Unfortunately, that's the exact situation I found myself in one fateful November day. I was seventeen. It'd been a full year since I'd become a strict, low-fat, fruit-noshing raw vegan - led there by a cocktail of food allergies and dewy-eyed trust in people from the internet (bad idea is bad). Perhaps too distracted by my constant brain fog, perpetual shivering, and the clumps of hair making a mass exodus from my scalp, I'd failed to notice the prime victim of my lopsided diet: my teeth.
Up until then, I had pleasant associations with the ol' dental chair. My mouth had only ever seen one cavity - a fluke in an otherwise pleasing track record. I'd never missed a day of flossing. I'd never needed braces. For me, dentist visits were an opportunity for people to tell me nice things and make me feel good about myself, even if I'd gotten too old for their goodie drawer of parachute men and Lisa Frank stickers.
So when that familiar praise didn't come, the blow was all the more devastating. After a series of "hmms" and heavy sighs, my dentist delivered the news: a grand total of sixteen cavities - more of an estimate, really, because the cavities-sprouting-from-cavities nature of the damage made it hard to count. Massive wear capped the surfaces of my back teeth, and my front ones were becoming translucent from enamel loss. Unsightly recession plagued my once-healthy gums.
The dentist didn't mince words when telling me he'd never seen someone so young with such a terrifying mouth - and it'd all happened in the span of one year.
The next few months involved five trips back to that same chair: four to drill the heck out of all the quadrants of my mouth, and one to grind down the misaligned bite I'd acquired from my new ceramic fillings. But that was only the beginning. Nearly as soon as I'd gotten the old cavities cleaned up, new ones started forming. My teeth continued their rapid decline. The bacteria-filled "gum pockets" crawled deeper from bone loss. I knew a drill wasn't going to be enough to save me.
To this day, I've never seen a group of people with such rapidly imploding dental health as the raw vegans. Even studies of their pearly whites seem to confirm that. It's like some sort of hazing ritual, in which the Cavity Fairy comes and sprinkles decay upon the mouths of new recruits. But the problems I encountered as a raw vegan were far from unique to meat-free, non-cooking mouths, and neither were the solutions I eventually found. For most of us, even those of a real food/primal/Paleo/ancestral persuasion, decades of subpar eating, overzealous brushing, and other teeth-harming practices have left us with some damage to fix. It's my hope that sharing the details of my own healing journey will help some of you on yours.
(This is probably the part where I should insert a disclaimer to protect my patooty from a lawsuit: dental problems can be quite serious, and if you're experiencing something debilitating or extremely painful or infection-related, you should probably head to a dentist instead of reading this. Also, floss. Just do it.)
Zig-Zags and Prongs
Let me make one thing clear: my road to healing wasn't linear. It had lots of loop-de-loops and mistakes and nights spent staring in the mirror, lips rolled over my teeth, convincing myself I would still be an okay person if I looked like Gumby. There were moments after trying things I was sure should work - adding more calcium to my diet, cutting down on fruit, eating pounds of kale - where I almost threw in the towel and resigned to a life of oral misery.
But eventually, I went from embracing mainstream beliefs about dental health - that cavities can't heal, that calcium is the biggest tooth-relevant nutrient, that candy and soda are the only foods you need to worry about - to doing a 180 on all those fronts, and feeling pretty confident in the ability for teeth to regenerate. For anyone out there who's struggling with dental issues, no matter how severe, don't give up hope.
Ultimately, my own tooth-healing saga, as accidental and fumbling as it was at the time, became something of a two-pronged approach. The first prong was protecting my chompers from the outside in, minimizing sources of external damage. The second prong involved rebuilding my teeth internally, with many delicious things. (That prong was a lot more fun.) Here's the full story.
Protect and Defend
In real-food circles, when you see an article about fermented foods, usually there are lots of exclamation points and pictures of beautiful bubbly sauerkraut, and testimonies about the slew of benefits those fermented things brought, and there is happiness. So much happiness. For that reason, what I'm about to say might get me booed off the cyber-stage:
Fermented foods wrecked my teeth.
Okay, that's a bit hyperbolic, especially considering my teeth were already wrecked to begin with. But when I unveganized, as part of my early healing attempts, I went hog wild on all things kimchi and sauerkraut - convinced the beneficial bacteria would do something awesome for my teeth and hair and everything else on me that was broken.
What happened instead was pain, and lots of it. I used to sit at the kitchen table with a heaping bowl of gingery, zangy, raw, delightful kimchi, convinced it was the best thing I could be forking into my mouth. A few bites in, my mouth would seize up with sharp, dagger-like pain, evocative of what it might feel like to give birth through one's jaw while also being electrocuted. The pain was so bad that it made "dentures by the time you're thirty" sound like a pretty good idea.
Perhaps it was my raging kimchi addiction that kept me blind to reality, but it took months of wincing before I realized those fermented veggies were making my teeth more sensitive, and worsening the damage I was desperately trying to fix. And after a little research, it was easy to see why: sauerkraut and kimchi have a pH of about 3.5, making them extremely acidic upon contact with your chompers - and capable of chewing through enamel with the best of 'em. That's about the same pH level as soft drinks like Coke and Pepsi.
(High-school science refresher, in case you slept through that lesson: a pH of 7 is considered neutral; anything higher is alkaline, and anything lower is acidic. Foods with pH levels below 5.3 start entering the "enamel damage" territory, especially if your teeth are already in a compromised state.)
Not surprisingly, my tooth pain resolved pretty fast after I started limiting fermented vegetables and other highly acidic foods, especially fruits I hadn't realized had such a low pH. I can eat those things now without any problem - at least in moderation; I still have to keep my inner kimchi-gorger in check - but during the early phases of healing, I had to be pretty cautious about giving my mouth an unintentional acid bath.
In case you're curious, here's a list of some of the low-pH foods that ended up on my "limit" list for a couple of years. You'll notice a lot of fruit on there. Given that my own teeth healing occurred with a diet packed with low-acid fruits (papaya and melons, largely), I tend to think the acidity of fruit is a bigger problem than its sugar content, as far as dental health goes. (Values taken from a list produced by the FDA.)
Apples: 3.3-3.9
Apricots: 3.3-4.0
Blackberries: 3.9-4.5
Blueberries: 3.1-3.3
Cherries: 3.2-4.1
Frozen cherries: 3.3-3.4
Dill pickles: 3.2-3.7
Grapes: 2.8-3.8
Grapefruit: 3.0-3.8
Ketchup: 3.9
Lemon juice: 2.0-2.6
Lime juice: 2.0-2.8
Mangoes: 3.4-4.8
Nectarines: 3.9-4.2
Olives (green, fermented - black fresh or canned ones have a pH of at least 6): 3.6-4.6
Peaches: 3.3-4.1
Pears (Bartlett): 3.5-4.6
Pineapple: 3.2-4.0
Plums: 2.8-4.5
Pomegranate: 2.9-3.2
Raspberries: 3.2-3.7
Sauerkraut: 3.3-3.6
Strawberries: 3.0-3.9
Tangerine: 3.3-4.5
Tomatoes (canned): 3.5-4.7
Vinegar: 2.4-3.4
Orange juice: 3.3-4.2
Red wine: 3.4
White wine: 3.0
Along with limiting acidic foods, I picked up a few other tricks of the trade to protect my teeth from outside invaders. I stopped brushing immediately after meals (apparently, scrubbing enamel before it remineralizes is no bueno). If I did have a moment of weakness and invade the kimchi jar, I would swish afterwards with water and baking soda to raise my mouth's pH. Boom! Sensitivity averted. And instead of using whitening toothpastes or other commercial whiteners to combat stains from chain-drinking tea, I started brushing with activated charcoal, which is gentle and miraculous. Seriously. I'm not kidding. It's amazing.
But those things were only bandaid fixes - ways to prevent my teeth from getting worse, but not really doing much to help them heal. The other leg of my journey was nutritional.
Rebuilding: A Triage of Fat-Solubles
As a vegan, it is, by several universal laws, a requirement to hate the Weston A. Price Foundation. It doesn't really matter why that hatred is there, so long as it's strong and vocalized at every relevant opportunity.
In my case, even after my departure from veganism, I maintained my WAPF-hating duties like a champ. How dare they put a picture of happy people on their webpage! How dare they eat butter! How dare they use... words... and colors. Despicable. I gradually ran out of reasons for my loathing, and after seeing virtually no improvement in my teeth after guzzling calcium supplements and dark leafy greens, decided to peruse their articles on dental healing. That's when the pieces started clicking together in a big way.
As I learned from a few WAPF articles, three fat-soluble vitamins - A, D, and K2 - tend to be the holy trinity for all things teeth. I wrote a bit about these nutrients on an earlier article directed towards raw vegans, but the nutshell version is that they work synergistically to support bone and tooth health, boost calcium absorption, and shuttle calcium where it needs to go. My own experience confirmed what I've heard time and time again from other self-healers of teeth: this combo works some small miracles.
(A special note on K2: hopefully everyone in this little corner of the food world has heard about this lovely nutrient, but if you haven't, you owe yourself a research safari. A great book on the topic is "Vitamin K2 and the Calcium Paradox" by Kate Rheaume-Bleue, and plenty of online resources abound - including some earlier posts here on Mark's Daily Apple.)
During Operation Save My Teeth, before I knew anything about fat-soluble vitamins, one of the first non-vegan foods I'd added to my diet was "probiogurt" - a raw, 30-hour fermented goat yogurt I ordered from a farm in Austin. It was also the first food that actually pleased my pearly whites: within a week of adding it to my diet, the translucent tips on my teeth became more opaque, and my nagging, chewing-induced sensitivity began to quell. Unfortunately, I'd stopped eating the yogurt on account of the farm becoming terrible and scammy and no longer shipping the orders I'd paid for.
At the time, I figured the yogurt's benefit had just been from its calcium content, and was genuinely baffled when supplementing didn't do diddly squat. Oh, ignorance.
Enter the WAPF website and its vitamin K2 revelations. Epiphany time! As I read about this precious nutrient, it suddenly made sense: vitamin K2 is a product of bacterial fermentation, and the "probiogurt" I'd been eating was likely teeming with it. It was probably the first food-based source of K2 my body had seen in years. After that "aha" moment, I started religiously supplementing with vitamin K2 - 5 milligrams a day from Carlson Labs. (That's still the brand and dosage I use to this day.)
Shazzam. Practically overnight, my teeth felt smoother, looked whiter, and lost a great deal of their painful sensitivity. And at my next dental cleaning, the hygienist confirmed a turn for the better: some of my "irreversibly" lost enamel was thickening; a few pre-cavity trouble spots were filling in on their own; and the periodontal pockets that'd been getting gradually worse were suddenly tightening back up - jumping from measurements of 4-5 millimeters on most teeth to 2-3. My lost-cause mouth was suddenly not so lost. Allow me to repeat: shazzam!
(Apart from supplementing, other K2 sources include natto, hard cheeses, soft cheeses, butter from pastured cows, egg yolks, liver, and probably other organ meats - K2 analyses are pretty sparse for most foods. Since I don't do dairy anymore, my main non-pill source is liver. Speaking of which...)
Along with vitamin K2, one of the most pivotal edibles in my dental saga has been liver. As far as "building strong bones" goes, I'm pretty sure those Got Milk? ads should feature people with paté moustaches instead of milk smears, though something tells me that might ding sales. I really can't praise liver enough. Along with being a decent source of vitamin K2, it's awesomely high in vitamin A - something in short supply on vegan diets and even some omnivorous ones, depending on how wisely the animal foods are selected.
For the last few years, I've wobbled back and forth between taking cod liver oil (this kind's my favorite) and eating free-range chicken liver a few times per week, and the result is the same: the benefits I already see from taking vitamin K2 get an even bigger boost. Whiter color, smoother tooth surface, less plaque build-up, less sensitivity, happier hygienists when I go in for a cleaning. When I slack off on the liver too long, my teeth are the first to chide me for it.
And last but not least, the third member of the fat-soluble gang: vitamin D. As a resident of the gorgeous but gloomful Northwest, vitamin D has been a lifesaver for me, maybe literally. After I moved out of Arizona in 2008 and landed in Portland, I started taking between 1,000 and 3,000 IU of vitamin D per day, depending on how quickly I manage to dash outside when the sun makes its forty-second cameo appearance. (There are plenty of feuding opinions on the best dosage, but in terms of maintaining the state of my teeth, that's been my sweet spot.) Although the benefits I've experienced from vitamin D have been most noticeable in the realm of mental health (e.g., taking it helps me not be a Seasonal-Affective-Disordered zombie from October to March), I've noticed a decline in the state of my teeth when my bottle runs out and I don't replace it for a few weeks. So, on my shelf it stays.
Flash Forward
It's been a whoppin' decade since I took my first bite away from raw veganism and towards better health, and seven years since the condition of my teeth really stabilized in a happy place. Of course, my mouth will probably never return to the pristine state it once held; I still have ups and downs when I'm not vigilant with the fat-solubleness of my diet, and I need more frequent cleanings than the average bear. But I'm 27 now, and all the teeth in my mouth are still mine. In three years, I expect it'll still be that way.
(And if not, I'll totally become that crazy lady who whips out her dentures at random moments and frightens the children. Win-win.)
therefore take some of his advice with a pinch of salt!