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Health Protocols

Oral Health

Diet and Lifestyle Considerations


A diet high in sugar and processed starches increases the risk of tooth decay and cavities (Touger-Decker 2003). This is because microbes including Streptococcus mutans (S. mutans) digest dietary carbohydrates and produce acids that erode tooth enamel (Mayo Clinic 2014a; Struzycka 2014). Fresh fruits and vegetables increase saliva flow, which helps wash food particles from teeth (Mayo Clinic 2014a), while eating foods that leave sugar in contact with teeth for long periods of time, such as sticky and gummy sweets, is thought to increase cavity risk (Mayo Clinic 2014a; Palacios 2009). Sugary sodas bathe the teeth in both acid and sugar and are therefore strong promoters of tooth decay (Kaplowitz 2011).

On the other hand, milk and milk products contain proteins that discourage the attachment of cavity-related bacteria to tooth surfaces (Johansson 2011), as well as phosphorus and calcium compounds that appear to promote remineralization of tooth enamel (Kaplowitz 2011; Palacios 2009). Studies have shown increased intake of calcium from dairy may be associated with lower risk of periodontal disease, and low dietary calcium intake is associated with more severe periodontal disease and tooth loss (Kulkarni 2014). In addition, rinsing with water or drinking unsweetened coffee or tea can help remove sugars from tooth surfaces (Mayo Clinic 2014a).

Vegetarians had better periodontal health than non-vegetarians in one controlled clinical trial (Staufenbiel 2013). In another study, men with the highest intake of whole grains had a 23% lower risk of periodontitis compared with men with the lowest whole grain intake (Merchant 2006).

Dental Hygiene

Brushing and flossing effectively remove plaque. Combined with regular dental care, brushing and flossing are critical for preventing cavities and periodontal disease (Struzycka 2014; Mayo Clinic 2014a). Tooth brushing at least twice daily is recommended to prevent tooth decay, with soft toothbrushes that cause less mechanical trauma to gum tissue generally preferred (Carvalho Rde 2007; Zimmer 2010; Mayo Clinic 2014a). Electric toothbrushes have been shown to outperform manual toothbrushes (Stoltze 1994; Hamerlynck 2005). Dental flossing, using either traditional string floss or a water flosser (eg, Waterpik), to clean between teeth is also important (Mayo Clinic 2014a; UMMC 2013). Several studies suggest water flossers, such as those manufactured by Waterpik, are superior to string floss for plaque removal and gum protection (Goyal 2013; Lyle 2012; Magnuson 2013). Home fluoride rinses, anti-bacterial rinses, and professionally applied fluoride treatments can also contribute to cavity prevention (Gluzman 2013; Mayo Clinic 2014a).


One study found that lack of physical activity is associated with poor periodontal health and increased risk of periodontal disease, while another large study found that higher levels of physical activity appear to protect against periodontal disease (Bawadi 2011; Merchant 2003). Preclinical and clinical research has shown that exercise reduces gingival oxidative stress and inflammation (Azuma 2011; Mendoza-Nunez 2014), which may contribute to improvements in periodontal health observed in older adults who engage in physical activity (Mendoza-Nunez 2014).