Dental Cavitation Surgery Posted on January 31, 2012 by Louisa Williams • 84 Comments PrintFriendly and PDFPrint - PDF - Email Appropriate Pre- and Post-Extraction Protocols When Surgical Intervention is Necessary The decision to pull a tooth is a very important and permanent one. It requires the active participation of the patient, the holistic physician/practitioner, and the biological dentist. If tooth extraction (or surgery of a former extraction site) is deemed necessary, individuals greatly enhance their chances of a positive outcome by adhering closely to pre- and post-cavitation surgery protocols. A dental “focus” is defined as an area anywhere in the mouth— whether a tooth or an extraction site—that is chronically irritated and/ or infected. These “dental focal infections” can include impacted wisdom teeth, incompletely extracted wisdom (and other) teeth, failed root canals, failed dental implants, and devitalized teeth (from deep fillings, crowns or physical trauma). What makes chronic dental focal infections so particularly difficult to diagnose is their relative silence in the mouth. That is, in contrast to acute illnesses such as ear infections that can feel quite fiery and hot, typically dental foci “smolder” for years, manifesting only mild and intermittent symptoms of pain and swelling. DENTAL FOCI AND DISTURBED FIELDS However, what is not silent are the “disturbed fields” which these dental focal infections typically cause in the body. For example, although a left lower (number 17) impacted wisdom tooth may manifest no significant pain or inflammation locally, the patient may be quite aware of distal symptoms related to this site. Chronic left shoulder pain and/or intermittent heart pain and palpitations are classic signs and symptoms of the disturbed fields secondary to this chronic dental focal infection (Figure 1). winter2011_williamsfig1 Figure 1 Note that these symptoms are also ipsilateral; that is, on the same side as the dental focus. If, for example, a patient complains of chronic right-sided symptoms such as writer’s cramp (wrist tendonitis), right hip or shoulder pain, and right sciatica, a knowledgeable doctor or practitioner would first want to rule out an ipsilateral—that is, right-sided—dental focal infection (Figure 2). This tendency of dental foci to cause ipsilateral disturbed fields is therefore an excellent diagnostic clue that can be used in helping to determine the primary cause of a patient’s particular chronic one-sided symptoms. winter2011_williamsfig2 Figure 2 CONSERVATIVE BIOLOGICAL DENTISTRY Good dentists do everything possible to try to save a tooth. They don’t recommend extraction—or even a root canal—until all other avenues of treatment have been exhausted. These can include ozone injections to try to heal infection in the tooth, laser treatments, isopathic remedies (Notatum 4X, Aspergillus 4x, etc.), and nutritional support (ubiquinol/CoQ10, crystal sulfur/MSM, Schuessler’s cell salts, original Quinton Marine Sea Plasma, etc.). Additionally, both biological dentists and holistic physicians and practitioners endeavor to first adequately diagnose what’s wrong with the tooth (or socket) in order to determine the underlying problem. For example, if a patient is eating excessive sugar this could be the true cause of pain and inflammation manifesting in a first molar. This tooth has a reflexive relationship with the pancreas and stomach. By changing one’s diet (and nothing is more motivating than the thought of a root canal or the loss of a tooth) to a nutrient-dense one and avoiding refined sugar, along with supportive nutritional supplementation, the first molar can often be saved. It should also be noted that it is essential in most cases to clear the teeth of any toxic dental materials such as mercury amalgam, and aluminum and nickel in conventional porcelain and gold crowns, before extracting teeth. Clearing the mouth of these heavy metals often removes a galvanic dental focus. This term refers to the intermittent pain or irritation (or no local symptoms) induced in a tooth from two different metals placed on or near a tooth. DENTAL GALVANIC FOCI Dental galvanism, or electrogalvanism, can even occur from just one amalgam filling since these fillings themselves are a mixture of mercury, silver, copper, tin and zinc. However, galvanic dental foci typically arise from a highly positively charged gold crown placed on or near a highly negatively charged mercury amalgam filling. When mercury makes contact with gold in the mouth, a galvanic cell or “dental battery” is formed, with a current running between the mercury (functioning as an anode) and the gold (functioning as a cathode). The resulting anodic corrosion of mercury in these dental batteries has been measured at ten to twenty times higher than corrosion in a single amalgam filling alone. As previously described, these strong electrical currents that create a dental galvanic focus can be relatively asymptomatic locally, but refer pain to distal parts of the body (ipsilateral disturbed fields), or they can cause intermittent mild irritation or pain in the tooth itself and surrounding gums. Unfortunately many dentists misdiagnose galvanic pain and refer patients to endodontists for a root canal. This is very disturbing to see in a patient’s history since these galvanic foci could have been cleared conservatively by simply replacing the gold and mercury with metal-free alternative dental materials, and thus saving the tooth. Therefore, if your dentist recommends a root canal for a sore or painful tooth, it is essential to get a second opinion. In fact, the ready recommendation of a root canal should be a red flag for any patient to seriously consider changing from a conventional dentist to a biological (holistic) one. Your health—and even your life—depend on it. HIGH QUALITY X-RAYS ESSENTIAL A periapical view, which is a specific x-ray of the root of the tooth in question, is essential to diagnosis. If there is a clear radiolucency at the root of the tooth; that is, a black circular area, this is an indication of a cavitation or hole in the jawbone. This area of chronic ischemia (lack of blood supply) and infection is referred to by various terms (osteonecrosis, osteomyelitis, NICO, etc.), but broadly speaking it is a dental focal infection. When there is an obvious radiolucency apparent on x-ray there is very little one can do to save the tooth, although some dentists have been able to reduce and even clear very small cavitation areas through ozone injections. However, in most cases, when the x-ray is positive, the decision whether to do a root canal or extract the tooth then needs to be made. If the periapical view of the tooth is negative; that is, no black radiolucency or other signs are apparent, then the biological dentist and physician endeavor to do everything possible to save the tooth with holistic therapies and supplements. However, it is important to remember that x-rays are not always definitive in determining dental foci. In fact, radiological evidence of a bone cavitation area is not even visible until as much as thirty to fifty percent of the jawbone is destroyed.1 So if symptoms continue despite holistic care, further imaging studies may be appropriate such as a 3-D Cone Beam Scanner, which uses digital technology to record images, revealing much more than simple “flat” x-rays. ROOT CANAL OR EXTRACTION? The irreversible decision of whether to have a root canal or extraction should only be made when both the dentist and doctor have exhausted all conservative measures to try to reduce the infection and save the tooth. When these efforts have failed over time, the first decision a patient must face is whether to have a root canal procedure or to extract the tooth. Dr. Weston A. Price, the quintessential holistic physician, always weighed the state of the tooth against the health of the patient: “. . . all pulpless teeth, root filled or not, harbor so much danger of becoming infected that they should be extracted, though the time as to when they should be extracted will depend on several contributing factors. If the patient belongs to a family in which there is a low defense for streptococcal infection, it had better be soon. . . If the patient is in another group with a very high defense and not much danger of overloads, and if it is a tooth that is greatly needed by that patient, I would advise you to do what I do: retain some of those root filled teeth, because I believe they are of more value to the patient in the mouth than out.”2 Price’s counsel, delivered during a 1926 dental conference, still holds the weight of truth today. That is, most biological dentists and practitioners find that if a patient is in excellent health, he or she can handle the stress of a root canal tooth. However, it is important for this tooth, as well as any associated ipsilateral disturbed fields in the body, to be monitored over time. If at any point positive signs and symptoms arise, and the patient’s health is compromised, then the decision as to whether the root canal tooth should be extracted must be reevaluated. In contrast, if a patient has suffered from chronically ill health for many years, then the decision of whether to extract a devitalized or root canal tooth is clearer. In these cases surgery is typically very appropriate. Or, for example, if a patient receives a grave diagnosis such as breast cancer, it is important that all root canal teeth anywhere in the mouth—but especially ipsilateral to the breast—be cleared in the face of this serious disease in order to try to save the patient (Figure 3). winter2011_williamsfig3 Figure 3 However, even when it’s clear that a tooth can’t be saved, simple extractions can be as irresponsible and ineffective as when an untrained conventional dentist removes mercury amalgam fillings. What is required is a knowledgeable and skillful dentist and sufficient pre- and post-surgery treatment in a well-prepared patient. This type of surgery is termed “cavitation surgery.” HISTORY OF CAVITATION SURGERY Cavitation has a dual meaning. As previously described, a cavitation is a cavity or hole of infection in a bone. In surgical nomenclature however, cavitation surgery is the term for the dental surgical procedure that removes diseased bone from within this cavity so that new healthy bone can grow back. G.V. Black, DDS, MD (1836-1915), known as the “Father of Cavitation Surgery,” treated many of these areas of chronic osteitis (bone inflammation) at the turn of the twentieth century. In his two-volume opus entitled Work on Operative Dentistry, Dr. Black characterized these cavitations in the jawbone as a progressive “death of bone” which was able to “soften the bone, often hollowing out the cancellous portions of large areas of bony tissue.”3 As described previously however, Black was amazed that even the larger jawbone cavitation areas full of necrotic (dead) debris could cause no visible redness, swelling or increase in patients’ temperature. However, when these bone cavitation lesions were “opened freely and every particle of softened bone removed until good sound bone forms…,” Black found that “. . . generally, the case makes a good recovery.”4 Thus, Dr. Black identified the serious pathological processes that are generated in infected teeth and bone, noted that these chronic dental focal infections were often relatively silent, and pioneered the cavitation surgery methods that are still being emulated today by trained biological dentists in the removal of these dental focal infections. CHOOSING A BIOLOGICAL DENTIST Biological dentists who specialize in cavitation surgery attend continuing education courses to learn how to most expertly extract devitalized teeth, as well as how to effectively clean out extraction sites that harbor infection from previously incorrectly extracted teeth. The primary cause of these jawbone cavitations in extraction sites is the failure of the conventional dentist or oral surgeon to remove all of the periodontal ligaments when pulling a tooth. These remaining periodontal ligament pieces later act as a barrier to the creation of new blood vessels and, therefore, to the regrowth of new bone. Dr. Hal Huggins likens the severity of this dental omission to the failure of removing the placenta (afterbirth) after delivering a baby: “Bone cells will naturally grow to connect with other bone cells after tooth removal—providing they can communicate with each other. If the periodontal ligament is left in the socket, however, bone cells look out and see the ligament, so they do not attempt to ‘heal’ by growing to find other bone cells.”5 In these incomplete extractions, approximately two to three millimeters of bone will superficially grow over the socket area, but beneath the bone a hole, or cavitation, will remain (Figure 4). As described previously, the term for the degeneration of bone in these cavitation areas, osteonecrosis, is defined as the death of tissue due to poor blood supply. Synonyms of osteonecrosis are inflammatory liquefaction, and, more familiarly, gangrene. Although this latter term may seem exaggerated since it conjures up ghastly images of partial amputations on the battlefield, for those of us who have witnessed a biological dentist spooning out oily black mushy bone from an osteonecrotic cavitation site, the term seems perfectly appropriate (Figure 5). Many dentists have this diseased tooth and bone tissues analyzed through pathology labs (contact Dr. Jerry Bouquot at (713) 500-4420, or jerry.bouquot@uth.tmc.edu). In one clinical study of thirty-eight patients referred by me to Dr. Russ Borneman for cavitation surgery, one hundred percent showed positive histological (tissue-related) signs of ischemic osteonecrosis (bone death) and osteomyelitis (bone marrow infection), thus confirming the clear pathological tissue within these dental focal infections.6 winter2011_williamsfig4Figure 4 It is essential to choose a well-trained and skillful dentist or oral surgeon to treat these ischemic cavitation sites. The best referral comes from your holistic doctor or practitioner if he or she is knowledgeable about dental focal infections. Referral from a family member, friend, or work colleague who has had success with a particular biological dentist can also be valuable. Additionally, going to the websites of the three major biological dental organizations in the U.S. can help further narrow down the decision-making process of choosing the right professional for this very specialized surgery. These organizations are: the International Academy of Biological Dentistry and Medicine (www.iabdm.org); the International Academy of Oral Medicine and Toxiciology (www.iaomt.org); and the Holistic Dental Association (www.holisticdental.org). Also check the Hal Huggins website (www.hugginsappliedhealing.com) PRE- AND POST-SURGICAL PROTOCOL Every biological dentist or oral surgeon has suggested procedures to follow before and after surgery. The following protocol is based on my experience over the past two decades preparing patients for surgery and treating them afterwards, and I hope can add to and support the biological dentist’s directions. With this protocol, along with carefully diagnosing for whom, as well as when, cavitation surgery is appropriate, and most important, the skill of a well-trained dentist or oral surgeon, I have had a ninety-nine percent success record since 1996. PRE-CAVITATION CONSIDERATIONS In the majority of cases it is best to clear the mouth of heavy metals before cavitation surgery. In fact, this may even obviate surgery in some individuals who have galvanic-induced dental foci as described previously. Additionally, patients with non-toxic dental restorations heal much better from surgery than those with toxic metals in their mouth. In contrast however, mercury removal is often contraindicated in cancer patients (until the tumors are cleared and lab tests negative), whereas cavitation surgery to remove the root canals and other devitalized teeth can be clearly indicated, tolerated well, and even life-saving in this population of patients. It is also important that liver detoxification pathways and kidney clearance functions are as optimal as possible. A simple Comprehensive Wellness Profile (CWP) from Direct Labs (www.directlabs.com) is a very affordable (over $500 worth of tests for only $97) and easy blood test to run to determine the functioning of these, as well as other organs and systems, in the body. Of course, a complete history and exam should also be performed by the holistic doctor or practitioner and the biological dentist to further assist in making the decision if the patient is healthy enough to undergo dental surgery. If an individual is very ill, it is often necessary to have this patient on his or her deepest homeopathic constitutional remedy for at least a month or two in advance, in order to facilitate immune, metabolic, and nervous system functioning before surgery. The new Sankaran sensation method of constitutional homeopathy is the single most curative modality known by this author to achieve health, and thus prepare an individual for a successful surgical outcome. Another important assessment to make before surgery is to determine whether the patient has a major tonsil focus. Chronic tonsil focal infections and chronic dental focal infections feed into each other and further infect each other. Patients with a chronic tonsil focus who want to have their wisdom tooth cavitation sites treated, for example, often don’t heal well. This observation was made in the 1920s by Dr. Henry Cotton (1876-1933), a brilliant, if controversial, psychiatrist who specialized in researching the effect of focal infections in the onset of mental illness. In his book, The Defective, Delinquent, and Insane, Cotton asserted that in most cases the wisdom teeth were not infected because they were impacted but were impacted because they were infected, and that this “infection is transmitted from the tonsils.”7 Before these suspected primary tonsil focus patients have dental surgery therefore, it is important to reduce the tonsil focus through avoiding commercial pasteurized dairy (the typical allergy food that causes chronic upper respiratory infections and the tonsillitis in childhood that eventually coalesces to a more hidden chronic tonsil focal infection later in life), rubbing Notatum 4X drops over the tonsils on the upper anterior neck area, and to be on their constitutional homeopathic remedy according to the new Sankaran system. Finally, vegans, and even many lacto-ovovegetarians typically do not consume enough protein to heal tissue, and thus, the surgical site, adequately. Lacto-ovo-vegetarians often become sensitive to the over-ingestion of eggs and dairy foods over the years, which greatly reduces their absorption of these normally utilizable protein foods. Lab tests and energetic testing can determine if a patient is deficient in protein, and if so, the encouragement of eating more eggs and dairy (if there is no allergy) as well as meat broths if the patient is willing, is often needed for at least one to two months in order to have a successful surgical outcome. THE FIVE HEALING DAYS It is imperative for patients to take at least three days off after surgery, but the most optimal protocol is to take the day of, plus the following four days off, a time period I have labeled as the “Five Cavitation Surgery Healing Days.” Patients should plan to rest and avoid any strenuous physical activity during this time. In fact, any exercise (except slow and short walks) or vibration from extensive car and plane travel can delay, and even block, healing of the surgery site. This rest and healing time is significant because if a “dry socket” forms from the invasion of bacteria in the area between the blood clot and the bone and the blood clot is lost, the surgery almost always must be redone at some later point. Dry socket is signaled by significant pain in the surgical site or the ipsilateral ear, and typically a foul odor. The standard treatment of antibiotics often does little because there is no blood flow in the area, and eugenol from the oil of cloves may actually further impair healing of the site. I typically recommend more Notatum 4X drops and laser treatments, as well as a castor oil pack on the suspected disturbed field (stomach, small intestine, liver, etc.) in the body. The best course of action though is for patients to take five full days off and follow this protocol carefully in order to allow complete healing of the site, and therefore only have to undergo this cavitation surgery procedure once. winter2011_williamsfig5a winter2011_williamsfig5b Figure 5 – Necrotic bone on left, healthy bone on right. The use of a therapeutic laser (830 nanometers and 100 milliwatts) is so effective during these five days in healing the inflamed nerves and soft (gums) and hard (bone) tissues, that it has become a sine qua non in my post-surgical protocol (available from jarek.mfg@shaw.ca). Patients rent this laser so they can use it in the comfort of their own home, treating the surgical site for one minute at a time, anywhere from six to ten times a day. This laser is so healing to tissue that it often obviates the need for any pain medication, or at the least, considerably reduces the amount of pain pills needed. Isopathic drops such as Notatum 4x and Aspergillus 4x (www.bioresource.com) are especially helpful post-surgically to augment healing in the site. Further, they can be dropped onto the surgical site at a protocol of two to three drops, three times a day during these five days, and then one or two times a day for one week afterward. When the laser is next applied over the site, these isopathic drops are then photophoretically driven into the surgical site for even deeper healing. Acute homeopathic remedies are also an important component in this protocol. Arnica montana 30C is most commonly prescribed to reduce pain and heal the bruising post-surgery at a dose of two pellets, three times a day, for five days, and then once a week thereafter. If the surgery was very deep and there is a chance that the maxillary (upper jaw) or mandibular (lower jaw) trigeminal nerve was injured, Hypericum perforatum 30C should also be taken at a different time of the day, but at a similar dosage schedule as the Arnica. If the surgery was particularly extensive and intense, patients may want to take the stronger 200C potency of both of these remedies. However, for those individuals who are already on their constitutional homeopathic remedy, usually redosing this remedy one to two times after surgery is all that is required. One to two vials of the mineral-rich Quinton Marine Sea Plasma (www.originalquinton.com) taken daily after surgery further ensures healing of the gums, jawbone, and neighboring teeth during these five days. Patients should hold the contents of each vial in the mouth for approximately a minute or more before swallowing. Finally, nutrient-dense bone broths are essential during these five recovery days. A clear broth from grass-fed organic beef, chicken, turkey, lamb, or from wild fish is especially important the first two days when the surgical incision has not fully closed and you don’t want any food particles to get lodged in there. Later you can purée vegetables (carrots, squash, turnips, onions, kale, etc.) to make a thicker soup to stave off hunger and supply more needed vitamins and antioxidants for further healing of tissues. POST-SURGERY OFFICE VISIT Besides the post-surgery dental visit to check on healing of the site and to remove any stitches, it is important for the patient to also see a doctor or practitioner knowledgeable in focal infections. At that visit the surgical site is checked, any neighboring autonomic ganglia (groups of nerve areas that can hold bacteria and other toxins transported from nearby ipsilateral dental foci) are treated, and any related disturbed fields caused by the focal tooth (or extraction site) are addressed if necessary. This clean up of all the areas in the body disturbed or infiltrated by infection from the chronic focal infection ensures more complete healing of the site, with no reflex “back flow,” or re-introduction of toxins or microbes, back into the dental focal area. CONCLUSION It is important that the decision whether to sacrifice a tooth or repeat surgery of an incompletely extracted site be made by the team of a doctor or practitioner knowledgeable about focal infections, a skillful and experienced biological dentist, and an informed patient. Appropriate pre- and post-surgery protocols can ensure a successful outcome and complete healing of the surgical site. For more information on diagnosing and treating dental focal infections please refer to my book, Radical Medicine (www.radicalmedicine.com). REFERENCES 1. J. Bouquot, In Review of NICO (Neuralgia-Inducing Cavitational Osteonecrosis), G. V. Black’s Forgotten Disease, 3rd ed. (Morgantown, WV: The Maxillofacial Center, 1995, p.3. 2. A. Nichols, The Virulence and Classification of Streptococci Isolated from Apical Infections,” The Journal of the American Dental Association, 13 (1926), p. 1227. 3. A. Black, G. V. Black’s Work on Operative Dentistry, vol. 1 (Chicago: Medico-Dental Publishing Company, 1936), p. 4. 4. Ibid. 5. H. Huggins, It’s All in Your Head (Garden City Park, NY: Avery Publishing Group, Inc., 1993), p. 46. 6. R. Borneman and L. Williams. “Histological Signs of Dental Ischemic Necrosis and Oteomyelitis Correlated with Clinical and Kinesiological Testing Indicators” (unpublished research findings from the Head and Neck Diagnostics of America Laboratory, Seattle, 1995-96). 7. H. Cotton, The Defective, Delinquent, and Insane (New York: Arno Press, 1980 [orig. pub. 1921]), p. 46. This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Winter 2011. Diet in Relation to Dental Caries Posted on February 16, 2016 by wapfadmin • 0 Comments PrintFriendly and PDFPrint - PDF - Email From the Archives Wise Traditions In this fascinating article, E V McCollum, a leading scientist of his day, sought to determine the cause of tooth decay. He notes that vitamins A and D help build strong enamel and teeth, and may provide certain immune factors, facts which he tries to meld with the theory that bacteria present in the mouth are the cause of decay. The description of the diet for diabetics is especially interesting—in the days before insulin, the only way to treat diabetes was with a high-fat diet—and this diet also protected these patients against tooth decay. McCollum prescribes such a diet as a sure way to prevent cavities, not because the high-fat diet provides protective vitamins, but because fats “coat the teeth” and thus protect them against bacteria! He also asserts, without evidence, that chewing helps strengthen the teeth. The article provides a good example of how even leading scientists have difficulty determining cause and effect. McCollum was a contemporary of Dr. Price. The article was published in Nature, January 25, 1941, Volume 147, pages 104-108. The carious lesion in a tooth is caused by acid decomposition of the enamel, and afterwards the dentine, associated with proteolytic destruction of the organic substance of the tooth. Caries of the teeth is restricted to man and other animals which eat liberally of carbohydrate-containing foods. Carnivorous man and animals do not suffer from this disease. Dental caries does not attack the surfaces of teeth indiscriminately, but occurs only at such sites as favour the lodgment of food residues, as in pits or fissures, or on surfaces of the enamel which harbor mucinous plaques. In such sites acid is formed by fermentation of carbohydrate by micro-organisms, and is protected against being washed away by saliva or by neutralization by salivary alkalinity. Throughout the Americas and Europe, and in most other temperate or torrid parts of the world, almost everyone eats liberally of carbohydrates, so the pabulum for feeding micro-organisms of every kind associated with fermentations is present in abundance at times in every mouth. Yet there is a great variation in the susceptibility of different people to dental caries. Numerous investigations have been devoted to attempts to discover why this great variation exists. Bunting and his associates, and Fosdick and his associates, have been foremost in studies of the microbiology of the oral cavity and its relation to caries of the teeth. A number of distinguished investigators have studied various aspects of the relation of the diet to susceptibility to this almost universal human affliction. I shall limit what I have to say to the nutritional aspects of this problem. TOOTH STRUCTURE IN RELATION TO DENTAL CARIES There is almost general agreement that potentially carious areas can be detected by a careful examination of the surfaces of the teeth. Dr. Thaddeus Hyatt, during his long tenure as chief of the dental clinic of the home office of the Metropolitan Life Insurance Company, directed his staff to explore the enamel surfaces thoroughly with a fine tine and when pits were found these were drilled and filled and the surfaces polished, thus eradicating potential food traps, or areas to produce later carious cavities. This system of caries prevention is known as prophylactic odontotomy, and has been found effective by others as a means of preventing the disease. It is fully established, therefore, that developmental defects in the enamel may predispose teeth to decay. FAULTY NUTRITION AND DEFECTIVE TOOTH STRUCTURE Experimental work with animals has shown clearly several ways in which dietary deficiencies during the period of tooth development can impair tooth structure. One of these is vitamin A deficiency. In deficiency of this nutrient the epithelia, no matter how they are specialized, as in mucous membranes, glandular secreting structures, and skin, suffer changes in structure and in loss of physiological function. Keratinization and desquamation of epithelia find their counterpart in the enamel-forming organ of the developing tooth, in changes in structure and partial or complete loss of function. The enamel-forming organ is of epithelial origin, being derived from embryonic gum tissue. Each cell of this organ secretes calcium, phosphate, fluoride, magnesium, and carbonate ions in such a way as to cause them to combine and deposit in the form of tenuous enamel prisms. These prisms form a mosaic, which, in the normal tooth, is of great perfection. When, owing to vitamin A deficiency, the enamel-forming cells are injured, prisms which are less dense than normal, or incomplete as to length, and imperfectly fitted together, form defective enamel. In the milder grades of this type there are pits in the enamel. In more severe grades of injury, the surface of the enamel of the greater part of the whole of the tooth may be rough, the enamel thin and deficient in hardness. This is the hypoplastic tooth. A second situation which may cause defective enameling of the teeth is that seen in the disturbance of calcium and phosphate metabolism seen in the ricketic state. When the diet is complete as regards vitamin A and all other factors which are concerned with the promotion of healthy development, except vitamin D, the enamel-forming organ may be normal in every way, but be unable to withdraw from the blood the necessary structural materials for the formation of normal enamel. In rickets the concentration of phosphate ions in the blood falls below normal, and this interferes with the formation of sound enamel because the solution from which the cells derive their substances is too dilute. Defects of enamel having their origin in disturbance of calcium and phosphorus metabolism have been most thoroughly studied by Lady Mellanby. She drew the conclusion from her observations that deficiency of vitamin D is of primary significance in predisposing teeth to caries susceptibility. The phosphate ion of the blood is maintained at normal concentration by the provision of this vitamin and, in addition to preventing defective bone growth, likewise has an important role in safeguarding the developing teeth against defects of structure. Lady Mellanby reported extensive experiments with children in Sheffield and Birmingham, all of whom were fed alike. To groups of these she gave generous prophylactic doses of vitamin D over a considerable period, and found that the incidence of dental caries was much lower in these groups than in the controls not receiving the vitamin. She expressed the belief that a diet highly favourable to normal calcification of bones and teeth could in considerable measure lessen the incidence of tooth decay. McBeath, of New York, has carried out experimental studies with large numbers of school children over a period of several years, along the lines laid down by Lady Mellanby. He finds that there is a seasonal incidence of dental caries, the highest incidence of new cavities occurring in late winter and spring, and the lowest in summer and autumn. These observations he correlates with the amount of ultra-violet light which the children receive at different seasons. He further found that when liberal daily doses of vitamin D were given children during the colder months, the seasonal curve of incidence is flattened out, the incidence during the months of low sunshine being closely similar to that of summer and autumn. This type of experiment places vitamin D, for which suitable doses of ultra-violet light is the equivalent, in the position of playing a significant part in influencing the susceptibility of the individual to dental caries. It is difficult to see how vitamin D can protect the teeth against decay merely by maintaining the body in a state favourable to calcification. Caries of the teeth occurs as the result of highly localized processes. In an area of stagnating food residues, acid is formed and protected against removal or neutralization, and is able to act more or less continuously in dissolving enamel. There appears to be no possible mechanism for resistance to acid erosion by enamel other than its density, which can be of but minor importance since the most perfect enamel is dissolved by acid when the pH reaches about 4.6, and the quality of enamel is not modified by any known agency after it is once laid down. If it is confirmed that sufficient ultra-violet light or if vitamin D favourably influences the body in its power to resist dental caries, it would seem that we must seek for an explanation in some effect upon the immunological mechanisms, which are of a nature to suppress the growth or functions of the microbial flora ordinarily associated with acid formation in the mouth. This might be exercised through the saliva or mucus, or other agency possessed by the epithelia. There do not appear to have been any studies recorded to test whether ultra-violet rays or vitamin D administration modify the oral flora. That an immunity to dental caries may be artificially induced is suggested by the success of Bunting and Jay in preparing a vaccine from cultures of Lactobacillus acidophilus which they isolated from carious cavities. Upon intradermal inoculation of caries-susceptible persons there was a cutaneous reaction in nearly all cases, and when the test was applied to a series of caries-immune subjects, the skin reaction was almost always negative. There are in the population a considerable number of people who apparently eat as wide a variety as do most of us, and certainly eat freely of some form of carbohydrate, yet are caries-immune or nearly so. Some are immune to caries of the teeth during a period of years and then become susceptible. There seems much reason to attribute such immunity to a systemic condition of some kind, and the most plausible explanation would seem to be an immunological one—the offending organisms find the mouth environment unfavourable because of the presence of something detrimental, and this something seems to be the product of the living tissues or glands accessory to the mouth. EFFECTS OF EATING SUGAR ON CARIES INCIDENCE The eating of sugar and sweets has long been popularly believed to cause the teeth to decay. This view is supported by the observations of Bunting and his co-workers, who, by means of dietary control, reduced the incidence of dental caries in an orphanage to a very low level. Upon permitting a group of children, whose mouths were free or nearly so of Lactobacillus acidophilus, and who were classed as caries-immune, to eat about three pounds of candy per week, they found that they soon became caries-susceptible, and that the oral environment returned to the caries-producing type. It is difficult to explain why eating sugar should be more likely to induce dental caries than cooked starch. Sugar is so easily soluble that it tends to be swallowed promptly as fresh quantities of saliva are secreted. Cooked starch, on the other hand, is pasty and is easily lodged in pits and fissures. Mixed with saliva and acid-forming organisms, starch would continuously undergo diastatic conversion into maltose, a fermentable sugar, thus furnishing an uninterrupted supply of nutriment for acid formation. Yet it is concluded by Bunting that this is not the case. Human experience confirms the findings of Bunting that people may eat freely of starchy foods and yet remain free from dental caries, or nearly so. An example are the people of the Island of Tristan da Cuhna, who consume potatoes as a staple food. The primitive Pacific Islanders, before the era of exploration, ate largely of starchy foods, yet they were almost free from dental caries. Sugar, therefore, seems on the basis of scientific observations now available, to be far more of a menace to the health of the teeth than are the starchy foods. A dietary study of outstanding interest in relation to the caries problem was reported in 1926 and 1928 by Bodd and Drain, of the University of Iowa. They made repeated routine examinations of the teeth of the patients in the pediatric clinic over a period of some years, and encountered many teeth which had large cavities, which ordinarily, would have an area of softened dentine surrounding the zone of destruction, but in these patients were found to have uncommonly dense and hard dentine walling off the cavities and arresting the progress of the carious processes. These cases of arrested caries, in which a secondary deposit of dentine had occurred, which formed an effective barrier against further invasion of the tooth, were found to be without exception diabetic patients. The arrest of dental caries appeared to have occurred as the result of their having been restricted to the low-carbohydrate high-fat type of diet now generally used by diabetic patients. This type of diet does not seem to have been further studied as a means of controlling dental caries, and is worthy of most careful consideration. If replacement of a considerable fraction of the carbohydrate moiety in our daily diets by fat will protect the population in great measure against dental caries, the fact should be made known, and such a diet recommended for non-diabetics. But human experience appears to afford fairly numerous examples of peoples who in great measure escaped the ravages of dental caries, who did not eat low-carbohydrate highfat diets. Chinese students in America appear to have a lower incidence of caries of the teeth than do persons of similar ages who have grown up in America. I have been repeatedly told by Chinese students that they experienced markedly increased incidence of tooth decay after spending a few years in the United States. The great majority of Chinese people have from very early times eaten freely of starch-rich vegetable foods. They eat various vegetable foods which have a detergent action on the teeth, which may be a factor of considerable importance in preventing stagnation areas. Experimental studies on the effects of deficiency of ascorbic acid (vitamin C) on the teeth indicate that the dentine-forming organ, the odontoblastic membrane, is peculiarly susceptible to injury in this deficiency state. The odontoblastic membrane lines the pulp cavity, and from its cell filaments (Tomes fibrils) permeate the dentinal tubules, which permeate the dentine to the base of the enamel. It seems certain that it is through the functioning of these fibrils that secondary dentine can be laid down near the outer border of dentine whenever irritation arises. This is a peculiar repair process, which, when the state of nutrition is near the optimum for calcification, can be called into being so as to arrest caries by a walling-off process. In this respect the perfection of function of the odontoblasts, which is influenced profoundly by the ascorbic acid supply, becomes an agency in the prevention of the extension of dental caries, but not of its incidence. The fact which has been thoroughly established by the work of Bunting with institutional groups of children, all of whom were provided with the same food, is that there are individuals in whose mouths Lactobacillus acidophilus grows profusely, and forms the principal flora, whereas the mouths of other individuals contain principally organisms of other types. This would seem to demonstrate that the character of the oral flora depends greatly on conditions other than the character of the food eaten day by day, especially when a mixed diet, affording a fairly wide variety, is eaten. The most plausible explanation for the observed facts would seem to be found in the humoral defence mechanisms of the mucous surfaces, the mucous secretions of the saliva. We have one outstanding example of the relation between the state of nutrition and the character of the oral flora. At one time it seemed that Chittenden and associates at Yale University, and also Goldberger, in Washington, were dealing with the same state of malnutrition in their experimental dogs, both believing that the condition produced by their different faulty diets was the analogue of human pellagra. At Yale the dogs were cured by the administration of butter or boiled carrots, both of which are sources of vitamin A. At Washington what appeared to be the same disease could not be cured by butter or carrots, but responded well to yeast administration, which did the dogs no good. In 1937 Smith and his co-workers at Duke University repeated both experiments and found that in the one case the dogs were in a severe state of vitamin A deficiency, and in the other of nicotinic acid deficiency. In both cases the earlier experiments had depended greatly on the mouth condition for making their diagnosis. The oral flora in both groups of animals was of the fusospirochaetal type seen in Vincent’s angina. This is an abnormal and pathological mouth flora, and overgrows the oral cavity when the tissues are debilitated. It appeared in the dogs as the result of two quite distinct types of malnutritional deficiency states. In these two conditions the overgrowth of the mouth by a pathological flora would seem to be best explained on the basis of a lack of some humoral factor or factors which the normal mouth contains, and which serves to suppress the growth of certain abnormal types of micro-organisms. Perhaps the decided differences in the oral cultures found in many individuals may be accounted for on the same basis, namely, the failure of the oral structures to produce some humoral factor of immunological significance. The recorded experimental data seem to warrant the acceptance of the following conclusions: If the nutrition of the individual is optimal during the development period of the teeth, their structure will be safeguarded, and freedom from structural defects such as pits, fissures, hypoplastic enamel, may be expected. It would seem that dense, thick, hard enamel must afford some degree of protection against dental caries. A state of optimum nutrition appears to afford marked protection against dental caries. It seems certain that such protection is in considerable measure due to some property of the mucous secretions or of the saliva or both, which tends to suppress the growth or functions of microorganisms whose presence in large numbers would be inimical to the health of the teeth. Subsistence throughout life on a strictly carnivorous diet will prevent dental caries. This would be impractical in most parts of the world, and if practicable, would be less satisfying than is a mixed diet. The presence of considerable carbohydrate in the diet is necessary for the development of carious teeth. There seems to be good evidence in support of the view that the regular consumption of a diet in which all the essential nutrients are present in adequate amounts, and in which the ratio of fatty acids to total carbohydrates (including the sugar which may arise from protein and glycerol) is not less than 1.5:1, prevents dental caries. This is equivalent to saying that a diet suitable for the diabetic is so constituted as to afford protection against dental caries, and even makes possible the arrest of the carious process in open cavities. This protective action of excessive fat in the diet may possibly be due to greasing the tooth surface and the cavity surface, thus waterproofing it and preventing access of water-soluble acids (for example, lactic acid) to the enamel surface. There seems to be good evidence that the elimination of sugar from the diet, and the provision of carbohydrate in the form of starch, affords a less favourable oral medium for the development of acid-forming organisms, and so protects the teeth against acid decomposition. It appears probable that the provision of an abundance of vitamin D, either taken directly, or derived from the action of ultra-violet rays on the skin, exerts a favourable action on the immunological mechanisms in the oral secretions or on the epithelia of the mouth, and makes for preventing the growth of excessive numbers of acid-forming organisms. The dentist can supplement the protection against dental caries which right eating can give, by early eradication of potential sites of decay. The food should always supply certain things which require vigorous chewing, since teeth which are not exercised do not retain optimum health. Every meal should end with some food such as raw fruit or a raw vegetable, which requires thorough mastication, both because of the exercise afforded the teeth, and for the detergent effect of chewing foods which do not have a tendency to adhere to the enamel surface. This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Winter 2015 The Invisible Toothbrush Posted on March 30, 2001 by Emmanuel Cheraskin, MD, DMD • 0 Comments PrintFriendly and PDFPrint - PDF - Email One of the many risk factors for heart disease is poor dental health. The root cause for both diseases is probably the same–nutritional deficiencies, including deficiency of vitamin C. In this article, Dr. Emmanuel Cheraskin presents evidence that serum vitamin C levels are just as important as brushing for the prevention of tooth decay. His research also explains why primitive peoples on nutrient-dense diets have no tooth decay, in spite of the fact that they do not brush their teeth. A long time ago, President Harry S. Truman was asked the question, “What’s new?” His response, “If you never heard it before, regardless of how old it is, it’s new!” Utilizing the Truman benchmark, several points are obvious. First, the present notion that dental accumulations–stuff like plaque and scum that gets on your teeth–contribute to dental diseases and that these collections can be mechanically removed is not only old but generally conceded. What is also not new, as far as the published literature is concerned, is that there are nonmechanical contributions to the common dental diseases. Many of the reports are 30 to 40 years old. Some of them are quite recent, particularly the innovative discussions by Nigel Clarke and his associate in Australia. However, what is really new and emphasized in this report, is that the accumulations in themselves may be due to the absence of an invisible toothbrush. The whodunit may well be hypoascorbemia–low levels of vitamin C! Obviously this is a relatively new thought and requires further study. And, by the way, vitamin C serves many other functions. It is well-documented as an electron donor and impressive scavenger; it plays important roles in protecting the capillaries from fragility and permeability; it is extraordinary for wound healing, and much, much more. So, providing the ascorbates may add a bonus to improved oral health. . . by contributing to general well-being! Some Facts Let’s start with three inescapable facts: 1.The principal site for chronic disease is the mouth, even in this day and age. 2.Ninety-five percent of the civilized population suffers with tooth decay and/or periodontal disease. 3.Judged by our current successes and failures, the present explanations and solutions are filled with contradictions. For example, more brushing and flossing doesn’t necessarily guarantee less disease. The National Institutes of Health (NIH)1 and other authorities, as we shall learn, argue that oral pathosis is a multifactorial problem. They identify three essential ingredients: (1) a critical microbial population, (2) appropriate diet and (3) a susceptible state, as shown in Figure 1. (These three factors apply equally to periodontal disease.) The figure implies that all three factors must be present for tooth decay to develop and that if even one of these three variables is absent, then pathosis does not occur. Figure 1 tooth decay=susceptible tooth+bacteria+sugar hi-toothbrush1 U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service, National Institutes of Health NIH Publication No. 80-1146 Be that as it may, researchers have focussed principally on the role of diet and microorganisms; only scant attention has been accorded the resistance/susceptibility factor. And, when researchers do consider the susceptibility factor, they usually speak of susceptibility and genetics as synonymous. This report will examine one aspect of the susceptibility factor, with emphasis on the measurability of tissue tolerance in oral pathosis. Specifically, we shall devote our attention to the question, “Can you get away with brushing your teeth less?” A Different Look at Mr. And Mrs. America We conducted a study that involved two hundred presumably healthy middle income Caucasians (with the usual mouth problems of dental caries and/or periodontal disease).2 To quantitate tooth cleansing, we chose the most simple arbitrary measurable system. Each subject was questioned regarding the frequency of toothbrushing. It was convenient to divide the participants into three groups, those with less than twice (n=71), those who brushed twice per day (n=95), and those who brushed more than two times daily (n=34). To assess tooth cleanliness we utilized a simple, popular and easy grading of foreign material called the Debris Score. In this study, we looked at only one measure of susceptibility, the fasting plasma ascorbic acid concentration. Our reason for focussing on the ascorbates is the fact that in some subsets of the general population suboptimal vitamin C state is as high as 100 percent.3 Additionally, we have studied vitamin C deficiency in dental patients and discovered that up to 72 percent may be hypoascorbemic.4 The Traditional Confirmation The most often asked question is, “How effective is toothbrushing?” In other words, “What’s the connection between debris (oral cleanliness) and toothbrushing habits?” hi-toothbrush2Figure 2 shows the frequency of daily toothbrushing by study participants on the horizontal axis and the mean debris scores on the vertical. Not surprisingly, those brushing least had the greatest accumulations of debris while the group that did the most toothbrushing had the least amount of debris. Thus, to answer the first question, there does indeed appear to be a convincing relationship between tooth cleansing (toothbrushing frequency) and tooth cleanliness (debris score). These observations support the current dental philosophy of the importance of local and mechanical factors in periodontal health and sickness. However, although the correlation coefficient was statistically significant (r=-0.265, p<0.01) it was not perfect. This suggests the possibility that other factors may be operative. A Second Opinion Turn on the television and within minutes, you are likely to hear about a newfangled vitamin-stuffed cereal. Tune in the radio and discover that we now have fiber in convenience foods. All of this stems from the well-established fact that vitamins and minerals influence every cell, tissue, organ and site in the human system. It figures, therefore, that the mouth should also be part of the story. What is the connection between nutrition and susceptibility to oral disease? In other words, the query now to be posed is, “Can we alter oral debris by changing vitamin state?” Our personal experience has been quite extensive with ascorbic acid.5-7 So, for purposes of this experiment, we pose the question thus: “What is the correlation of vitamin-C status and oral cleanliness without altering the usual oral cleansing habits?” hi-toothbrush3Figure 3 pictorially portrays the plasma ascorbic acid levels in the study participants on the x-axis. The 200 subjects were arbitrarily divided into three near-equal subsets. There were 68 with the poorest ascorbate levels, ranging from 0.0 to 0.4. Sixty-seven showed the best vitamin C levels (0.8 to 1.3) and 65 had average vitamin C levels (0.4-0.7). The average debris scores are shown on the y-axis. Note that those with the poorest ascorbic acid levels had the most debris while the group with the best ascorbate state had the least accumulations. The correlation is statistically significant (r=-0.210, p<0.01), very much like that shown in Figure 2, and also not perfect. Therefore, within the limits of these data, there appears to be a very real correlation between vitamin C state (as a possible nonmechanical contributor) and debris, irrespective of tooth cleansing habits. The Current Ecologic Thinking What we have shown thus far (Figures 2 and 3) is actually an analysis of a series of surreal events. In the real world, people who do or do not clean their mouth also do or do not ingest ascorbates. Thus we need to determine whether the accumulations are the result of how much one brushes or how much vitamin C is ingested. hi-toothbrush4Figure 4 depicts the frequency of daily toothbrushing on the x-axis and the average debris scores on the y-axis. This time the 200 subjects were divided into two equal subgroups. The 100 subjects with the relatively poorer plasma ascorbic acid levels (less than 0.6 mg%) are shown by the black columns; the other 100 with the better vitamin C status (greater than 0.6 mg%) are shown by the gray columns. Note that in those showing the lower (poorer) plasma ascorbic acid scores, there’s an obvious inverse relationship. In other words, and not surprisingly, the greater the toothbrushing frequency, the less the debris (0.87). This has already been demonstrated (Figure 2). It is also statistically confirmed (r=-0.337, p0.05). Here is part of the explanation for the well-known fact that some of us need to brush our teeth less than others. Summary and Conclusions The centerpiece for stomatology–the medical study of the physiology and pathology of the mouth–is cleanness. Thus, we are told that good cleansing habits will result in good oral hygiene (cleanliness) and poor cleansing habits will result in poor cleanliness. It is evident that plaque material may be removed from the tooth surface with effective mechanical cleansing techniques as shown in the literature8 and earlier in this report (Figure 2). Hence, the interface structures, that is the teeth, may, with proper instruction, be altered through a change in the external world (toothbrushing, flossing, irrigation). Much less clearly understood is the importance of the inner world, namely gingival tissue metabolism, to foreign and external accumulations. In the past, plaque has been regarded as inert matter. Now it is recognized that this so-called debris is a microcosm containing myriads of living neutrophils and other formed elements. Its environs are remarkably similar to human blood and tissue fluid.9 As such, it should–and does–reflect metabolic changes within the host tissues. Viewed in this perspective, the role of the organism’s metabolic status as a possible contributor to plaque formation becomes more understandable. The findings of this investigation, as represented in Figure 3, suggest that plaque is indeed also related to the internal milieu as judged by vitamin C metabolism. In other words, this can be viewed as a demonstration of nonmechanical brushing–an invisible toothbrush. These findings are consistent with other published reports of nutrient-debris relationships. For example, Coven10 has reported a significant connection between gingival ascorbic acid and debris score in children. Another study11 found marked differences in foreign accumulations between Adventist and non-Adventist teenagers. The authors concluded that they were related to diet and not to differences in brushing frequency. It has also been confirmed by Mandel that the plaque represents the initial phase in calculus formation.12 Obviously, cause and effect can be more convincingly imputed from clinical trials. One such study13 reported a resolution of materia alba, calculus and stain when 500 mg of ascorbic acid was daily administered for 90 days to 35 mentally retarded boys. Dusterwinkel, et al14 and Lane and his associates15 reported reducing debris scores significantly with multivitamin and mineral supplementation. Notwithstanding, even in this day and age, it is still materially held that the only solution to plaque control is to remove it mechanically.16-17 If nutrients are determinants of plaque, as the present investigation and other studies suggest, this concept may be incomplete. The need for further investigation of nutritional approaches to oral hygiene (tooth cleanliness) would thus seem to be appropriate. Viewing brushing frequency-debris score relationships, as influenced by ascorbic acid status (Figure 4), provides additional insights into plaque prevention and control. At all levels of brushing frequency, those with the better plasma ascorbic acid levels exhibit cleaner teeth. In fact, the average debris score (0.92) for those who brush less than twice daily but have better vitamin C levels compares favorably with that of the poorer C subjects who brush twice or more daily (0.90 and 0.87). The key fact underscored in this investigation is not the existence of one particular nutrient-plaque relationship, but the need to completely reevaluate existing concepts of oral hygiene (tooth cleanliness). The philosophic considerations and the practical implications of the ecology of oral health and sickness not only continues but seems to intensify. This is superbly borne out in the citations by Nigel Clarke and his co-worker:19 “Some individuals experience severe inflammation to minimal plaque, whereas others have minimal inflammation to heavy plaque….Whether these variations occur as a result of differences in host response or in virulence of the microbes is undetermined; however, the probabilities point to host factors rather than to microbes….Periodontal disease has long been recognized as a chronic disease, but the literature describes a disease that is derived entirely from the effects of a microbial colonization of the gingival crevice. If this were so, it would mean that periodontal disease is unique among chronic diseases, all of which represent the long-term cumulative effects of interaction between a host biologic system and the surrounding environment….Perhaps dentistry has lost the perspective between the oral tissues and the entire organism…” Additionally, we note the interest of these Australian investigators in the relationship of ecological principles to the specifics of oral disease. This is emphasized in the following quotation: “[There is a possible] causal role for the host factors and [there is the suggestion] that the type and severity of periodontal disease(s) are reflections of the competence of the host defense rather than of the virulence of commensal oral organisms. . . [It can be] postulated that chronic periodontal disease results when environmental factors, specifically those that compromise the peripheral blood supply, disturb the delicate balance between host and parasite in favor of the parasite…” Finally, the importance of ascorbates is also emphasized as one of a number of contributing factors to the genesis of periodontal pathosis: “…It has been established that 20 percent of gingival collagen is turned over daily….Fibroblasts require ascorbate to produce collagen. Hence, the high turnover of gingival collagen probably renders gingival remodeling and repair particularly vulnerable to ascorbate deficiency. Vitamin C is also required by polymorphs in their vital defense role. “The phagocytic and chemotactic functions of the white cells require vitamin C concentration within the cell…Although debate continues concerning the required plasma ascorbate levels, it appears likely that the demand for ascorbates and essential metabolites for defense and repair of gingival tissue may be met in the presence of chronic inflammation, smoking, stress, inadequate diet, aging, or any other vaso-constrictive factors…” It should be emphasized that we have lots of data about vitamin C because we have studied the ascorbates extensively. What the results would be depending upon other vitamins, as well as other dosages in terms of host resistance and susceptibility, is an unanswered question. Nevertheless, the fact of the matter is that vitamin C can serve as an invisible toothbrush. Sources of Vitamin C In milligrams (mg) per 100 grams Acerola berries 1300 Peppers, red chile 369 Guavas 242 Peppers, red sweet 204 Leafy green vegetables 50-180 Parsley 172 Peppers, green sweet 128 Broccoli 113 Brussels Sprouts 102 Watercress 79 Cauliflower 78 Persimmons 66 Cabbage, red 61 Strawberies 59 Papayas 56 Oranges & juice 50 Cabbage, green 24 Lemon juice 23 Liver, calf 36 Note: Hunter-gatherers obtained vitamin C from certain organ meats, such as adrenal glands and parts of the stomach. Many wild fruits and vegetables have much higher levels of vitamin C than those that are cultivated. Sidebar NATURAL VERSUS SYNTHETIC VITAMIN C By Thomas Cowan, MD It is common these days to use the terms vitamin C interchangeably with ascorbic acid. In fact, there are numerous differences between these two very distinct biological entities. Vitamin C, found in numerous plant and animal foods, is a necessary nutrient for humans in that we make none of our own vitamin C. Natural vitamin C is a complex mixture of at least 9 or 10 distinct molecular entities. These include ascorbic acid (the preservative part of the complex), tyrosinase (an enzyme), rutin, bioflavenoids, copper, manganese, and other enzymes and minerals. Each of these compounds has a synergistic effect with the other substances, the end result being a potent and complicated compound that has far-reaching biological effects. Some of these effects include reducing capillary fragility (thus reducing the tendency to bruising or bleeding), improving the integrity of the collagen fibers, binding and thereby neutralizing histamine (lessening allergies), and many other vital functions. Ascorbic acid has only one effect, that is anti-oxidation. While many nutritionists and physicians sing the praises of anti-oxidants in our diet, the fact is that excessive anti-oxidation inhibits our cellular mechanisms from digesting and disposing of unwanted tissue. This is perhaps why the latest studies on excessive use of ascorbic acid show that it may contribute to the development of coronary artery disease. This situation would never arise from the use of the whole vitamin C complex as found in natural foods. References 1.National Institutes of Health Brochure No. 80-1146, Bethesda, U. S. Department of Health and Human Services. 2.Clark, J.W., Cheraskin, E. and Ringsdorf, W.M., Jr. An Ecologic Study of Oral Hygiene. Journal of Periodontology/Periodontics 40: #8, 476-480, August 1969. 3.Schorah, C. J.Vitamin C Status in Population Groups. IN: Counsell, J.N. and Hornig, D.H. Vitamin C (Ascorbic Acid)1981.Englewood, Applied Science Publishers. 4.Cheraskin, E. and Ringsdorf, W.M., Jr.Vitamin C State in a Dental School Patient Population. Journal of the Southern California State Dental Association 32: #10,375-378, October 1964. 5.Cheraskin, E., Ringsdorf, W.M. Jr. and Sisley, E.L. The Vitamin C Connection 1983.New York, Harper and Row Publishers, Inc. (hardback) 1984. New York, Bantam Books, Inc. (paperback). 6.Cheraskin, E.The Vitamin C Controversy: Questions and Answers. 1988.Wichita, BioCommunications Press. 7.Cheraskin, E.Vitamin C…Who Needs It?1993.Birmingham, Arlington Press 8.Arnim, S.S.Thoughts Concerning Cause, Pathogenesis, Treatment and Prevention of Periodontal Disease. Journal of Periodontology 29: #3, 217-223. July 1958. 9.Arnim, S.S.Microcosms of the Mouth – Role in Periodontal Disease. Texas Dental Journal 82: #3, 4-10, March 1964. 10.Coven, E.M.Relationship of Vitamin C State and Oral Health of a Pedodontic Group in a Prepayment Program. Industrial Medicine and Surgery 24: #5, 410-412, May 1965. 11.Holmes, C.B. and Collier, D.Periodontal Disease, Dental Caries, Oral Hygiene and Diet in Adventist and Other Teenagers. Journal of Periodontology 37: #2, 100- 107, March-April 1966. 12.Mandel I.D.Histochemical and Biochemical Aspects of Calculus Formation. Periodontics 1: #2, 43-52, March-April 1963. 13.Cohen, M.M.The Effect of Large Doses of Ascorbic Acid on Gingival Tissues at Puberty. Journal of Dental Research 34: #5, 750-751, October 1955. 14.Dusterwinkle, S., Cheraskin, E. and Ringsdorf, W.M., Jr. Tissue Tolerance to Orthodontic Banding: A Study in Multivitamin-Trace Mineral Supplementation. Journal of Periodontology 37: #2, 132-145, March-April 1966. 15.Lane, W.B., Nutrition and Oral Response to Orthodontic Banding. University of Alabama School of Dentistry Thesis, August 1968. 16.Waerhaug, J.Current Basis for Prevention of Periodontal Disease. International Dental Journal 17: #2, 267-281, June 1967. 17.Greene, J.C.Oral Health Care for the Prevention and Control of Periodontal Disease-Review of the Literature. World Workshop in Periodontics 1966. Ann Arbor, University of Michigan Press, pp. 397-455. 18.Waerhaug, J.Epidemiology of Periodontal Disease – Review of the Literature.World Workshop in Periodontics 1966. Ann Arbor, University of Michigan Press, pp.181-222. 19.Clarke, N.G. and Carey, S.E.Etiology of Chronic Periodontal Disease: An alternative Perspective. Journal of the American Dental Association 110: #5, 689–691, May