Want to make coffee less acidic? Add cream to it

The table below is from a 2008 article by Ehlen and colleagues (), showing the amount of erosion caused by various types of beverages, when teeth were exposed to them for 25 h in vitro. Erosion depth is measured in microns. The third row shows the chance probabilities (i.e., P values) associated with the differences in erosion of enamel and root.

As you can see, even diet drinks may cause tooth erosion. That is not to say that if you drink a diet soda occasionally you will destroy your teeth, but regular drinking may be a problem. I discussed this study in a previous post (). After that post was published here some folks asked me about coffee, so I decided to do some research.

Unfortunately coffee by itself can also cause some erosion, primarily because of its acidity. Generally speaking, you want a liquid substance that you are interested in drinking to have a pH as close to 7 as possible, as this pH is neutral (). Tap and mineral water have a pH that is very close to 7. Black coffee seems to have a pH of about 4.8.

Also problematic are drinks containing fermentable carbohydrates, such as sucrose, fructose, glucose, and lactose. These are fermented by acid-producing bacteria. Interestingly, when fermentable carbohydrates are consumed as part of foods that require chewing, such as fruits, acidity is either neutralized or significantly reduced by large amounts of saliva being secreted as a result of the chewing process.

So what to do about coffee?

One possible solution is to add heavy cream to it. A small amount, such as a teaspoon, appears to bring the pH in a cup of coffee to a little over 6. Another advantage of heavy cream is that it has no fermentable carbohydrates; it has no carbohydrates, period. You will have to get over the habit of drinking sweet beverages, including sweet coffee, if you were unfortunate enough to develop that habit (like so many people living in cities today).

It is not easy to find reliable pH values for various foods. I guess dentistry researchers are more interested in ways of repairing damage already done, and there doesn't seem to be much funding available for preventive dentistry research. Some pH testing results from a University of Cincinnati college biology page were available at the time of this writing; they appeared to be reasonably reliable the last time I checked them ().

Looking for a good orthodontist? My recommendation is Dr. Meat

The figure below is one of many in Weston Price’s outstanding book Nutrition and Physical Degeneration showing evidence of teeth crowding among children whose parents moved from a traditional diet of minimally processed foods to a Westernized diet. ()

Tooth crowding and other forms of malocclusion are widespread and on the rise in populations that have adopted Westernized diets (most of us). Some blame it on dental caries, particularly in early childhood; dental caries are also a hallmark of Westernized diets. Varrela, however, in a study of Finnish skulls from the 15th and 16th centuries found evidence of dental caries, but not of malocclusion, which Varrela reported as fairly high in modern Finns. ()

Why does malocclusion occur at all in the context of Westernized diets? Lombardi () put forth an evolutionary hypothesis:

“In modern man there is little attrition of the teeth because of a soft, processed diet; this can result in dental crowding and impaction of the third molars. It is postulated that the tooth-jaw size discrepancy apparent in modern man as dental crowding is, in primitive man, a crucial biologic adaptation imposed by the selection pressures of a demanding diet that maintains sufficient chewing surface area for long-term survival. Selection pressures for teeth large enough to withstand a rigorous diet have been relaxed only recently in advanced populations, and the slow pace of evolutionary change has not yet brought the teeth and jaws into harmonious relationship.”

So what is one to do? Apparently getting babies to eat meat is not a bad idea (). They may well just chew on it for a while and spit it out. The likelihood of meat inducing dental caries is very low, as most low carbers can attest. (In fact, low carbers who eat mostly meat often see dental caries heal.)

Concerned about the baby choking on meat? See this Google search for “baby choked on meat”: (). Now, see this Google search for “baby choked on milk”: ().

What if you have a child with crowded teeth as a preteen or teen? Too late? Should you get him or her to use “cute” braces? Our daughter had crowded teeth as a preteen. It overlapped with the period of my transformation (), which meant that she started having a lot more natural foods to eat. There were more of those around, some of which require serious chewing, and less industrialized soft foods. Those natural foods included hard-to-chew beef cuts, served multiple times a week.

We noticed improvement right away, and in a few years the crowding disappeared. Soon she had the kind of smile that could land her a job as a toothpaste model:

The key seems to be to start early, in developmental years. If you are an adult with crowded teeth, malocclusion may not be solved by either tough foods or braces. With braces, you may even end up with other problems ().

Tooth decay and silver diamine fluoride

Silver diamine fluoride (SDF) is a substance that can be applied on dental caries - where tooth mass has been destroyed by the action of bacteria that feed primarily on simple sugars. (Candy and sugary drinks are major culprits in this respect; fruits are not, in part because of the combination of a relatively low sugar content with the protective effect of the extra chewing needed.) Many studies have shown the effectiveness of SDF in the treatment of dental caries. The chart below is based on a study by Chu and colleagues ().

The chart above compares, in terms of normalized performance, “arrested” caries in a group of children using SDF against a control group not using SDF. Arrested caries are those in which there is no progression of the lesion; that is, in arrested caries the destruction of tooth mass is either stopped or reversed. The control group level can be seen as one in which a limited amount of arrest occurs (probably due to dietary changes and improved dental care), because the percentage of arrests among those treated with SDF was 100! And, yes, in spite of what most dentists will tell you, tooth decay can be reversed ().

As a side note, dentists do not necessarily tell their clients that tooth decay is irreversible because they want to keep the revenue flow coming into their offices. The sad reality is that most dental care patients will not be able to change their diet enough to reverse tooth decay. Because of that, it would arguably be professionally irresponsible to tell those patients that tooth decay progression can be stopped or reversed without treatment. As Weston Price has shown in his pioneering field studies (), reversing tooth decay requires not only elimination of refined sugars but also increased intake of fat-soluble vitamins (particularly vitamins A, D, and K2).

The chart below is from the same study by Chu and colleagues. It compares, also in terms of normalized performance, new caries formed over a period of time in a group of children using SDF against a control group not using SDF. As you can see from this and the previous chart, not only does SDF application stop or reverse tooth decay, it also prevents new dental caries from forming. From the empirical results it appears that this extends to teeth other than the teeth treated with SDF, presumably because of the action of the offending bacteria on the teeth that are next to those with caries.

SDF has been used in the past in various countries such as China, Japan, and New Zealand. Only recently the use of SDF has been approved in the USA. So, next time you go to the dentist to have dental caries treated, ask if they are able to use SDF and what the likely outcomes will be. Probably there will be no injections, drillings, or fillings. It seems that the only downside is that the brown spots characteristic of tooth decay tend to turn black after SDF is successfully used!

A case of a very large salivary stone

Salivary stones are the most common type of salivary gland disease. Having said that, they are very rare – less than 1 in 200 people will develop a symptomatic salivary stone. Usually they occur on one side of the mouth only. They seem to be more common in men than in women. Most of the evidence suggests that they are not strongly correlated with kidney stones, although some factors can increase both (e.g., dehydration).

Singh and Singh () discuss a case of a 55-year-old man who went to the Udaipur Dental Clinic with mild fever, pain, and swelling in the floor of the mouth. External examination, visually and through palpation, found no swelling or abnormal mass. The man’s oral hygiene was rather poor. The figures below show the extracted salivary stone, the stone perforating the base of the mouth prior to extraction, and an X-ray image of the stone.

I am not a big fan of X-ray tests in dental clinics, as they are usually done to convince patients to have dental decay treated in the conventional way – drilling and filling. Almost ten years ago, based on X-ray tests, I was told that I needed to treat some cavities urgently. I refused and instead completely changed my diet. Those cavities either reversed or never progressed. As the years passed, my dentist eventually became convinced that I had done the right thing, but told me that my case was very rare; unique in fact. Well, I know of a few cases like mine already. I believe that the main factors in my case were the elimination of unnatural foods (e.g., wheat-based foods), and consumption of a lot of raw-milk cheese.

However, as the case described here suggests, an X-ray test may be useful when a salivary stone is suspected.

Chew your calories and drink water: Industrial beverages and tooth erosion

Dental erosion is a different problem from dental caries. Dental erosion is defined as the removal of minerals from the tooth structure via chemicals. Dental caries are the result of increased site-specific acidity due to bacterial fermentation of sugars.

Still, both have the same general result, destruction of teeth structure.

Losing teeth probably significantly accelerated death among our Paleolithic ancestors, as it does with modern hunter-gatherers. It is painful and difficult to eat nutritious foods when one has teeth problems, and chronic lack of proper nutrition is the beginning of the end.

The table below, from Ehlen et al. (2008), shows the amount of erosion that occurred when teeth were exposed to beverages for 25 h in vitro. Erosion depth is measured in microns. The third row shows the chance probabilities (i.e., P values) associated with the differences in erosion of enamel and root. These are not particularly enlightening; enamel and root are both significantly eroded.

These results reflect a broader trend. Nearly all industrial beverages cause erosion, even the “healthy” fruit juices. This is due in part, but not entirely, to the acidity of the beverages. Other chemicals contribute to erosion as well. For example, Coke has a lower pH than Gatorade, but the latter causes more erosion of both enamel and root. Still, both pHs are lower than 4.0. The pH of pure water is a neutral 7.0.

Coke is how my name is pronounced, by the way.

This was a study in vitro. Is there evidence of tooth erosion by industrial beverages in people who drink them? Yes, there is quite a lot of evidence, and this evidence dates back many years. You would not guess it by looking at beverage commercials. See, for example, this article.

What about eating the fruits that are used to make the erosion-causing fruit juices? Doesn’t that cause erosion as well? Apparently not, because chewing leads to the release of a powerful protective substance, which is also sometimes exchanged by pairs of people who find each other attractive.

Reference

Leslie A. Ehlen, Teresa A. Marshall, Fang Qian, James S. Wefel, and John J. Warren (2008). Acidic beverages increase the risk of in vitro tooth erosion. Nutrition Research, 28(5), 299–303.