I went from having halitosis, plentiful brown plaque deposition on my teeth and routinely painful gums and teeth to being completely halitosis-free, having greatly reduced and lighter coloured plaque and no pain in much of the teeth and gum that used to be painful. This happened over the course of more than a year (to date) of searching for the best oral hygiene practices, and having stuck (for the last 6 months) with what I can wholeheartedly call the most effective mouth cleansing routine I have ever experienced.
This is not a fairytale – not all of my dental dilemmata have disappeared. But enough of them have for me to feel a heightened quality of life, and for me to want to share my story, allowing readers to glean what inspiration they desire from it. I hope it services the wellbeing of at least one of you. If you’re not one for background stories and wish to simply skip to the part where I detail my present oral routine, please skip the first section and go straight to ‘2) The Good Stuff’.
I will update this article as my own understanding develops, whether through success or failure. But this has been enough babble. Let’s get to…
1. The Story
At the end of July 2017, I developed searing and lasting pain in my upper right 2nd pre-molar. It did not come out of the blue – it had been painful on and off for the past year, with increasing intensity.
The dentist told me at the last check-up 8 months ago in my home city (a capital city in the Asian continent) that my teeth were all in order. Apart from a filling in my lower right 2nd molar done many years ago, I had no teeth clinically treated. I brushed my teeth judiciously using the World Dental Federation’s guidelines twice a day – after waking up (although admittedly, sometimes after breakfast) and after dinner. I had been prescribed a chlorhexidine mouthwash for the halitosis (and when this one didn’t seem to help, a different one was prescribed by a different dentist that also was not much good) which I used equally responsibly. My genetics seemed to favour multiple tooth-based catastrophes- despite being a more careful and punctual brusher than myself, my 47-year-old mother had fewer natural teeth in her mouth than fakes. Neither of us ate more sweets than the average Asian or European (except for when I succumbed to binging episodes). My diet was rarely inquired after in connection with my oral health, and I assumed mine was good enough, as it seemed to conform with the conventional medical advice on the subject, which I was familiar with. The connection between my bullimic binge-eating episodes and oral health was not to become apparent for many months yet. Nor were the futility of my oral cleansing routine or the holes in the conventional wisdom regarding dental health.
Back to July 2017- the tooth pain had become so severe that I could not focus on the most menial tasks with its constant presence. I am not one to take pain medication- during the course of my increasing interest in bodily matters, I have learnt that pain is a distress signal of the body, a mere symptom of something going awry. Ignoring it without attempting to discover its underlying cause and fixing THAT is bad enough, but silencing it is sill worse. Pain is the fire alarm in your kitchen when you left a napkin too close to the stove and it caught fire. Taking a pain killer amounts to snipping off the electrical wires to the alarm and carrying on with your day.
As I had not hearkened well enough to my fire alarm in the past year, it had grown to a deafening siren. With the greatest regret, I went to a dentist. At this point I was living in a capital city of Europe. I am generally not entirely trustful of any individual who offers me services for a fee rather than out of the goodness of their heart, and this often means I end up asking many questions and really evaluating the usefulness of the service to me. I was informed that the cavity causing the pain in my 2nd premolar was located between my first and second premolar and that a root-canal surgery (i.e scraping out the dentine and pulp cavity of the tooth, then filling and sealing it up) was required to treat it.
The crippling pain in my mouth at the time made the dentists’ recommendation amiable enough to me, and I have no doubt they made it in good faith. More than a year since then however, I wonder if I would have consented as soon as I did then, knowing what I know now. The heavily anaesthetized procedure has resulted in a dead tooth that still hurts randomly from time to time. I do not have the courage to bear another one like it, as I have a terrible fear of surgical procedures (which this particular one did nothing to assuage either!).
I opted out of the crown placement that usually follows the treatment- my mother has multiple such uncrowned teeth, and the name of the game seems to be munching consciously and avoiding hard food (which I have found out firsthand becomes rather easy to do in no time). The only silver lining in the dark cloud of that ordeal was that it impressed upon me the need to reevaluate my understanding of oral health, and this I had started the very day the pain had become unbearable.
Perhaps as a further sign of the fact that medical professionals too, at the end of the day, have their gaze set on the cash, neither of the dentists attending to my root canal felt it necessary to check the rest of my teeth and give me a heads-up about existing or impending cavities (of which there were many, as I found out later myself), or even to ask what my dental habits were and what my lifestyle or diet was generally like (which I discovered were the root cause of my diseased tooth) and recommend effective changes. Perhaps they are themselves unaware of the importance of these aspects, perhaps they have too much work in a day to inquire after them, perhaps the omission was intentional; whichever it is, the overarching lesson is that no one is as interested in or capable of deciding one’s health and well-being as oneself.
Ever since the procedure, I started flossing at least once and at most twice a day. This recommendation was not ever made to me, but it seemed like the only bit of the conventional advice regarding oral care that I was not following (principally because it is not partciularly emphasised in my home country). I did indeed see the utility of and reasoning behind it once I started, since yellow and sometimes strong-smelling gunk was being forced out of the spaces between my teeth. It was not difficult to understand how this could happily produce cavities like the one that had just harrowed me. I also wondered if I might not be consuming enough calcium and getting enough Vitamin D. Convinced these were the missing links, I took a moderate Vitamin-D supplement, ate more good sources of calcium and added flossing to my usual regime of brushing twice a day with a suitably fuoridated toothpaste. Flossing never stopped being cumbersome and time-consuming to me, and I hated it as much as I valued it. Further, it often brought my sensitive gums to the point of bleeding, and I couldn’t help observing that a considerable bit of gunk was left behind despite it. And yet I ploughed on.
Then towards the end of November 2017, my upper right 1st premolar (neighbour to the now dead tooth and fellow victim of the interdental cavity that felled the latter) began to hurt now and then with a pain it had not presented before. I panicked- I desired nothing more than never requiring a surgical process ever again. Over a few days of delving in to less conservative and seemingly less authoritative sources on the subject of teeth and dental caries, I discovered a whole new framework of knowledge. Many of what I had heard dentists say suddenly seemed potentially bollocks, and many of my own doubts about the efficacy of standard dental techniques seemed justified. Thanks to the work of a small handful of rare medical professionals and dozens of educated, courageous and observant lay people who have shared their experiences on the internet, I was able to arrive (far from smoothly- I often just MUST indulge a hunch in order to accept its falsehood) at a set of practices that reversed the vast majority of problems I had with my teeth in the next 6 months. A small proportion of these practices I developed myself in the course of my learning, trial and error.
The next section will be devoted to describing and justifying my daily oral hygiene routine.
2. The Good Stuff
I will not relate the failed attempts here, much as I desire to tell the complete story. The whole saga would be rather a long read. I cannot also provide detailed scientific explanations: I am a biology and chemistry enthusiast and have always had excellent grades in both subjects, but I have no tertiary academic training in either. What I do have is a relatively scientific approach to understanding my body, a lot of time to devote to this endeavour, and a thirst for sensible new information from seemingly rational sources that can help me succeed in it.
My oral care strategy is multifaceted. In order to put the reader’s memory at ease, I’ll separate these equally important facets in to the Servicing, Supplying and Supporting of the oral environment. Allow me to dive straight in:
Servicing (physical cleaning and maintennance)
Becoming familiar with how your teeth look and feel and how they are positioned is paramount. I use a simple portable pair of vanity mirrors, where one can be made to reflect the image of the other. Looking for signs of progress or regress in my oral atmosphere has become a great component of my taking care of it.
Two myths that I have discovered, at least as far as I myself am concerned, are that 1) commercial toothpaste is necessary for preventing plaque formation and dental caries and 2) one must regularly change one’s toothbrush. I abandoned commercial toothpaste and adopted a personal formulation 9 months ago; my teeth have becoming noticeably cleaner and gums healthier in that time. I have also been using the same toothbrush for almost a year, albeit cleaned often with boiling water (especialy after the two cases of infection I had over the period: a cold and varicella virus respectively) and left well ventilated.
Before I can share the recipe for the toothpaste I have just bragged about, I must append the list of myths thusly; 3) flossing is necessary, 4) one must purchase an antibacterial mouthwash to be rid of death-breath (as I like to call it), and 5) brushing after eating is necessary to dislodge cavity-causing food particles. The veracity of these myths I discovered when I dumped flossing for an ancient practice called oil pulling, which I tweaked in to making a mouthwashing paste for myself that has dealt death to my death-breath and an affordable and practical means of cleaning my teeth after meals. The cleanliness of my mouth became visible and palpable in a few weeks of adopting the toothpaste and mouthwashing practice that follows.
Alighting from sleep in the morning, I drink a lot of water, swishing it around in my mouth and through my teeth as an elementary cleanup. Then I take about half a teaspoon of the mouthwashing paste described below and move it about in my mouth in a swirling motion. Much like the high frequency water/detergent waves used to dislodge dirt from delicate machinery like certain automobile parts, by consciously and repeatedly guiding the paste (which will become increasingly fluid as it dissolves in the saliva) through the spaces between teeth and past the cusps and groves of the premolars and molars, one can dislodge bits of food and gunk from between these spaces, even around the restrictive wisdom teeth (i.e the 3rd and last molars), which are largely inaccessible to a toothbrush. My reasoning was that a liquid could sneak its way in to crevices too small for bristles and too awkwardly placed for one to reach with one’s hands, and this certainly seems to be the case. Being conscious of where the liquid is flowing and changing the pressure and direction of it using the tongue and cheek muscles is the essence of this outstanding cleanse, which I realised I could perform while going about doing chores or getting myself dressed, and not necessarily standing in one place. I do this for about 20 minutes, or even as long as half an hour. It is important to hear that swish-swash sound and feel the liquid going through the rows of teeth, however there is no need to push and pull at great pain to your muscles or jaw. Practice slowly and it will become steady with time. If perceptibly large pieces of food are detected by my tongue in the process, I remove solely these and continue. The very same procedure I perform once again before bed. The mouthwash recipe contains ingredients that neutralise acids already present in the mouth, usually produced by resident bacteria (NaHCO3, CaCO3), are antibacterial, antifungal or adsorptive (coconut oil, tea tree essential oil, activated charcoal, table salt, MgCl2), and remineralising (i.e capable of providing raw materials to the enamel for its repair, as in the case of CaCO3). I believe that the oily nature of the starting paste that gradually transitions to a more aqueous nature as time goes by and spit is produced provides a greater range of chemical environments for the successful capture of a greater range of ‘gunk’ as well; whether a certain component of the gunk is chemically soluble in polar (eg. water) or covalent (eg. coconut oil) molecules, it will most probabaly be caught up by swirling the mouthwashing paste at some point.
After swishing the mouthwash in this way, I spit it out (it will look beige and flow almost water-like at this stage; you might even recognise some food particles in it!), I proceed to consciously brush my teeth (again, I do this routine both after waking up and before bed). Consciousness is key; everyone’s dental arrangement is a bit diferent and most of us have teeth sticking out at odd angles. These non-conformist teeth ( for example, overlapping incisors or wisdom teeth that have not come out perfectly straight or are still emerging) should be given the most attention, since they increase the number of little crevices between teeth or between teeth and gums where food particles can lodge comfortably and be safe from eviction. Having a good idea of how your teeth are arranged is immensely useful here too; rather like being familiar with the features in your room, such that you can even find your way around in the dark. The ideal scenario is to have no food partciles whatsoever lodged in this way, but this being almost impossible to achieve is no reason for one to get as close to it as possible 🙂
I do not use the WDF formula anymore at the moment. I brush the grooved surface of each tooth in small strokes that are round or straight and slant the brush in whichever way that allows the cusps of the tooth to be maximally cleaned. Then I brush the inner (tongue) side of the teeth using a circular or up-and-down motion along the interdental spaces, again paying attention to how exactly my teeth are arranged. Then I brush the outer (cheek) side of the teeth the same way. This means that I hold the brush at various different angles depending on the single tooth or set of teeth I’m brushing; nothing else seems to make sense to me considering the subtle variations in presentation that even my most uniform teeth show. The results suggest this situation-specific approach to brushing is paying off. My toothpaste is much simpler than my mouthwash: it has merely agents of abrasion and pH increase (NaHCO3, CaCO3) and antimicrobial agents (coconut oil, tea tree essential oil). A very small amount of the paste suffices for me: a little less than a quarter teaspoon of it or a light swipe with the brush, although I used considerably more of it a few months earlier. Brushing the surface of the tongue thoroughly every time (till it looks and feels clean) as well as under the tongue and the hard palate seem to me essential to the routine.
Now on to the recipes!
3 tablespoons calcium carbonate powder
2 tablespoons sodium bicarbonate powder
about 2 tablespoon tablesalt, preferrably sea salt with no anticaking agents (mine is iodised)
1 teaspoon magnesium choride (nigari is largely magnesium chloride and is what I use. This may be left out or substituted with more table salt)
about 3 tablespoons of cold-pressed virgin coconut oil (the less it has been processed the better. You can add a little more or less to obtain a pleasantly pasty consistency)
1/4 to 1/2 teaspoon activated charcoal
10 – 20 drops of tea tree essential oil
Mix the ingredients together in this order in to a paste and store in a sealable container of choice (continuous exposure to open air may cause oxidation of the oils).
3 tablespoons calcium carbonate powder
2 tablespoons sodium bicarbonate powder
about 2 tablespoons cold-pressed virgin coconut oil
10 – 20 drops tea tree essential oil
Mix the ingredients in this order till a smooth paste is fomed and store in a sealable container of choice.
The final aspect of Servicing the mouth will be the easiest, cheapest and most practical; namely, using water or spit after exposure of the mouth to food or drink to perform a thorough rinse. Gather some spit (the more you gather, the more will be secreted by the salivary glands) or take some water in to your mouth and swish exactly as with the mouthwash. Concentrate on consciously removing food debris and gulp back used spit/water in favour of a fresh batch whenever you desire. I notice that my mouth smells much better after meals after I started doing this than before (I do not use any chewing gum, candy or lozenges as mouth fresheners although I am partial to certain herbal leaves or stem).
Removing debris in this way seems to drastically reduce the food supply available for the microbiome of the mouth to digest and survive on, resulting in palpably less microbial activity and therefore a better mouthfeel and fresher breath.
To test the efficacy of my replacing flossing with the twice daily use of the mouthwashing paste and swishing with water or spit after meals, I flossed some of the worst-offfenders among my interdental spaces about 4 months after I quit flossing. To my exuberant joy, nothing more than spit seemed to come out and it was odourless too; if there was any gunk at all, it was not significant enough for me to see it with close inspection.
UPDATE(September 2018): One final form of servicing that showed positive results for me is a controversial one to mention: done right, it seems to work like a charm, but it is very possible to go south with it. I use stainless steel pins (the ones you use on clothes) or safety pins over a small range of sharpness to scratch at the bits of brown plaque I can see using my mirror till they disappear. Having a steady hand and not poking the gums with the needle or scratching healthy enamel is key. Small, relatively light yet steady and orderly strokes seem to be the best (no chaotic lottery ticket scratching, please!). Afterwards, I rinse well with spit and Support my teeth, as detailed further down. This step is pivotal to the process!
Brown, hardened plaque cannot be removed by brushing, so this physical dislodging seems necessary. However, I notice that the plaque I removed 5 -7 months ago still hasn’t returned – not even in a discrete way. This I ascribe to the changes in diet I have made as well as the servicing aspects above.)
Supplying (nourishing and reinforcing gums and teeth)
There is a steady flow of blood to the pulp of the tooth that also nourishes the dentine (first living layer) of the tooth, and that brings with it nutrients, oxygen and blood cells (including those of the immune system). Minerals such as calcium and phosphorous (key elements of the main compound in tooth enamel, hydroxyapatite) are also dissolved in saliva, which has the additional advantage of containing antibacterial compounds such as lysozyme. From excerpts out of works by holistic dentists such as the famous Weston Price, blogs and podcasts by lay people like me with a scientific bent who have studied those works caefully and from perusing scientific papers on the subjects of dental caries and tooth demineralisation (structural weakening of the enamel) and remineralisation (reinforcing of the enamel), I gleaned the following;
- Teeth are in a constant tug-of-war between remineralisation and demineralisation. Food, especially acidic and sugary food, as well as the processes of biting and (over)brushing cause the wearing down of enamel (demineralisation). In the case of sugary and acidic food, the wearing down is chemical, as acids leach mineral ions out of the hydroxyapatite crystals of the enamel. In the other two cases of wear, it is physical wearing down, and this is generally easier to fix and less destructive than the chemical erosion.
- Saliva plays a role in remineralisation that cannot be overstated. Not only are the nutrients supplied to the interior of the tooth via blood critical for maintaing gum and tooth health, but saliva staying in contact with teeth is directly necessary to remineralise the enamel. Lower salivary production is linked to greater occurrence of caries. Saliva also does the equally important job of neutralising acids and lowering the pH of the mouth and plaque present. The presence of high quality saliva (quality will be decided by the nature of one’s diet) in frequent contact with teeth repairs enamel that has been eroded. This fact will be recalled later on in this section.
- An infected tooth has a chance of becoming healthy again without antibiotic use (thanks to the capabilities of a healthy immune system) provided that the infection has not gone beyond a certain point; judging that point seems to be difficult, but procuring root-canal treatment for, or worst of all, extracting a tooth that is showing signs of infection or cavity formation seems to only be medically necessary in a minority of cases. Both procedures are, after all, expensive ones; it does not take a stretch of imagination to understand how it would work in a dentist’s favour to conduct more rather than fewer of such procedures. One would be well advised to press for information about alternatives in such a case, in my opinion.
- In order to facillitate remineralisation and fight infection, one’s body has to have the necessary compounds in stock. The best way to obtain those compounds is through an appropriate diet, resorting to supplements only if absolutely necessary. Repairing dental damage or preserving good oral health therefore takes eating well. We are, as it were, what we eat. Particularly important nutrients for dental health and cavity reversal are calcium, phosphorous, vitamin D, vitamin K, omega-3 fatty acids and magnesium. I also find that having good levels of zinc and vitamin C, as well as taking herbs and spices such as ginger, onion and garlic seem to generally improve the functioning of my immune system. Any other macronutrient deficiencies one has may also need to be fixed in order for remineralisation/immune function to operate smoothly; most nutrients are parts of complex cascades of bioreactions, the courses of which converge in to and branch from one another.
My own bullimia makes it challenging for me to stick to a near perfectly healthy diet (that I in fact find satisfying in every instance except when my bullimia gets the better of me and I sink in to a binge). I think I would see greater results faster if not for this hiccup. Indeed after I began to notice the improvements brought on by the ideal diet, I began to diverge from it less strongly even during binge spells. That ideal diet, in my case, was achieved as follows (;
- Cutting out refined sugar and processed food – my threshold of tolerance of sweetness has greatly decreased since I managed this about 8 months ago. I have no refined sugar in the cupboard, and make yoghurt, condiments and sauces at home. I only very rarely eat heat-and-eat food and generally make all meals at home with minimally processed ingredients that are as fresh as possible. It is important to note that fibrous fresh fruit, although sweet, is not a source of refined sugar, although it is still imperative to swish thoroughly with water and/or saliva afte consumption.
- Reducing intake of or eliminating food that become pasty or sticky in the mouth, like peanuts, pastries, most types of bread, pasta and some preparations of beans. Anything that seems particularly difficult to dislodge by rinsing would be a candidate.
- Increasing calcium intake by eating more white beans, appropriate nuts and seeds, probiotic full-fat yoghurt and aged cheeses like camembert and emmental. Eating such cheeses with fruit also seems to be able to neutralise the acidity of fruits and increase the availability of phosphorous to the tooth, so they are doubly beneficial. Incidentally nuts, beans and seeds are also good or excellent sources of phosphorous, provided they have been sprouted, soaked or heated intensely.
- Increasing vitamin D intake by spending the appropriate amount of time in the midday sun, eating 2 – 3 eggs a day (preferably with the yolk cooked without exposure to great heat) and eating supplemented food or taking a supplement in the sunless months.
- Having 1 – 2 tablespoons of cold-pressed linseed oil, rich in the omega-3 acid alpha linolenic acid (ALA). It appears to be the case that the omega-3 acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are more useful for remineralising teeth, but the best sources of these are cod liver oil and fatty fish like cod and salmon. ALA is converted to EPA and DHA in the human body, but that conversion rate is generally believed to be low. A paper reporting quite elegantly that the conversion rate was found to be manifold higher in vegetarians (such as myself) and vegans was the greatest factor in my decision to stick with ALA and rely on my potentially higher conversion rate.
UPDATE(March 2019): I gave up vegetarianism approximately 6 months ago. It pained me greatly to, since contributing to minimising the suffering of sentient animals was my motive to become vegetarian (already having been forced to come a rung down from veganism due to health concerns). However, beginning to try to eat more like my ancestors would have before the agricultural revolution has significantly improved my perceived and empirically observed health and wellbeing. My skin has greatly improved, my teeth and mouth feel stronger and more repaired, I have less gastrointestinal discomfort after meals and I feel more energetic. My current diet habits in a nutshell are: consuming primarily meat (from as great a variety of sources as possible: chicken, beef, lean meat, offcuts, organ meat, bone etc), fruit (as per the biological definition of the word), some leafy greens and some egg; avoiding dairy with the exception of aged cheese and occasionally full fat cream); completely abstaining from nuts and seeds of all sorts; avoiding significant amounts of wheat and other cereals in all their forms, and eating only once or twice a day with no snacking in between. The only supplement I take is fish oil, for the EPA and DHA it offers (the smell of fish generally puts me off eating it). I will leave my initial dietary habits from when I was still vegetarian unedited, however, since they might be helpful to anyone not willing or able to eat meat. Nevertheless, I must stress that eating (unprocessed) meat in good proportions and combinations rapidly and convincingly boosted my sense of being in good health.
- Eating a good deal of cabbage, kombu, pumpkin seeds and spinach. I will not delve in to the complexities of nutritient absorption and optimal combination of foods for enhanced absorption here, but the first three are good sources of vitamin K, kombu is an excellent source of iodine (I was deficient in iodine) and spinach and pumpkin seeds are fair sources of magnesium.
- Eating fewer times a day and having plenty of fibre at every meal; chewable fibres seem to have a cleansing effect on grinding surfaces of teeth.
- Having plenty of hydration in the form of water, unsweetened herb teas and the occasional black/green tea. Drinking black tea or coffee with a meal, however, impairs mineral absorption
Support (making remineralisation easier)
When I had fixed my diet and oral hygiene practices, the greatest boon to the state of my mouth seemed to be harnessing the power of saliva- by using any occasion where I could have my mouth closed for at least five minutes to gather saliva in my mouth and swish it back forth through my teeth and up in to the valleys of my molars, paying more attention to what I knew were my problem areas. One can swish for about 20 minutes at a stretch, and I have noticed that it becomes easier to gather saliva the more I gather and swish. One does not have to swish so vigorously that one’s face feels sore however – indeed, this can be injurious in the long term.
This frequent swishing enables more of the surface area of my teeth to stay in contact with saliva, especially for the upper teeth. This facilliated remineralisation, pH increase and antimicrobial activity, as can be inferred from the benefits of saliva listed in the ‘Supplying’ section.