Written by Dyami Millarson
Underlying tooth decay, there is a constant battle between demineralisation and mineralisation (*1). Dental caries may simply be defined as the cumulative result of the cyclical ebbs and flows of demineralisation and mineralisation (*2, *3). Remineralisation is the term used for the normal daily process whereby the teeth, namely the enamel and dentin, are repaired from demineralisation (*4). Enamel is the material that covers the outside layer of the teeth above the crown (*5). It is one of the most mineralised and hardest parts of the human body (*6). Enamel is a composite of both organic and inorganic components, and the same is the case for dentin (*1). So far we have spoken about enamel, but we ought to treat dentin in more detail as well: although enamel is the hard dental tissue that may be defined as the outermost part covering the crown, dentin is the hard dental tissue that is the whole body of the tooth (*7). Alternatively, dentin may be more specifically defined as the dental layer under the enamel which covers the surface of the teeth (*8). Enamel and dentin are also seemingly contrasted with the latter being defined as a mineralised dental tissue and the former as a mineralised dental structure (*9), but I am not sure what to make of this distinction; it seems that this distinction might be practically inconsequential.
Context is relevant for understanding the definition of mineralisation: when we speak of mineralisation in this article which deals with tooth decay, it is relevant to specify that biomineralisation is meant by this (*7). In the context of soil science, mineralisation is the process by which organic matter is converted to mineral nutrients, which are easy to absorb for the roots of the plants growing in the thus mineralised soil (*10). However, biomineralisation is the process by which biological organisms produce minerals (*11), and that is the process we are interested in for understanding tooth decay and we mean biomineralisation when we speak of tooth mineralisation. The science of biomineralisation is the study of biologically produced materials, such as human teeth, as well as the study of the biological processes leading to the formation of such organic-inorganic composites (*12). As a refresher for the reader who might be inundated with new facts, I already mentioned in the previous paragraph that enamel and dentin are composites of both organic and inorganic components. The formation of hard dental tissues, such as enamel and dentin, involves the following two processes: a biological process which includes cell signalling and a biochemical process where the biomolecules interact for the formation of crystal apatite (*7).
Apatite refers to any member of a series of phosphate minerals and apatite comes from an Ancient Greek word for deceit, as apatite resembles a plethora of other minerals (*13, *14). Apatite is, in fact, the most common phosphate mineral, and is the main source of phosphorus required by plants in the soil (*14). So apatite is also relevant for soil mineralisation. Apatite is not popular as a gemstone because it is too soft, and thus considered too brittle for most jewellery use (*13, *15). Calcium phosphate, which is another name for apatite, is what the bones and teeth of humans and animals are made of, and the biological apatites, of which the aforementioned human and animal hard tissues are composed, are usually hydroxylapatites, also known as hydroxyapatites without an l in the third syllable (*14, *16). Apatite found in bone has a unique chemical composition as well as unique geometry and the basic composite structure of bone, as seen from the nanoscale, consists of collagen fibrils densely mineralised with hydroxy(l)apatites (*16). For those who do not know, collagen is the single most abundant protein in the animal kingdom and may simply be defined as an insoluble, hard, fibrous protein that accounts for one-third of all the protein in the human body (*17, *18). Although there are 16 types of collagen in total, 80-90% of the collagen which is found in the human body consists of types I, II and III. The collagen molecules as found in the body pack together and form long thin structures known as fibrils. Type I collagen, of which the vast majority of the fibril-type collagen in the human body consists, is not only found in the human bones and skin, but also in the connective tissues, tendons and fibrous cartilage (*19).
Cavitation occurs once the enamel and dentin do not have the proper structure anymore for maintaining their mineral framework, and remineralisation may be regarded by the dentist as an insufficient treatment at that point (*2). Remineralisation is therefore a form of preventative medicine, i.e., the dentist seeks to prevent the formation of cavities by means of dental remineralisation (*20). However, demineralisation is not a continuous one-way process, but it is a cyclic event characterised by waves of mineralisation and demineralisation (*3). Although dental remineralisation may, in practice, be employed by the dentist for the prevention, repair and reversal of dental caries, which is a synonym of tooth decay by the way, there is a definite limit to what mineralisation therapies by the dentist can do, provided that they are not accompanied by proper dental care at home (*20). It is therefore vital that the following be answered: what, then, is proper dental care? Here are some dental care tips: brush your teeth no less than twice a day and keep in mind more than twice a day may be desirable, brush your tongue as well, flossing is equally important as brushing your teeth and so you should never skip this, floss all of your teeth properly no matter how difficult it may be to reach them and so take the time for a proper flossing routine, drink plenty of water instead of sugary beverages, and generally avoid foods that contain lots of sugar and carbohydrates as well as foods that have a low pH, i.e., foods that are acidic (*21, *22, *23). Microbial activity is associated with the onset of dental caries, and when one eats too much sugar, carbohydrates or foods with a low pH, one is feeding those cariogenic bacteria with nutrients that they need for breaking down one’s teeth, and so limiting sugar, carbohydrates and low-pH foods is a practical and viable strategy for preventing the onset of tooth decay in the mouth. Saliva plays, moreover, an important role in protecting the teeth against damaging microbial activity and natural anti-microbial agents, such as spices, herbs and probiotics, seem effective for controlling cariogenic microbes, i.e., micro-organisms responsible for dental caries (*24, *25)
Although my keen interest in phonetics already made me instinctively interested in the mouth, one of the main reasons I was alerted to the importance of oral hygiene was the ageing-related fact that good oral hygiene reduces mortality risk and a good dental care regimen should therefore be taken extremely seriously by those who wish to follow a longevity-promoting lifestyle (*26). Seeing the link between oral hygiene and longevity is undoubtedly an indispensable health-boosting insight, and I have become much more attentive to dental care ever since I became aware of this fact. I recall that I watched cartoons as a child about bacteria that were destroying the teeth, and that is when it first dawned upon me that micro-organisms were responsible for tooth decay, which is what made me very concerned about cleaning my teeth and so I never experienced a single cavity until 2020 around my 26th birthday when I had been lax with dental care for a while due to experiencing prolonged heightened levels of stress, which usually makes one vulnerable to developing dental caries. Natural compounds extracted from the following herbs and spices may be effective against cariogenic bacteria: Bauhinia forficata, Curcuma xanthrorrhiza, Licorice Root, Eurycoma longifolia jack, Cinnamomum burmannii, tea tree, Sterculia lychnophora Hance, Melia azedarach L., Tamarix aphylla L., Cinnamon bark, Acacia arabica, Ginger-garlic paste, clove, Acacia catechu, Thuja orientalis, Camellia japonica, Quercus infecteria, Pongamia pinnata, Cymbopogon citratus (*25). I use a few drops of tea tree oil mixed in a cup of water as my preferred mouthwash product, though one should be careful not to ingest the tea tree oil and therefore one ought to make sure to wash one’s mouth thoroughly with water after one has finished gargling with the mix of tea tree and water to rinse one’s mouth. When my gums hurt or if my gums are bleeding, I may apply some tea tree and it usually works; I usually spit it out after 10-15 minutes of holding the tea tree in my mouth with increasing saliva formation, and then I wash my mouth with water.
Micronutrients may be essential for oral health, because research has demonstrated that they reduced oral inflammations, such as gingivitis and periodontitis (*27). Gingivitis, which is basically an inflammation of the gums, is a commonly occurring, mild form of gum disease (*28, *29). This inflammation may be caused by bacteria and if this inflammation is left untreated, it may develop into periodontitis, which is a much more serious medical condition than gingivitis (*28). Interspersed with all the factual information, let me add one more personal anecdote to this article: I believe that I may have been experiencing an inflammation of my gums due to bacterial overgrowth this year, and what helped me in my case was having more dishes with lots of pepper. I noticed already this summer that my gums had receded a little bit, and for this reason, I may look into the topic of regrowing the gum in another blog article. When it comes to habits preventing the formation of oral cavities, we already know that it is best to avoid sugary foods as mentioned in one of the previous paragraphs, but in case we do choose to engage in such a guilty pleasure, it is recommend that the sugary foods be eaten with a meal rather than between meals (*30). Although it may be counterintuitive to have sweets with meals, it is truly the best habit for the teeth, and while I am writing this down, my mind is instinctively making the following analogy: many vitamin and mineral supplements ought to be taken with meals because this is the best habit for the gut. (Such instinctive analogies that my mind draws for me usually have a mnemonic function.) As perceived within the context of the notion that saliva may be important for protecting and repairing the teeth, it might be advisable to include salivation-promoting foods in one’s diet: peas, bananas, Brussel’s sprouts (*31).
Which vitamins and minerals are healthy for teeth? Vitamins A, B and D, magnesium, iron and not to forget calcium and phosphorus, which we talked about in the context of apatite also known as calcium phosphate, are relevant for dental and skeletal health (*31, *32, *33). The functions of the following vitamins and minerals are not to be overlooked: vitamin A builds the enamel and keeps the gums healthy, vitamin D deposits calcium in the jawbones that support the teeth and it boosts dental mineral density, phosphorus repairs and protects the enamel, and calcium forties the enamel (*33). While one needs sufficient calcium to fortify one’s teeth and bones, one ought to commit to memory that one needs vitamin D for the absorption of calcium (*32). One may obtain vitamin A from dairy products, oily fish and liver products such as beef liver, lamb liver, liver sausage, cod liver oil, king mackerel, salmon, bluefin tuna, goat cheese, butter, cheddar (*34, *35). One may obtain vitamin B from leafy greens, turkey, legumes, sunflower seeds, yoghurt, milk, mussels, trout, salmon, clams, chicken, eggs, oysters, beef (*36). One may obtain vitamin D from red meat, oily fish, egg yolks and liver products (*37). One may obtain magnesium from nuts such as almonds and cashews, seeds such as pumpkin seeds and chia seeds, leafy greens such as spinach, legumes such as black beans and in smaller quantities from fish and meat (*38, *39). One may obtain iron from beans, nuts, dried fruit, red meat and liver products (*40). One may obtain calcium from leafy greens, dairy products and fish where one also consumes the bones such as is the case with sardines (*41). One may obtain phosphorus from poultry products such as eggs and chicken and turkey, dairy products such as yoghurt, milk and cheese, lentils, nuts such as cashews, pumpkin seeds, seafood such as salmon and scallops, quinoa, beans, amaranth, sunflower seeds, liver products, potatoes, and beef (*42, *43, *44). Some may also recommend bone broth as a way to help the teeth recover from dental decay (*45).