Every three to five years there’s an article about the exciting new breakthrough that is going to eliminate tooth decay as a problem forever. They come around, if not exactly like clockwork, with much the same framing every time:
1. There’s a new discovery and it’s going to banish all dental drills forever.
2. Excited researchers have made breakthrough (possibly even involving human subjects, but frequently in rats); expect product to be on market in 12-24 months.
3. Straight-faced explanation of how tooth decay is a real problem, like none of us are going to take it seriously without statistics on how many billions of dollars we spend on fillings every year
4. Insert joke here about unemployed dentists.
5. But seriously folks, keep brushing!
In theory, this ought to be straightforward. We know what causes tooth decay: a bacteria called Streptococcus mutans (S. mutans for short).
S. mutans produces plaque in order to stick better to your teeth, where it happily lives on the sugar in your diet, pooping out lactic acid (sorry, “producing it as a byproduct”), which is what wears holes in your teeth. (There are apparently other bacteria hanging out in your mouth that also produce acids, but S. mutans is the one that gets pointed at the most often.) We could go after the bacteria itself, by killing it. We could vaccinate against the bacteria, the way we do with tetanus and diphtheria. We could interfere with its ability to build bacterial condos. So many possibilities!
All the way back in 1998, CNN reported that a California-based firm called Planet Biotechnology had developed a vaccine (a tasteless, colorless liquid painted directly onto the teeth twice a week for three weeks) that eliminated S. mutans. “The company hopes they can roll out a consumer product in 2001 or 2002,” the article finished. Planet Biotechnology is still around and still says they’re working on this vaccine (as well as trying to cure the common cold) but if there’s been a whisper of news about their amazing vaccine since 1998, I couldn’t find it.
In 2002, Harvard professor of oral biology Martin Taubman and associate clinical professor of oral biology and pathophysiology Daniel Smith developed a different type of vaccine. They focused on one of the enzymes used by S. mutans to produce plaque, and made an oral vaccine to stimulate production of antibodies against this enzyme. “We’re now ready to test the vaccine in humans,” Smith said in an article in the Harvard Gazette, “But we’re frustrated by a lack of money to produce it in the quantities needed.” The list of Taubman’s publications makes it clear that this wasn’t something he ever gave up on. But he apparently retired from full-time faculty status in 2014, and the vaccine is not yet available.
Coming at the problem from a radically different angle, Jeffrey Hillman from the University of Florida developed a genetically engineered strain of S. mutans that doesn’t produce lactic acid, and also kills off the regular S. mutans that’s already in your mouth, making it possible for the non-cariogenic S. mutans to take over. This sounded both super appealing and kind of Andromeda-strain-esque. I mean, if it turned out the genetically engineered S. mutans also made you grow a third eye, then what? Fundamentally it’s a really hard bacteria to get rid of which is why so many of us get cavities.
And apparently that’s more or less what the FDA said when the biotechnology company Oragenics tried to test this in clinical trials (they called it SMaRT Replacement Therapy). “We initiated our first Phase 1 clinical trial in April 2005, but we found it difficult to find subjects who fit the trial’s highly cautious inclusion and exclusion criteria,” the Oragenics website said (in what sounded like a rather petulant tone, though maybe I was reading that in. They were required to test the stuff out on people who had no actual teeth, just dentures.)
[blockquote cite=”Oragenics” type=”left, center, right”]We concluded this trial early after enrolling only two of the 15 planned subjects. The FDA then recommended that we revise the protocol for the evaluation of ten healthy male subjects, ranging from 18 to 30 years old and with normal dentition, in an institutionalized setting. After we submitted additional information, the FDA issued a clinical hold letter in June 2007 for the proposed trial with the attenuated strain, citing the need for a plan with respect to serious adverse effects; a plan for the eradication of the attenuated strain in trial subjects’ offspring; and a required pregnancy test for female partners of subjects.[/blockquote]
After a few more rounds with the FDA, Oragenics threw in the towel.
More recently, in 2011 there was a study done in China on an inhaled vaccine. This got io9 pretty excited even though as of 2011 they’d only tested the vaccine in rats. (I’m not saying animal testing is worthless, but we’ve cured all sorts of things in rodents that humans are still dying from.)
Finally, in 2012 — okay, this is the weirdest one, probably. Two researchers announced with a lot of fanfare that they had discovered a new molecule which they were calling Keep32 (as in, keep all 32 of your teeth) that killed all cavity-causing bacteria in 60 seconds. This got reported on CBSnews.com, Time.com, HuffPo, and they even have a Wikipedia article despite the fact that the originating English-language site is Britain’s Daily Mail and let’s just say that as news sources go, this one is legendary for their tolerance for inaccuracy.
The two researchers are identified as José Córdoba, a researcher at Yale University, and Erich Astudillo, from the Universidad de Santiago, Chile. University employees are generally very easy to find: plug their name and institution into Google and they should pop right up. So, there doesn’t appear to be anyone named José Córdoba affiliated with Yale. In fact, there doesn’t seem to be anybody by that name working in academia at all. I did find a scientist named José Córdoba Chacon working at the University of Chicago but he’s never been affiliated with Yale and also he’s an Endocrinologist with no apparent research interests in dental health. Erich Astudillo was easier to turn up, although when I found him on Linked In. I thought I probably had the wrong guy because his work seems to have nothing to do with biotechnology. But when I looked for Top Tech Innovations, I found a website looking for investors and that had his picture, which matched his LinkedIn picture. His Twitter also links to a web site that I think is supposed to be the company his LinkedIn page says he works at — but when I went to the site all I found was a placeholder.
So…investment fraud? Hoax? Two entirely legitimate people whose business failed (and one of them, I don’t know, swore off academia forever and fled to a monastery without an Internet connection?) Your guess is as good as mine. Dear legitimate news sources: when your originating source is the Daily Mail, you might want to follow up with a spot of web searching, at least to check institutional affiliations.
All this got me wondering just how far back this “new breakthrough! Should be a commercial product in two years, tops!” phenomenon goes. I checked the New York Times archive and found an article from March 18, 1967. “Vaccine Sought for Tooth Decay: Research Projects Hope to Develop Immunization.” Researchers at the University of Notre Dame had vaccinated rats against “one type of cavity-causing organism,” though this article, at least, doesn’t make any grandiose predictions about when it’ll be ready for human trials.
On the other hand, on February 27, 1977, the New York Times confidently predicted, “Coming: A Vaccine Against Tooth Decay. It’s already worked on monkeys and rats, so why not humans?” And on December 16, 1980, there’s an extended article that quotes Jeffrey Hillman (remember him from 1000 words ago? Even in 1980 he was working on the “good bugs to drive out the bad” approach) and Martin Taubman (the Harvard guy who just retired!…) even in 1980, he was focused on stimulating antibodies against the enzyme that lets plaque stick to your teeth. Hillman humorously notes that if there were a market for preventing tooth decay in rats, “we would have it cornered,” but nonetheless expected a practical vaccine to be developed by the end of the decade. You know. 1989.
So, you know…don’t procrastinate that filling. Fight those Cavity Creeps:
There are, however, a few things (other than the brushing and flossing you’re either already doing, or already not doing) that have been clinically found helpful that you can try, if you want.
The intervention you’re most likely to have heard about (other than, you know, fluoride) is xylitol. This is an artificial sweetener that might kill S. mutans and prevent tooth decay. I say “might” because the research results conflict. In 1995, there was a study in Costa Rica in which 2,630 children brushed with either xylitol or fluoride toothpaste; the xylitol toothpaste provided a statistically significant reduction in cavities relative to the fluoride.
On the other hand, a study done on adults in 2013 found no reduction in cavities for people who sucked on xylitol lozenges, and a study that fed xylitol-sweetened gummy bears to children lost so many study participants (due to kids moving away and changing schools) that they basically didn’t get a result at all. If you want to try xylitol gum or candy, it’s definitely not going to harm your teeth. It might or might not help them. If you dislike xylitol, and I’ll note that it can cause diarrhea in some people, don’t use it.
Next up: mouth bacteria. Your mouth is an amazingly complex place, filled with bacteria, some of which keep the S. mutans partly in check. There are probiotics you can take to bolster your mouth’s population of friendly bacteria, if that entire sentence didn’t just send you screaming out of the room. A 2001 study gave milk enriched with Lactobacillus rhamnosus GG to preschool children, with a control group given regular milk. The study showed a significant reduction in cavities among the kids receiving the probiotic.
You can totally just go buy yourself some of this bacteria: it’s also called acidophilus, i.e., that stuff they use to make yogurt and that’s known as nature’s remedy for yeast and stomach trouble. I’m not sure they’ve tested acidophilus taken in capsules; you can buy probiotic lozenges that will let those friendly bacteria hang out in your mouth for a while every day. (G-U-M brand makes a lozenge, Periobalance. Apparently they sent out samples to bloggers at one point, along with PH testing strips to let their test customers check out the acidity of their mouths. I’m always a fan of at-home science experiments, so if you are too, you could order yourself some saliva PH test strips and document your findings.)
Green tea apparently also has well-established anti-cavity properties. You can buy green tea extract in little capsules, but most of the studies showing a benefit were studying people who just drank a lot of green tea. Green tea is easy to find and simple to brew. If you’re drinking it for its oral-health-promoting properties, maybe don’t put any sugar in it, though.
This one’s primarily for gum disease but since it goes after plaque, I would expect it to help with decay, as well. There’s a mouthwash made with a chemical called delmopinol that was approved back in 2005 as a medical device (not a drug! A device!) It’s available in the U.S. as G-U-M Perioshield Oral Health Rinse. It’s available over the counter, so like this other stuff, you could just go buy it – but is not recommended for people under age twelve, or pregnant women. It works by preventing plaque from adhering to teeth in the first place (which is why it’s a “device” — the action is mechanical.)
And finally, there’s fluoride, which has been bringing all the conspiracy theorists to the yard since 1950.
Years ago I made a passing reference to routine dental care (including fluoride treatments) in a blog post about economic privilege and within an hour had a drive-by comment from someone ranting about the evils of fluoride.
I’m not going to get into water fluoridation here; if you’re in the US and not taking steps to avoid it, you’re almost certainly drinking fluoridated water, and if you’re somewhere that doesn’t fluoridate the water supply, you’re probably not going to personally fluoridate your OWN water.
In terms of things you could do, though, if you have a lot of cavities and your dentist hasn’t recommended this: fluoride mouthwash. (Check labels! A lot of the mouthwashes at the store are just to make your breath smell nice. That’s not what you want. I mean, you probably want your breath to smell nice, too, but not as much as you’d like to avoid root canals.) Fluoride rinses can actually remineralize small cavities that have started to form, if you use them daily. (Spit them out, though. Fluoride rinses should not be swallowed, any more than toothpaste should.)
I grew up in the 1980s, and clearly remember dental health being presented as a moral issue. If you were virtuous and brushed your teeth, you wouldn’t get cavities; poor hygiene practices and overconsumption of sugar would be punished with cavities. You can still see this attitude — you’ll see it in the open contempt toward people with visible decay (most of whom are poor, and that’s why they can’t afford dentistry). You can see it in the fact that a good health care policy will cover the vast majority of your appendectomy or your broken arm or the removal of your suspicious mole, but a good dental plan probably covers 50% of your root canal (or maybe 75%, if it’s a really good dental plan). People who need dental care are presumed to have been irresponsible.
And if you’ve read this far, if you take nothing else away from this article, take this: there are a lot of reasons for bad teeth, from saliva composition, to sinus trouble (mouth breathers dry out their teeth and get more cavities), to medications that cause a dry mouth, to reflux, to enamel that didn’t form quite right because you ran a high fever one time as a young child. Don’t assume that someone who gets a lot of cavities just needs to have better hygiene; it’s as stupid as assuming that someone with acne just needs to wash their face regularly. And if you get a lot of cavities: even if you’re eating a lot of sweets or drinking a lot of soda, there are millions of people eating that same candy-heavy diet as you and following the same hygiene regimen who are not getting cavities. Try some of the extra stuff listed here. But also, let yourself off the hook. Sometimes our bodies fail us; that doesn’t make it our fault.
And maybe? Someday? Maybe there will be a vaccine for this.
(But don’t count on it.)
Featured image courtesy of Shutterstock