J.D. Moyer

beat maker, sci-fi writer, self-experimenter

Why I Am Taking a "Watch and Wait" Approach re: Two Small Cavities

In the kisser!

In the kisser!

Recently I went to my new dentist in Oakland. While going to the dentist is rarely much fun, everyone at this office is friendly and professional, and you get good dental advice with very little guilt-tripping. They are also amenable to my treatment preferences, such as getting X-rays every two years instead of every year.

My dentist pointed out two small cavities while I was there. She showed me the cavities with a small mirror, and also had me listen to the sound of metal pick touching my teeth. “Clanking” is good, indicating the enamel is hard. When the instruments sticks and doesn’t clank around, that can indicate the enamel is soft.

I made an appointment to get the two cavities filled. The estimate was $240 per cavity, which according to this site is just slightly above average for composite fillings. I’m self-employed and I don’t carry dental insurance, so for me all dental costs are out of pocket. Cost is definitely a consideration in regards to dental care. On the other hand, dental health is a real priority, and I’m not going to wait until I have a toothache to take care of any problems.

A couple days after making the appointment for the fillings, I called the office and cancelled it. I told them I wanted to take a “watch and wait approach,” and check those teeth again in six months.

Here’s my reasoning behind the decision:

1. Neither tooth has ever been drilled before. If at all possible, I’d like to keep it that way.

2. I’m concerned about the overtreatment of microcavities (also known as “incipient carious lesions”), as discussed in this article from the New York Times. It’s not that I think my dentist acted unethically in suggesting I treat the teeth, but the trend in dentistry in general is to drill and fill smaller cavities that, in years past, might have been given a “watch and wait” pass.

One also has to consider the incentive system. What if, instead of getting paid by the filling, dentists were to receive a fixed annual stipend from the government for keeping your teeth healthy, as part of a national healthcare system. Would so many fillings be recommended?

3. Six months ago, I had soft spots in two of my upper right molars. To her credit, my dentist said I could have either them filled, or use a fluoride rinse and see if the enamel hardened up. I chose the watch-and-wait approach. One tooth hardened up entirely, possibly because of my home treatment plan (see below). The other one she didn’t notice until I reminded her of it, at which point she checked it again, noticed it was still a little soft, and recommended a filling.

So, at least one tooth has hardened up on its own. Possibly, my home treatment plan is working. So I’m going to give it another six months, and see what happens. Here’s what I’m doing:

Dental “Enamel Building” Home Treatment Plan

1. Brush twice a day with fluoride toothpaste, at least once with an electric toothbrush (Oral B).

2. Floss at least once a day, before bed.

3. Fluoride rinse after brushing, at least three times a week. Right now I’m using ACT, but I plan on buying a “more natural” brand that is not only alcohol free, but also doesn’t contain propylene glycol and artificial color (but still contains .02% fluoride).

4. Reduce my protein intake. My period of best dental health (no cavities at all) was when I was a lacto-ovo-vegetarian for a number of years (of course this could be entirely coincidental, or related to the fact that I also didn’t drink coffee or consume alcohol at the time). A more-or-less paleo diet works well for me these days, but I think reducing total protein intake (thus making my overall diet less acidic) could potentially assist in the process of tooth remineralization. There are other reasons for me to reduce meat intake in particular; I carry a recessive gene for hemochromatosis (I learned this from my 23andMe profile). I’ve never had a toxic iron levels, but I never have low iron either (even though I give blood regularly, and even when I was a vegetarian). I’m also concerned about recent research linking carnitine consumption to species of gut bacteria that raise TMAO, which in turn may contribute to arteriosclerosis — that probably deserves a post of its own in the future. I’m replacing “lost” meat calories with good fats (olive oil, coconut oil, avocados, etc.) and slightly more beans. Compared to most people I probably still eat a high-protein diet, since I eat fish and poultry or eggs pretty much every day, in addition to nuts, aged cheeses, yogurt, and other high-protein foods.

5. Fat soluble vitamins several times a week (K2, Mk-7 form, 100 mcg / D3 2000-4000IU, cod liver oil for vitamin A 1t). K2 especially may help with bone and tooth remineralization. I also eat dietary sources of vitamin K2 including aged cheeses, and pate made from poultry liver (providing the Mk-4 form). In this post, Stephen Guyenet discusses the relationship between tooth healing and fat soluble vitamins.

6. A magnesium glycinate supplement on most days, as well as adequate calcium intake from yogurt, aged cheeses, whole sardines, almonds, cooked leafy greens.

7. Good diet overall — whole foods, high nutrient, low in sugar and grains. No soda, which is highly acidic and dimineralizing.

8. Rinse mouth after eating to restore neutral pH level, especially after acidic foods and beverages (of which I consume a fair amount, including citrus, berries, coffee, and wine).

9. Chew xylitol gum, which normalizes pH, and has been shown to reduce caries. Xylitol is made from xylose, a wood sugar extracted from the white birch tree.

So, we’ll see how it goes. I’ll report back in six months with the results of this n=1 experiment.

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20 Comments

  1. Linda Lancione

    Hi John David,

    I am glad you’re doing this. I’m going to start on your tooth care program when I get home! Night before last I broke a tooth at dinner, probably bit down on a tiny fragment of walnut shell in a bite of cake. So today I’m driving up to the dentist, will probably need a yet another 1300.00 crown. I think I have soft enamel! Anyway, I love your proactive health care, and need to give mine an upgrade. Have been eating gluten free here, thanks to our very accommodating and wonderful “culinary resident” who insists on making a gluten free option for everything, meaning I still eat a lot more grains and sugar than I’m used to.

    BTW Chris Kresser has some recent post on the red meat research you mentioned.

    I guess I must be in the home stretch of my residency; I dreamed you and I were trying to figure out when my day with TR was. I’ll be glad to see you all!

    Love,

    Mom

  2. Chris Masterjohn has an excellent article on red meat and TMAO at http://www.westonaprice.org/blogs/cmasterjohn/2013/04/10/does-carnitine-from-red-meat-contribute-to-heart-disease-through-intestinal-bacterial-metabolism-to-tmao/

    Re teeth, have you read Ramiel Nagel’s book on curing tooth decay?

    For me, the biggest difference was getting enough vitamin A. Jaminet recommends 10,000IU/day of retinol. I increased mine from about 3,000IU/day to ~11,000 by going from 1/2 tsp/day of fermented skate liver oil to 2 tsp/day, and eating more egg yolks, and I really notice the changes in terms of reduced tartar/plaque and tooth strength.

  3. Richie

    Chris Masterjohn argues that red meat doesn’t raise TMAO any more than common fruits and vegetables. And seafood seems to raise it the most:

    http://www.westonaprice.org/blogs/cmasterjohn/2013/04/10/does-carnitine-from-red-meat-contribute-to-heart-disease-through-intestinal-bacterial-metabolism-to-tmao/

  4. Thanks for the links … Masterjohn makes some good points.

  5. OK….so I know this is about tooth decay, but you also raised another issue – hemochromatosis (HCT). Be careful with this hereditary condition. If anyone in your family tests positive for the recessive gene, everyone should be tested. Both parents have to carry the recessive gene to pass an active form of this condition on to their children. The models say that out of 4 offspring to two carriers, one will have to be treated, two will be carriers and one will be completely unaffected and quite possibly not a carrier. This is much more common than most people think – 10-15% of Americans have active HCT and will need periodic phlebotomy (which is the treatment for this) for life. The American College of Clinical Pathologists recommends testing for everyone by age 25 or so. Especially at risk are those of Northern European, Jewish and Scandinavian descent. It took my husband almost a year and a half of phlebotomy to get his iron levels back to normal and he now has a blood draw about every two months. Iron is stored in all body tissues, but the liver and heart are most at risk. Cardiac arrest and liver cancer are common if this is left undiagnosed. Women are often diagnosed later than men due to blood loss from menstruation. Early diagnosis and a phlebotomy schedule lead to a completely normal life for most people.

    • Good point. Just checked my wife’s profile on 23andMe to make sure, and she doesn’t carry this trait.

      • Any children you have could be carriers and if they hook up with someone else who’s also a carrier……….this is a generational cautionary that never goes away. Once again, as always, knowledge is power.

  6. Hi J.D. I enjoyed reading this post. I wanted to share some information that may help you interpret the results of your experiment. Undisturbed, demineralized enamel can remineralize, but it’s ability to do so can be inhibited by having an explorer (the sharp hook) stuck into it. If that tooth still develops a cavity, it doesn’t necessarily indicate that the routine you adopted to help it remineralize was unsuccessful. I found the Evidenced Based Dentistry journal (http://www.nature.com/ebd/index.html) while doing research for a series of posts I hope to draft over the next few weeks. There are a couple of articles there that indicate similar outcomes for crowns vs composite fillings for conservative restoration of posterior teeth. Perhaps Mom doesn’t “need” a crown after all.

  7. As always, excellent post, thank you very much for taking the time to share your mind with us.
    You said: “…with an electric toothbrush (Oral B).”
    Any arguments against Philips’ Sonicare that I should read about?

    • Not that I know of! I made some music for an Oral B commercial years ago and got a free product sample of the “Oral B 3D” when it first came out. Liked it and stayed with the brand.

  8. I agree about taking a “watch and wait” approach. You might find this site of interest, and especially this page:
    http://www.healingteethnaturally.com/drilling-filling-risks-damages-dangers.html

    The site also has a lot of info about xylitol for oral health, and recommends using the sugar on its own rather than as chewing gum. That’s what I do myself.

    I don’t know about the fluoride rinse, but it looks like everything else you’re doing is great.

  9. Colin

    hey I just found out I have two cavities a month ago, scheduled an appointment ($175 for both cavities after insurance), and cancelled the day before. very reassuring to hear you doing the same thing. ive never had a cavity before and unlike your awesome dentist, my dentist couldn’t even show me the cavities! she said they weren’t visible on the xray since they were microscopic essentially and would not point them out to me. very strange. it was my first time going to a corporate dentist instead of family owned, I felt like I was in an assembly line. anyway thank you for your post.

    • altamisal

      That’s the deal with most dentists unfortunately, they over-treat, and this in itself can lead to more issues down the line. Drilling weakens the teeth.
      Anyway, glad you canceled the appointment Colin. I can’t think of many things I enjoy less than sitting in the dentist’s chair!

  10. The Running Princess

    I have been a vegetarian for 15 years. I haven’t had a cavity in 20 years. I was diagnosed with a cracked tooth and a cavity in two different teeth one week ago. I was told I need a crown and a filling. I refused both. I have dental documented records of a cracked tooth that my body healed. I have drastically reduced my refined sugar intake. I have increased my nutritional intake to give my body the building blocks to heal. I have added coconut oil pulling and herbal mouthwash to pull out poisons. I am sleeping with a mouthpiece to relieve pressure on my teeth while I sleep. My body heals itself. It is always reassuring to share healing stories with like minded people.

  11. Go veg

    Hello and thanks for your post. I understand you stay away from most meat because it’s acidic. Please note, dairy is also very acidic. Animal products are most acidic when they are digested (alkaline before digestion). This acidity inside our bodies erodes bones everyone in our bodies. A plant based life style is more alkaline even though some starches, nuts and beans are a bit acidic (no where near animal products). Vegetables and fruits are acidic outside of our bodies but most alkaline once digested. Bacteria and disease thrive in acidic environments. Please check your PH can order strips to put on your tongue from online. Of course you don’t want to be too alkaline otherwise that’s not healthy either. I’m going to see a Holistic Dentist/Natural Dentist and I can’t wait. Treatment is much different! Again, thanks for the post!

  12. altamisal

    This girl’s experience is inspiring. Following her example, I am taking eggshell powder daily.

    And someone posted today in my Vitamin C For Optimal Health Facebook group:
    “vit c works miracles for me spotless teeth and no cavities, inflammation down- I am excited bc I’ve always had cavities no matter what I did – fascinating how a small change makes a huge life quality difference!”

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