"The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease." - Thomas A. Edison

Peter Varley BDSc, FDSRCS, DFHom(Dent.)and Ron Ehrlich BDS (profile)

Introduction

Nutrition is a new science and there is still discussion about which foods we should eat and in which combinations for maximum benefit. There are many theories about diet and many of these are frequently revised.

The mouth is the first part of the digestive process and dentists are perfectly placed to advise what should be consumed and monitor it through their regular contact with their patients. The potential to improve the individual's health and that of society as a whole is enormous.

The advisability of the use of vitamin and mineral supplements can cause confusion and it is important to realise that Recommended Dietary Allowance (RDA) more often refers to the prevention of dietary deficiency disease rather than the achievement of optimal health. This explains the sometimes ten fold difference between the RDA and a therapeutic dose.

Nutrition and General Health

Therapeutic vs Prophylactic Nutrition

One should consider the difference between therapeutic and prophylactic nutrition. Therapeutic nutrition is treating individuals who have specific medically related problems. Prophylactic nutrition designed to maintain optimal health.

Maintaining optimal health

May be summarised by following the basic principles that the food we eat should be:

• whole fresh food eg, whole grains, brown rice.
• complex carbohydrates i.e. fruits, vegetables.
• low fat, not just cholesterol free.
• free of artificial colouring, preservatives, salt or sugar.
• preferably eaten raw.

Such a diet enhances our immune system, thereby reducing our susceptibility to disease and helping us to achieve optimal health.

Treating a Health Problem

When treating a health problem we must first eliminate those foods to which the patient is intolerant and then provide, if necessary, therapeutic doses of any supplements that are lacking.

The best way to assess those foods to which the patient is intolerant is to carry out the Basic Diet Experiment.¹. The thinking behind diet is that we are all unique biochemically and what is good for most people may not be good for an individual.

Nutrition and Oral Health

Nutrition for oral health is no different to nutrition for general health. It is important to realise that oral health reflects the impact that poor nutrition has on our health in general. In the 1930's Dr Weston Price² travelled the world living with and studying isolated peoples, their diets and conducting testing to determine the deterioration that occurred (physical, social and psychological) after they adopted a modern western diet. Millions of dollars are now funding medical research to find the cause of diseases that Price so conclusively demonstrated were the result of nutritional deficiency.

Price studied and compared isolated and modernised communities. He found that on a natural ancestral diet the incidence of dental decay affected a very small proportion of the population while a modern diet high in refined carbohydrate increased the incidence of tooth decay dramatically.

Table 2: Summary of DR Weston Price's finding on the effect on tooth decay comparing isolated and modernised communities.

Community	Community isolated - decay rate per hundred teeth examined	Community modernised - decay rate per hundred teeth examined
Switzerland	2.3	20.2
New Caledonia	0.14	26
Fiji	0.42	30.1
Polynesia	0.6	33.4
African tribes	0-0.6	12.1
NZ Maori	0.76	95

Not only did Price link tooth decay to poor nutrition but also showed that in a natural ancestral diet jaws are well formed without significant crowding yet within one generation of eating a modernised diet dental crowding and malocclusion were widespread.

Tooth Decay

The relationship between diet and decay is well established with the frequency of consumption of refined carbohydrate (sugar) being a critical factor. Most attention has focused on the intake of sucrose and its relationship to the incidence of decay. Diet may affect caries either by:⁴

• altering the structure and resistance of the tooth during its development and immediately after eruption.
• changing the environment and influencing bacterial attack through sugar intake.

More recently Leonora et al^5-7 suggested that rather than being just a local effect of sugar on tooth structure, there is also a systemic effect. There is a fluid flow through the tooth. In people resistant to dental decay it is from the pulp through the dentine and then through the enamel.

The direction of flow is under the control of the hypothalamus. This produces a parotid hormone-releasing factor which allows the parotid gland to produce a hormone which controls the direction of fluid flow in the tooth. With adequate parotid hormone the fluid flows from inside the tooth out. With the ingestion of sugar the parotid hormone is suppressed and flow is reversed, possibly resulting in decay.

Periodontal Disease

Classically gum disease is thought of as an imbalance in host-parasite relationship. There are of course two sides to this equation with the majority of treatment centring on the removal of plaque (the parasite) to treat gum problems. Needless to say it would be dental heresy to suggest that plaque control is not the most appropriate course of treatment. There is however the host to consider.

     Diet is the most logical way of optimising our health, improving the quality of our tissues on a cellular level, their ability to regenerate and repair, and generally bolstering our immune system.

Of particular importance for periodontal health is vitamin C because of its necessity in maintaining collagen as an essential part of cell walls. Coenzyme Q10 is a substance involved in electron transport in mitochondria, the power packs of cells. It has some chemical characteristics similar to vitamin E and is found in a wide range of food. Research has suggested that topical application of Coenzyme Q10 improves adult periodontitis not only as a sole treatment but also in combination with plaque control. A more traditional view questions the experimental technique and conclusions of some of the research.

Nutritional Support for Mercury Toxicity

For those embarking on amalgam removal and undergoing a subsequent detoxification programme some suggested nutritional protocols are outlined below.

Pre treatment

Supplementation should be commenced 2 weeks prior to the first appointment and continued for 2-3 months after the last appointment. The purpose of supplementation is as follows:

• to condition the cell membrane so that toxic metals may be more easily removed from the internal parts of the cell as well as from the cell surface.
• to break the binding of proteins from protein-mercury compounds.
• to release mercury from these compounds.
• to provide a transportation link (usually to sulphur) to carry mercury away for excretion.

The greatest exposure to mercury occurs when the material is placed and when it is removed. Removal needs to be done carefully under rubber dam and supported nutritionally. There are a range of supplements that could be considered, depending on the patient's health when amalgam removal is undertaken.

Detoxification

The body's ability to rid itself of a toxic substance such as mercury is dependent upon:

• mobilisation of that substance which is bound in the cells of tissues and organs.
• proper liver function.
• excretion through the kidneys via the urine.
• elimination in the stool via the bile.

In the liver, detoxification includes two general phases:

1. Phase I - cytochrome enzymes act to oxidise, reduce or hydrolyse. These forms can then be excreted.
2. Phase II - conjugation enzymes convert toxins to water soluble form for excretion or elimination.

These phases may be enhanced, depending upon the availability of critical rate-limiting nutrients. The importance of optimal gut barrier function is critical. The importance of an optimal diet cannot be overstated. There is a strong inter-relationship between diet and stress affecting gut barrier failure and the liver's ability to effectively detoxify the body. One of the causes of gut barrier failure is diet.

Diet

A poor diet can cause irritation and/or inflammation of the mucosal epithelial cells leading to increased permeability, decreased enzyme and lysosomal activity, atrophy and malabsorption. This results in:

• malnutrition deficiencies.
• food and chemical allergy/intolerance.
• microbial imbalance.

Chelating Agents

Mercury has a special affinity for enzymes with a suphhydryl protein component. These enzymes are involved in intracellular respiration, free radical scavenging and detoxification. The use of chelating agents, particularly the sulphur-containing amino acids, attempts to support the detoxification process by binding to the mercury. To remove mercury from the tissues the chelator must bind it more strongly than any substance already present in the body. In addition, the chelator must not remove metals from the enzymes which require them to function properly.

Nutritional Support for Temporo-Mandibular Dysfunction(TMD)

As dentists we must not only be aware of how to support the jaw with occlusal therapy but must also be aware of the bigger picture and advise our patients how to optimise their health and healing capabilities.

The problem of food allergies is important in the treatment of chronic pain of musculoskeletal origin. Pain is contingent on activation of the nociceptive system. One of the most potent chemical mediators of the nociceptive system is histamine. Food allergies or intolerances can result in the production of histamine and may be a basic point that is frequently overlooked. Allergies or intolerances will also effect the absorption and utilisation of essential nutrients. The basic diet experiment involves food that is simple and wholesome. Incorporating a simple elimination diet under the guidance of a nutritionist may identify an underlying problem which is often overlooked.

There are two programmes to consider in the nutritional support of TMD:

1. to facilitate healing of the soft tissue lesions.
2. to minimise exposure to histamine by reducing the exposure to food sensitivities.

Healing Through Nutrition

In order to facilitate healing, optimal nutrition is an excellent starting point, particularly in conjunction with structural work on soft tissues. The priority at this stage is to improve the function of the gut barrier. The two factors that influence gut barrier are diet and stress. Improvement in function of the gut barrier can be initiated by The Basic Diet Experiment.¹

Food Sensitivity

To minimise the patient's exposure to histamine in the tissues it is necessary to test for food sensitivities.

Food Sensitivity Testing Instructions

After completing the 10 day Basic Diet Experiment, the patient will be able to test for body and brain sensitivities to the 11 foods restricted during the diet test.

The main value of the Basic Diet Experiment is that it helps patients learn what is best for their individual body. What is good for most people may not be good for the patient personally.

Conclusion

Nutrition is critical to our general health. Dentistry deals with aspects of health which range from the basics of tooth decay and health of the gums to nutritional support associated with mercury toxicity and chelation therapy. The dentist's involvement in jaw dysfunction which is an integral part of chronic head and neck pain raises the issue of nutritional support to facilitate healing of muscle lesions and joint structure.

Dentists are well placed to provide ongoing nutritional advice and support. They see their patients on a regular basis and are helping to maintain the first part of the digestive tract so it seems perfectly reasonable to monitor what is consumed.

The way to achieving excellent health appears deceptively simple:

• fresh and wholesome diet free of chemicals and preservatives.
• regular and gentle exercise.
• quality time to relax on a daily basis.

Nutrition is not only a complex issue but a challenging discipline. The rewards however are great.

References

1. versaul G. Dental Kinesiology. Las Vegas: Privately Published, 1977.
2. Price W. Nutrition and Physical Degeneration, 50th ann ed. New Canaan, Connecticut: Keats, 1989.
3. Fonder A C. The Dental Physician. Rock Falls, Illinois: Medical-Dental Arts, 1985.
4. Jenkins G N. Physiology and Biochemistry of the Mouth, 4th edn. Oxford: Blackwell Scientific Publications, 1978.
5. Leonora J, Tieche J M, Steinman R R. The effect of dietary factors on intradentinal dye penetration in the rat. Arch-Oral-Biol 1992; 37(9): 733-741.
6. Leonora J, Tiech J M, Steinman R R. Further evidence for a hypothalamus, parotid gland, endocrine axis in the rat. Arch-Oral-Biol 1993; 38(10): 911-916.
7. Leonora J, Tieche J M, Steinman R R. High-sucrose diet inhibits basal secretion of intradentinal dye penetration-stimulating hormone in pigs. J App Physiol 1994; 76(1): 218-222.
8. Hanioka T, Tanaka M, Ojima M, Shizkuishi S, Folkers K. Effect of topical application of coenzyme Q10 on adult periodontitis Mol Aspects Med 1994; 15 Suppl: 241-248.
9. Watts T L. Coenzyme Q10 and periodontal treatment: is there any beneficial effect? Br Dent J 1995 March 25; 178(6): 209-213.
10. Ziff S, Ziff M F, Hanson M. Dental Mercury Detox. Orlando, Fl: Bioprobe Publisher, 1993.
11. Dietch E A. The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure. Arch Surg 1990; 125: 403-404.

Associations

The British College of Nutritional Medicine East Bank, New Church Road Smithills Greater Manchester BL1 5QP UK. Tel: 01884 255059 Fax:01884 255059

I.O.N. Institute of Optimum Nutrition Blades Court Deodar Road London SW15 2NJ Tel: 0181 877 9993 Fax: 0181 877 9980

Courses

Details of general courses in nutrition can be obtained from the above associations. There are no courses as yet limited to nutrition in dentistry.

Previous Chapter Next Chapter