Human Animal

Introduction

Today, dental care is an industry, one with immense product research and marketing behind it. It produces hundreds of different (yet similar) product formulations of toothpaste and other oral health products for dental health. Still, despite high technological innovation, the incidence of oral disease has only increased in recent years; cavities, gingivitis, and malocclusion are now commonplace when, during Paleolithic times, they were extremely rare (according to the fossil record). This is because even our modern day advanced dental care technologies and practices (i.e. fluoride, SLS, daily brushing, etc.) cannot fully compensate for the oral microbiome dysbiosis and direct enamel erosion caused by modern diets. Not only can modern dental care not fully compensate, but it also directly causes harm through certain carcinogenic, cytotoxic, and otherwise harmful ingredients as discussed later. 

The Evolutionarily Natural State of Oral Health

So, how did Paleolithic humans have such good oral health without the technology? The human oral biofilm (plaque), a semi permeable film of bacteria on the teeth, evolved throughout the Paleolithic period as an adaptation to a largely acidic diet. The biofilm is mostly made of alkali producing bacteria (selected through salival proteins) which largely serve to block acid producing (cavity causing) bacteria from dominating the oral micro biome. However, even without significant acid producing bacteria, additional protection is still necessary due to the acidity in natural human diets. This need is fulfilled by the natural demineralization-remineralization cycles driven by a synergy between saliva (the ion reservoir) and the alkali producing bacteria. Once acidity enters the mouth, it may, at first, acidify the biofilm, but saliva is often able to buffer or neutralize the acid before demineralization of teeth occurs. In the case that the acid is not fully neutralized and demineralization occurs, the enamel releases dissolved mineral ions which are then retained in the biofilm rather than lost. Once saliva flow and alkali producing bacteria raise pH, and salivary proteins release bound calcium ions, mineral supersaturation occurs (the presence of the mineral ions trapped in the biofilm and the calcium ions released by salivary proteins) and teeth are remineralized. It is largely this mechanism that maintained healthy teeth in Paleolithic humans so, though widely thought to be harmful, plaque/biofilm (in this healthy state) is actually a natural protective factor against tooth decay. 

Modern State of Oral Health and its Causes

However, with the advent of both the Neolithic (agricultural) and industrial revolutions, diets have changed and so have the sources of oral acidity and demineralization. Whereas before the main source of acid was weak plant acids, now, acid consumption is more frequent, more potent, and often liquid (sodas, etc.). This increased dietary acid is enough to both select for aciduric (acid surviving) and acid producing bacteria (allowing them to dominate beneficial bacteria) and also directly cause demineralization and erosion through contact. Additionally, the high refined sugar and carbohydrate content of modern diets has further selected for acid producing bacteria which thrive on sugar. As a result, a feedback loop occurs in which oral conditions select for acid producing bacteria, said bacteria proliferate and dominate the biofilm, and the acid produced by these bacteria makes the oral conditions more conducive still. 

The Modern Necessity of Dental Care and its Effects

So, considering the increase in dietary sugar and acid, the subsequent domination of acid producing bacteria in the biofilm, and the erosion caused by both the acid producing bacteria and the direct dietary acid exposure, it is no wonder that there is a huge demand for toothpaste and related dental care products. For most people, toothpaste is a necessary compensation for a poor diet, and it’s effective. Fluoride is effective at remineralization; sodium lauryl sulfate is effective at mechanical removal; tetropotassium pyrophosphate is effective at removing calculus, and so on. However useful, many common chemicals in toothpaste are accompanied with significant potential adverse effects that include allergic contact stomatitis (stannous fluoride), epithelial sloughing (sodium lauryl sulphate), plasma cell lesions (CAPB), cancer (sodium saccharin), and many more. Some chemicals, including calcium pyrophosphate and disodium pyrophosphate (an anti-calculus agent) even negatively affect the natural demineralization-remineralization cycle, actively inhibiting oral health rather than just helping it.  And it isn’t just modern engineered ingredients that have harmful effects; for example, baking soda, which is widely used as part of a natural/mild alternative to modern toothpaste, is a potential cause of dentin sensitivity and receding gums, and cinnamon flavoring and some herbal toothpastes are associated with plasma cell gingivitis. 

Modern Ubiquity: Food Access, Addiction, Profit Incentive

As we previously discussed, the advent of diets high in carbohydrates and sugar was the impetus for poor oral health and, consequently, the development of (often) harmful oral care formulations. Importantly, however, these two food types influenced culture quite differently. Grains were the staple food of agricultural societies because of logistic necessity, and healthy foods, like organ meat and fruit, were still prized above grain, the subsistence food. Sugar has, for most of history, been the opposite type of food as grains: a highly prized luxury. This longstanding culinary status was based on the evolutionary survival value of sweetness and the related brain chemistry as well as the scarcity of sugar. However, with the advance of mass sugar production, sugar transformed from scarce and luxurious to commonplace and cheap. Its extreme palatability, addictiveness, and calorie content didn’t change though, and as a result of this combination, and corporate monetization thereof, it became a subsistence diet staple for the modern poor, similar to grains before it. Wide sugar consumption is like grain consumption in that it is a source of cheap calories for those who lack access to better, more expensive food, but different in that it is also extremely desirable and addictive outside of survival necessity, meaning that the issue affects all social strata. It is these two aspects that have led to the development of large-scale industry surrounding the intricate production of purposefully addictive processed sugary foods and their consequent ubiquity in society, the perfection of the cheap, low nutrition subsistence diet that began with grains. This represents a development in the reason for poor diet and oral health, a shift from the low access to alternative foods that drove grains to the low alternative access, addictiveness, and corporate profit incentive driving sugar. 

The Precedent of Reactive Health 

It is this ubiquity, along with the sheer length of time that oral health has been in decline, that has led to a cultural pathology of living (eating, dental care) in a way that is “normal” and “balanced” and fixing decaying oral health as it presents later. This I will refer to as “reactive health”, and it can be clearly observed in more areas than just dental care (i.e. skin care, hair care, fat loss). Though this conception of health can be thought of as stemming back to the first ancient tooth powder after the Neolithic revolution (perhaps the first instance of humans living in a way contrary to their evolution), it is no doubt exacerbated by the commodification of health inherent to modern capitalist society. Despite growing societal knowledge of holistic evolutionary health perspectives, reactive health is still the prevalent health framework because of two main factors. The first is that a modern capitalist lifestyle including poor diet, alienation from community, low sleep, etc. produces or exacerbates problems like poor oral health, mental health crises, and insomnia. The second is that, under this system (and its problems), there is a significant incentive and ability to commodify health and sell profitable solutions for it. These reactive product solutions are so well advertised and normalized that they take precedence over lifestyle as a health solution in the societal consciousness. This dynamic cements a positive feedback loop in which modern health problems require solutions; the solutions sold by industry can’t address the root cause; and more health problems are created (i.e. water supply pollution from plastic microbeads in toothpaste or endocrine disruption from triclosan in toothpaste). 

The Current Paradigm: How Best to Respond

Due to the prevailing reactive health paradigm, health now seems to require diligent weariness regarding consumption, whether it is sugary food, oral health products, or other consumables. Today, it is the job of the individual to reorient his approach to health from reactive to evolutionarily aligned (proactive), and to be mindful of his consumption and exposure. Ask always “Is this a health issue that Paleolithic humans living in a state of nature suffered from?” “Is this ailment modern?” 

Sources

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