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“Is this real life or is this just fantasy?”

A recent article discussing dentistry and paleo has garnered some attention lately.  (http://robbwolf.com/2013/08/29/dentistry-harmony-nature/   Oddly, there are no references for any of the claims made in the article.  Seeing how there are so many statements made as fact I find this disconcerting, as I have no reference to verify the comments.

The premise appears to be that humans “mess up” natures perfection in a number of ways.  The specific ways that dentistry is involved with this are then discussed – from jaw formation related to breast/bottle feeding to nutrition.

 

The simple fact that a paleo style diet will dramatically reduce carbohydrate intake will help to reduce cavity risk!  Unfortunately, the author makes many more leaps of faith throughout the article.

 

Rather than getting caught in a landslide let’s take a step into reality.  What follows is an analysis of the claims and discussion of the science as it relates to the topics in the original article.

 

The first paragraph starts out with an appeal to the naturalistic fallacy by stating, “Nature gets it right, humans mess nature up.”  (Also called the “appeal to Nature” – http://www.fallacyfiles.org/adnature.html)  The naturalistic fallacy happens frequently because many people have a tendency to think that nature knows best.  We think natural is better than processed or synthetic or man-made.  Unfortunately, this error in thinking can easily lead us astray down a slippery slope of thought to illogical conclusions.  It is important for us to take a good look at any subject or product or philosophy and consider it on its merits and not on whether or not it is natural.  After all, cyanide, dinosaurs, and candiru fish (http://en.wikipedia.org/wiki/Candiru) are all natural too…

 

The next topic is how feeding a child affects the jaw development. 

 

“Humans are the only animals with crooked teeth.”

“Recent research has shed some light on why…”

How can someone make these claims but not provide the references?

A simple search on www.pubmed.com (a few are listed in the references section below) reveals multiple studies demonstrating variations in teeth throughout the animal kingdom.

 

I wonder how many of the animals with malocclusion were bottle fed, nipple fed, or left to fend for themselves?!

 

Growth and development of a human (including the jaws) can be affected by genetics, nutrition, environmental factors, and other influences.  Depending on which research you read the act of breast feeding or bottle feeding has anywhere from no influence to moderate influence on the development of the jaws.  Easy come, easy go; little high, little low.  There are hypotheses about the various effects but they are simply unproven hypotheses at this point.  There is some validity to the nutritional value of breast milk being better than formula (less of an issue now than it used to be).  There is also some validity to the value of holding the baby against the chest and the positive psychological impact this can have.  There are also benefits for the mother to breast feed (e.g. glucose tolerance).  It is important to note that the mothers’ nutritional intake will impact the breast milk slightly; conversely, if the mother is abusing drugs, alcohol or herbal medicine these can be passed on to the child via breast milk.

 

Oral habits such as finger and/or thumb sucking are more important indicators for jaw deformity than breast feeding vs bottle feeding.

 

Spare him his life from this monstrosity

I cannot find any data to support the idea of lower jaw development being dependent upon the food texture or consistency.  There was one rat study but even it was not supportive of the food texture having any meaningful impact on jaw development.

 

This section ends with the statement:  “Our modern civilization has given us a life of convenience at a great cost to our health, which we are just beginning to realize.”  The logical fallacy at play is the Appeal to Fear (https://bookofbadarguments.com/).  Also, that statement has nothing to do with the section on breast feeding.  In fact, our paleolithic ancestor children probably died if they could not breast feed.  We have significantly improved infant mortality because of our modern lifestyle.  This does not mean I agree with the current diet of sugar and carbs in which most people still indulge.

 

The next section discusses how to eliminate tooth decay naturally.

 

This should be very straightforward.  We know that caries is multifactorial.  It takes bacteria, a tooth, a food source and the right environment (acidic).  The bacteria are already there “naturally.”  They are also transmissible (yes, you can give your kids or loved ones the cavity bugs).  The food source is sugar.  This idea has been around for a very long time.  Less well published is that carbohydrates break down into sugar.  This is a terrific reason to go Low Carb/High Fat!  Finally, the acid – Soda, juice, energy drinks, acid reflux.

 

Milk = bad.  Plant oils = bad.  Hey, wait a second!

Caught in a landslide, let’s escape to reality

We were told in the first paragraph that nature gets it right.  While my personal opinion is that we should limit milk and certain oils my point is to highlight the naturalistic fallacy rearing its ugly head again.

 

My problem with this section of the article is two-fold:  first, a lack of references for the claims;  second is that it becomes more than eliminating tooth decay.

 

Oral health can affect health, well-being, and athletic performance.  Appropriate self-care involves a comprehensive oral health regimen which should be customized for the individual based on their risk factors for cavities, gum disease, and other stresses.  If you are high risk then diet alteration is critically important.  Also, take a look at the reference for Carifree in the references section.

 

Finally, we have reached the Biomimetic Dentistry section. 

 

Biomimetic is a marketing term.  Dentists, using all kinds of materials, have been “mimicking” natural tooth form for ages.  George Washington had a great set of dentures that were made to mimic real teeth.  Depending on the source you may read that he had teeth made from ivory, bone, or other teeth.

 

Research is being done to constantly improve materials to make them more similar to real teeth.  However, we have a long way to go to design anything as amazing as a real tooth.  If your tooth fails for some reason (cavity, fracture, gum disease) you should realize that, unless you change how you care for your mouth you will likely need the tooth/teeth tended to again.

 

Next, amalgam is attacked.  The composition and handling of amalgam has changed dramatically in the 150+ years that it has been around as a filling material for cavities in teeth.  It has done incredibly well and is 2nd only to gold as an all-around tough material for fillings.  Amalgams do not cause teeth to break.  The claims made in the article are an example of the Hasty Generalization fallacy (http://en.wikipedia.org/wiki/Hasty_generalization)  Time and function cause teeth to break.  Research overwhelmingly supports the long-term benefits of amalgam. Currently, there are materials that rival the toughness of amalgam.  These tooth colored fillings come with a price.  Literally, they are often more expensive.  Also, they are more technique sensitive to place.

 

Oh mama mia, mama mia, let me go!

 

The outcome of any material to last in the mouth is dependent on the individual cavity risk, tooth position, oral habits, size of the filling, quality of the placement, and strength of the material itself.

 

I’m not sure why the author goes on to disparage “most dentists” by saying they place amorphous blobs as fillings.  The quality of filling placed by your dentist is going to be on a bell curve just like anything else in medicine.  We also run into the naturalistic fallacy again.  I wonder if evolution means what the author thinks it means (http://www.youtube.com/watch?v=G2y8Sx4B2Sk)

 

The advice I would give would be to take the time to get to know your dentist and ask questions about the diagnosis, treatment, options, prevention, etc.  Trust of your medical providers is important so take the time to hold up your half of that relationship.

 

In conclusions, there is much more that could be said about any one of these areas.  My hope is that this helped provide some common sense to an area that can sometimes lack it.  If you are more interested in any of these subjects or want more about critical thinking please comment and/or check out some of the reference websites.

 

If I’m not back this time tomorrow

Carry on, carry on

Cheers!

Jason Luchtefeld, DMD

FAGD, FICOI

 

Veterinary research:

Vet Rec. 2012 Jul 14;171(2):44. doi: 10.1136/vr.100829. Epub 2012 Jun 15

J Vet Dent. 2011 Summer;28(2):102-9

J Vet Dent. 2011 Spring;28(1):8-15

Can Vet J. 2010 Mar;51(3):267-70

Breast vs bottle research:

Ir Med J. 2012 May;105(5 Suppl):31-6

Pediatrics. 2012 Jun;129(6):1134-40. doi: 10.1542/peds.2011-3121. Epub 2012 May 28

BMC Res Notes. 2012 Mar 16;5:150. doi: 10.1186/1756-0500-5-150

Braz Oral Res. 2013 Jan-Feb;27(1):62-9. Epub 2012 Dec 4

http://www.sciencebasedmedicine.org/separating-fact-from-fiction-in-the-not-so-normal-newborn-nursery-pacifiers-and-nipple-confusion/

http://www.beyondveg.com/nicholson-w/angel-1984/angel-1984-1a.shtml

Breastfeed Med. 2012 Dec;7(6):464-8. doi: 10.1089/bfm.2011.0123. Epub 2012 Sep 10.

 

nt J Pediatr Otorhinolaryngol. 2012 Apr;76(4):500-6. doi: 10.1016/j.ijporl.2012.01.005. Epub 2012 Feb 5.

Preventing Cavities Section:

J Am Dent Assoc. 2013 Oct;144(10):1148-1152.

Br J Sports Med. 2013 Sep 24. doi: 10.1136/bjsports-2013-092891. [Epub ahead of print

http://carifree.com/patient/learn/learn.html

BioMimetic Dentistry section:

Photo:  http://www.vcstar.com/photos/2010/oct/23/110263/

Clin Cosmet Investig Dent. 2013 May 15;5:33-42. doi: 10.2147/CCIDE.S42044. Print 2013.

Oper Dent. 2013 Apr 3. [Epub ahead of print]

J Dent Res. 2010 Oct;89(10):1063-7. doi: 10.1177/0022034510376071. Epub 2010 Jul 26

Note: apologies to Queen for my butchering of some of the lyrics of Bohemian Rhapsody