthesis, bone metabolism, and is an antioxidant.


Also, certain foods would have beneficial effects, such as cocoa which contains theobromine (from the methylxanthine family). Studies have shown that theobromine helps harden tooth enamel and helps prevent the formation of tooth decay. Also, it contains antibacterial polyphenols.

Cranberries, that we usually know for their antibacterial effects on the urinary tract but apparently they also have oral and dental antibacterial effects. Eating cranberries could therefore not only prevent cavities, but also help prevent gum and mouth infections.

Finally, I think your grandmothers offered you cloves in case of toothache. Indeed, they contain eugenol which is antioxidant, anti-inflammatory, antimicrobial and analgesic. Eugenol is also found in cinnamon.


7/ Are there any surprising sources of nutrient that our listeners might not be aware of?

The red color on the back of shrimp or other seafood, as well as in certain algae, is actually a very powerful antioxidant called astaxanthin. However, don't expect an antioxidant effect from consuming just a few shrimp. It's also not a good idea to have a shrimp feast to get the antioxidant effect ;-) However, adding antioxidant intake from different sources here and there can really make a difference (synergistic effect of intake): the astaxanthin from shrimp + the quercetin from red onions + the gingerol from ginger + the lycopene from tomatoes with a bit of anthocyanin from blueberries for dessert, with that we start to have quite a good antioxidant effect.





8/ We often hear about the negative effects of the sugar on teeth. Can you explain how sugar impacts oral health and how can we minimize its effects?

The sugars that pose a problem are those that are fermentable. That is to say, which are fermented by bacteria in the mouth. If the oral microbiota contains a predominance of so-called “cariogenic” bacteria, they ferment sugars and make substances (polymers) which allow the bacteria themselves to adhere to the surface of the tooth. This will form what is called a biofilm which makes them resistant to antibacterial attacks. Plus, they will use it as food to survive.


Also, they produce organic acids from these sugars which will therefore acidify the oral pH. And this decrease in PH is at the origin of demineralization phenomena. they diffuse through plaque and into the tooth, and can dissolve calcium phosphates. Demineralization begins when the pH of the plaque drops below 5.5. To respond to this, buffers, such as bicarbonates, present in saliva, diffuse into the plaque and attempt to neutralize the acids present. They thus stop the leak of calcium and phosphates until the next phase of acid production. If the sugar intake is too high and/or repeated, our buffer system is overwhelmed and the PH remains acidic.


Depending on the sugars ingested, these phenomena are more or less important. The most fermentable sugars are sucrose (table sugar), glucose and fructose. So these are all the added sugar, table sugar, glucose-fructose syrup that we find everywhere in industrial foods, sodas and fruit juices (be careful with healthy smoothies), sugars from starchy foods (bread, rice, pasta, etc.).


Starch is a complex sugar so it takes longer to ferment then it generate less acidity.


There are risk factors that promote the development of tooth decay through sugar consumption:

- The frequency of ingestion and the type of sugar consumed plays an important role.

- The rate of degradation of carbohydrates influences the duration of contact of sugar with the teeth, thus lengthening the period of acid production.

-The texture of the food, sticky or not, and its shape, solid or liquid, modify the capacity and retention time of the food with the teeth.

  -The timing of consumption is important, because the saliva which dilutes and neutralizes the acidity of plaque is more abundant during a meal than between meals, and more during the day than at night.

  - Snacking and sipping are behaviors that lengthen the period of acidity in the mouth.


The most cariogenic drinks are: Alcohol, Fruit juices, Sweet drinks.

The most cariogenic solid foods are: Candy sugar, Jams, Crisps, Sweet or savory snacks, Cakes, Ice cream, Honey, Dried fruits, Bananas, Bread, Pasta.


9/ Are there healthier alternatives to sugary snacks and drinks that still satisfy our sweet craving?

Xylitol and erythritol, which are found naturally in plants, have a protective effect against cavities. This is linked to the fact that the oral flora does not contain enzymes capable of fermenting these polyols, thus inhibiting the action of microorganisms such as Streptococcus mutans.


Xylitol come from Birch, labeled E965, belongs to the polyol (sugar alcohol) family. Sweetening power is elevated when you heat it. It Proven positive effects on oral health especially thanks to his antibacterial effects. Also, it is a probiotic for the microbiota particularly promoting the formation of propionate (short chain fatty acid). However, becareful with it because you could have gastrointestinal problems with excessive consumption.


Apparently, erythritol could have the same effects as well as allulose but more studies have to be done on it.


10/ What are simple changes people can make to their diet to improve their health?



  • Eat vegetable for each meal,

  • Use spices as ginger, turmeric, cinnamon, cloves instead of salt

  • Introduce good source of fat: olive oil to cook and flaxseed, walnut or rapeseed oil for dressing, avocado oil, small fatty fish.






Can you share any quick and easy recipes or snack idea good for our teeth?

1 kefir yogurt + cinamonn + 1 spoon of cacao powder + dried cranberries + (1 tsp of erythritol)


12/ Beside diet, are there any other lifestyle factors that can influence oral diet?

  • Brush your teeth after each meal,

  • Floss your teeth every day

  • Do deep cleaning at the dentist every 6 months.

  • Alcohol, cigarettes, boulimia damage seriously teeth and gums

  • Coffee and tea give you yellow teeth


13/How does hydratation and overall wellness play a role in maintaining a healthy mouth?

Hydration is important for saliva quality. Saliva consists mainly of water, electrolytes, proteins and glycoproteins. She has many roles such as:

  • Through its flow (its clearance), it dilutes, decomposes and eliminates food debris towards the digestive tract,

  • Its neutralizes the acid produced by plaque bacteria with the bicarbonate ions it contains,

  • It has antibacterial properties thanks to the secretory immunoglobulins (IgAs), lysozymes, catalases, lactoperoxidases and other enzymes it contains,

  • Its high saturation in phosphate, calcium and fluorine ions intervenes in the balance between demineralization and remineralization of the enamel.


14/ How does prioritizing nutrition for oral health contribute to our overall wellbeing in the long run?

Oral health is super important. On one hand, because saliva and macrobiota serves as our first barrier against what we called the "non-self." This means if they do not fulfill their antibacterial role and their role in digesting food, pathogens and undigested large molecules will end up in the stomach. This will have an impact on the entire digestive tract leading for example to dysbiosis type putrefaction or stomach hypochlorhydrie.


Additionally, dental occlusion is very important: I emphasize the importance of chewing at each of my consultations. Good chewing resolves 50% of digestive problems (acidity, poor quality of bile acids, dysbiosis, and SIBO). so CHEW!


Also, when the gums are inflamed, harmful bacteria can enter the breach and enter the bloodstream. This causes systemic inflammation, which represents a very high risk of cardiovascular diseases.


So my best advise will be chew properly and check with your dentist regularly if your occlusion is good and if you have infection.


15/ What advises do you have for listeners who wants to start making positive changes to their diet?

I would say start by eating vegetables with every meal and using spices. I have a rule for myself that I call the 3-color rule: I must have at least 3 different colors on my plate. This forces me to vary, to have different sources of polyphenols, vitamins, and minerals.


Also, try to organize yourself to limit the consumption of processed foods and to have time to cook.


A bit more challenging for some: reduce meat consumption by having vegetarian meals. In any case, avoid consuming animal proteins in the evening.


Finally, vary your intake of monounsaturated and polyunsaturated fatty acids: olive oil, small fatty fish, flaxseed oil, rapeseed oil, avocado oil, walnut oil, ground flaxseeds, chia seeds, pumpkin seeds. To make sure you vary your oils, I use olive oil for cooking on low heat and in an opaque bottle in the fridge, I have a bottle with a mix of oils that I use for salads (50% olive oil + 50% of mix of flaxseed, raspeseed, walnut oil).


And above all, don't forget to smile with your beautiful teeth 😉!



Many thanks to Doctor Salahudeen for his invitation to participate in his inaugral podcast! I thank him for his collaboration... and the little coaching before the podcast to make me feel more relax 😅.




 

Sources:


The Role of Nutrition in Periodontal Health. Shariq Najeeb, Muhammad Sohail Zafar, Zohaib Khurshid, Sana, Zohaib, Khalid Almas. Nutrients, September 2016.


The Impact of Diet, Nutrition and Nutraceuticals on Oral and Periodontal Health. Gaetano Isola.Nutrients. 2020 Sep.


Fanny Galmiche. Le rôle de l’alimentation dans la santé bucco-dentaire. Sciences du Vivant [q-bio].2011. hal-01739082


Dental biofilm: ecological interactions in health and disease. P. D. Marsh, Egija Zaura. Journal of Clinical Periodontology / Volume 44, Issue S18 / p. S12-S22.

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