Do Vegans Get More Cavities?

Today's Blog--

A diet high in saturated fat, which can clog our arteries and lead to inflammation, is  considered a key underlying causal factor for periodontal diseases like gingivitis. This may explain why chronic gum disease is associated with sexual dysfunction. By looking in your mouth your dentist may find out more about you than you realize!

We know impotence can be reversed with a more plant-based diet; what about periodontal disease? A new study I feature in my 2-min video Plant-Based Diets: Oral Health found that higher intake of high-fiber foods, especially fruits, may at least slow periodontal disease progression. A healthy diet may also protect the sexual function of women.

So what is a safe intake for cholesterol and saturated fat? See my video Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

For oral cancer it’s a no-brainer. According to the latest review in the journal of the American Dental Association highlighted in my video, “Evidence supports a recommendation of a diet rich in fresh fruits and vegetables as part of a whole-foods, plant-based diet.”

The foods found most protective include raw and green/leafy vegetables, tomatoes, citrus, and carrots. Citrus fruits are acidic, though. Fine, less oral cancer, but what about the health of the teeth themselves? Might eating lots of sour fruit erode our enamel?

Early case reports that raised red flags involved unusual circumstances like sucking on lemon wedges. See my video Plant-Based Diets: Dental Health for pictures of what happens when you give your preschool child a banana to suck on as a pacifier or juice 18 oranges a day for over a decade (if you dare!).

The conventional wisdom has been that fruit juice may be bad for our teeth, but whole fruit is fine. This was challenged recently. The ability of fruits and their juices to erode enamel appears to be similar. For the chart that compares grapes to grape juice, carrots to carrot juice, oranges to orange juice, apples to apple juice, and tomatoes to tomato juice, click here.

Now fruits and fruit juices weren’t as bad as soda—Diet Coke takes the title for softening teeth the quickest. But it was a surprise that fruits and their juices had comparable effects. The Dental Association put an interesting spin on it: If eating fruits and vegetables whole has the same demineralizing effect as juice, they argued, then hey, maybe fruit juice is not so bad at all! Of course the glass-half-empty interpretation of fruit being as erosive as juice may be that fruit is worse than we thought for our enamel.

Indeed, the latest research on whether the consumption of fruit is cavity-causing found that the frequency of fruit consumption was associated with higher odds of cavities, though they acknowledge that the role of fruit sugars in initiating dental cavities in humans has long been a subject of debate.

Those eating plant-based diets may have less disease of the tissues surrounding the teeth, but if people who eat a lot of fruit get more cavities, then what about the health of the teeth themselves? Though vegetarians and vegans don’t have more cavities than those eating more conventional diets, they may have greater signs of acid erosion on their teeth (as documented in two studies I run through in my dental health video). So what should people do?

There are a number of foods and drinks that have the potential to cause dental erosion, both unhealthy foods like soda and sour candy, as well as healthy foods like fresh fruit and certain herbal teas. In the biggest study to date, consuming citrus fruits more than twice a day was associated with 37 times greater odds of dental erosion compared to those who consumed citrus fruits less often. It also appears risky to consume apple cider vinegar or sports drinks once a week or more and soft drinks daily. These habits resulted in the odds of erosion being ten, four, and four times greater, respectively, than when the habit did not exist.

How can we get the benefits of healthy foods like citrus while minimizing the risks of dental erosion? The most important thing is that we should never brush right after we eat sour fruit. We should wait at least 30 minutes. Acid softens our enamel such that if we brush right away we can actually brush away some of our teeth!

profile a study where they had some folks swish an acidic solution (Diet Sprite) and then brush immediately after, or 10, 20, 30 or 60 minutes after. Drinking soda without brushing at all can lead to some enamel loss, but we may double or triple that damage if we brush our teeth when they’re in the acidified softened state. The researchers suggest we should wait at least 30 minutes and probably a whole hour afterwards to be safe. The simple solution is that after eating anything sour we should rinse our mouth with water to help neutralize the acid.

So should we avoid healthy foods like citrus? No! We just need to rinse.

What’s so great about citrus? See for example:

More on oral health in:

Anything else people eating healthy diets should be aware of? The most important consideration is vitamin B12. See my blog posts Vitamin B12: how much, how often? and Vegan B12 deficiency: putting it into perspective.

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Image credit:  NATO Training Mission-Afghanistan/ Flickr

  • HemoDynamic, M.D.

    #Smiling :-) at your Pearly White information!

  • Diana Ng

    I’ve been on plant-based since June last year but I’ve got gum disease and my bones have been shrinking from my front teeth on my mandible causing loose teeth. What causes this? And what can help, Dr. Greger?

    • farseas

      Are you eating plenty of green leafy vegetables like spinach, kale, arugula for plant based calcium? Maybe add some whole sesame seeds too, which contain tons of calcium. Add Natto or MK-7 supplements to your diet to make sure all that calcium gets to your bones and teeth.

      Also, watch out for vinegar as it can make your mouth acidic and cause tooth decay. Always rinse your mouth out thoroughly after eating and brush an hour later. Too much fruit can also cause your mouth to lose the proper PH. Rinse, rinse, rinse…

  • Ann

    I still have cavities. But I think its because of me eating corn crackers with organic peanut butter every day, like 6 a day (at tops 1 tablespoon peanut butter a day).
    All the rest is plant based, high raw (85%)

    • beccadoggie10

      Hi Ann, Corn crackers may have a double whammy since both corn and crackers are carbohydrates and break down into sugars in our body.

      My cavities ceased when I made choices like eating a serving of organic rice, quinoa, or frozen (and heated) organic corn with my beans instead of snacking on chips or crackers with nut butters.
      Corn, btw, is genetically modified with organisms of other species or kingdoms in order to resist more herbicides as well as to be an insecticide in the body of the insect or animal who eats it.
      And Roundup, the herbicide made by Monsanto, is corrosive to metal. No telling what it can do to our teeth when it builds up in food and into water supplies.

      I’ve changed my way of eating since learning about the politics of food in North America.

      Occasionally I eat almond butter smeared on a banana. After devouring this, I swish my mouth out with carbon filtered water, This has me eliminate cavities… thus far.

      I think it’s the choices we make whether or not we eat vegan.

  • BB

    I have been on a whole food plant based diet for 4 years and have noticed that I have better oral health now than I did before. The PH of my saliva is more basic than that of my non-plant based children. And the PH recovery after eating citrus food is surprising. My saliva PH is actually higher right after eating oranges than before eating oranges.

  • BB

    I think the whole oral health issue is correlated with bone loss in non-plant based people. Teeth are like bones and if your diet is making your body acidic – there are more things than your bones that are de-calcifying…. it might be your teeth too! Anyone want to do a study on that?

  • BPCveg

    Hats off to you, Dr. Greger, for an excellent article. Thanks for the very useful information.

  • beccadoggie10

    I’ve been avoiding sucking on fruit and drinking sugary or diet soft drinking for 50 years, but that did not stop me from getting cavities until I changed my diet to vegan to reduce pain and inflammation from osteoporosis. I have used fluoride toothpastes when brushing all along. But that did not alter the cavities received prior to going vegan.

    For me, eating dark leafy green veggies instead of consuming dairy seems to have reduced my cavities from one or two per visit to zero, which was noticed by both my dentist and periodontist. I’ve had no increased dental health issues from eating vegan, as well.

    • Melissa

      I find that very interesting, I have a son who is only four years old and he has nine cavities. At his last visit at about eight or nine months ago, he had no visible cavities. Everything I have read so far has led me to believe that to heal cavities one has to consume meat, dairy, etc. I find your comment encouraging and would like to ask if you would mind sharing your diet tips with me.

  • Arruniel

    Drinking a glass of water with fruit can help wash away some of that citric acid.

  • Paleo Huntress

    As a paleo template advocate, I’m not a supporter of the WAPF. But frankly, when the man found that the cultures eating diets containing SIGNIFICANT levels of animal protein and saturated fat were the ones with the least dental disease, it’s really hard to make an argument that saturated fat causes it- otherwise in those cultures eating more than 3/4 animal foods , we’d expect to find them toothless.

    Sorry Doc, this one doesn’t even get off the ground.

    • Guest

      Too funny: Just read the comments and look for her:

      • susan

        That was funny. It just shows that she was hunted down and called out for no reason–or, in other words, simply because she disagreed with others. That’s a shame but it seems that monotone policy is the way this works here.

  • Warren M

    I’ve been on a plant based diet for nearly 4 years. I’ve been able to go from a 6 month dental check up to a yearly check up. I think I could scale it back even more. The hygienist says my teeth look great, very little plaque. I think I’ve had one small cavity in that time. I don’t eat a lot of citrus though.

  • GoingVeganUK

    After 3 years on a plants only diet my husband’s chronic gingivitis has magically disappeared.This is something we were not expecting. Plants are curing inflammation in the gums which tells me that inflammation elsewhere in the body that we are not aware of is also being healed.

    • Thea

      I love stories like this! Thanks for taking the time to post. And your conclusion sure makes sense to me!

    • Paleo Huntress

      It took an entire three years? Forgive the criticism, its really awesome that the inflammation is gone, but the fact that it took three years is not exactly a ringing endorsement for pb diets.

      • GoingVeganUK

        Oh dear I should have been more careful in my wording! I should have said we have been eating a plant based diet for 3 years and my husband has just told me that his gingivitis has disappeared. He has recently been to the dentist and this brought to his attention that it was better. Sometimes when people have a condition that is intermittent they don’t immediately notice when it goes away.

        • Paleo Huntress

          ~nods~ I know just what you mean. Has it been three years since your husband last saw the dentist too?

          • GoingVeganUK

            Why are you so aggressive? Are you the Richard Dawkins of paleo food? I am simply posting an interesting anecdote on a site where there are people who may be interested.I am not trying to prove anything!

          • Paleo Huntress


            I once suffered a foot injury and ended up with plantar fasciitis that was pretty debilitating. I know that for months it was really obviously uncomfortable, but it faded away so gradually that I can’t say when it was actually healed. This is what I referred to when I said I know just what you mean.

            You said your husband had recently been to the dentist, and in thinking about how most people go once or twice a year, it occurred to me to ask if he’d been to see him prior to this last visit. This kind of stuff fascinates me and I like to try and suss out possible cause. I wasn’t trying to be aggressive, and I’m sorry if it sounded that way. I hope you’ll accept my apology.

  • A

    What helps me is brushing my teeth with a xylitol-based tooth paste like Tooth Builder or Squiggle Enamel Saver *before* eating sour fruit. Or simply rinsing my mouth with with a xylitol solution (xylitol plus water) after eating fruit, since brushing right away would destroy the enamel. There is a book on this topic called Kiss Your Dentist Goodbye, written by a dentist, if anyone’s interested.

  • Shanna

    I am very healthy vegan for 2 years and to me its being really frustrating, I am literally watching my teeth decay, I never had such horrible teeth health, my teeth is literally braking apart falling into pieces, right now I got a swollen grand in my neck and tooth pain in all corners of my mouth, its disgusting! I heard that washing with baking soda after eating might help, I will try.

    • Alex the WFPB dentist

      Are you having lots of dried fruits? They have very concentrated sugar thus can cause cavities if left in the grooves of your molars. How about honey or syrup, pop consumption? Lots of lemon or lime can lead to erosion. Washing with baking soda can help because it neutralizes the acids produced by the bacteria on your teeth when they convert dietary sugar to acid. The best thing to do, however, is be aware of sugar and acid consumption (vinegar, etc.) and keep it to a minimum.

  • Mery Daae

    ok, so if lemon is great, so is eating as many fruits as possible, so is apple cider vinegar, how do we do all this and not get the side effects? I seem to have improved the appearance of my teeth (whiter and smoother) with a plantbased diet, my gums are less inflammed and I guess less plaque buildup but I have higher teeth sensitivity and I think I might have developped 2 cavities in the short time (+-7months) Ive been plantbased. thoughts please?

    • Emily Jane

      Try taking vitamin k2 supplements. I take mk7 (menanoquine 7). It directs calcium into bones and teeth and away from arteries. I think the only plant-based food that contains k2 os natto.

  • Steve True

    Cheese neutralises acid in the mouth cheddar is the best, vegan cheese would be better because its slightly alkaline, rather than cheese made wiith cow milk which is slightly acid.

  • Krista

    By my knowledge, periodontal health in relation to cavities is not superficial. It has to do with an underlying deficiency of fat soluble vitamins – A, D, E, K. Talking about sugar/fruit/carbohydrates and their effects on teeth is really minimal in comparison to the importance of fat soluble nutrients which promote remineralization.

  • Puppy the Guinea Pig

    An alternative point to consider: could lack of Vitamin K2 in the diet be the reason for the observed dental erosion differences in vegetarians/vegans? To understand more, read about the old studies of dentist Weston Price involving an “X activator” -a vitamin like component he was finding in animal products that seemed to prevent dental carries! Today some nutritionists believe the “X activator” he was trying to understand was actually Vitamin K2. Vit K2 is mostly found in consumed animal fat products. K1 is absorbed from the greens we eat and there is much reason to believe that humans may not be able to turn K1 into K2 systemically, as some animals can. If this is true, then having healthy levels of Vit K2 are diet dependent and vegans are at greatest risk of deficiency. Fortunately there are oral supplements we can buy, but many people are not yet aware of this rarely discussed vitamin! I am vegan and I’m not taking any chances- I supplement with a Vit K2 capsule (and FYI Vit K2 is the same think as Natto and MK-7 mentioned in another comment).

    • Bob Dorris

      Has anyone experienced significant remineralizing of teeth using simply K2 while on a vegan diet, or have other good insights on vegan diet, Weston Price concepts & cavities? And, do you think that K2 can replace the the oil butter?

      I’ve been vegan for about 6 years, and feel great EXCEPT I’m having bad dental issues. Had an abscess & extraction about a year ago, and now starting to have similar pain in another tooth. I clean my teeth like crazy, so it must be dietary. I eat a ton of kale, broccoli, beans, nuts, whole grains, zero sugar, and have done that for years.

      Most dairy really congests me, and the idea of eating all the animal food recommended by the Weston Price protocol sounds like a prescription for heart disease & cancer, based on all the research shown here by Dr, Greger and elsewhere. However, losing my teeth like this isn’t very appealing, either.

      I’m temporarily doing the Weston Price protocol while trying to save a tooth. Afterward, I’m considering trying just taking the Cod liver oil & Butter oil daily in combination to a vegan diet (beans & grains included) to see if that strikes a balance between preventing tooth decay without being too much animal product.

      I’d appreciate any more insights from others who have worked through this issue with some success!

      • Puppy the Guinea Pig

        Hey Bob. I do not have any direct experience with correcting bad dental health via K2 supplementation- only a Vegan x 1 yr and doing preventative supplementation before it becomes a possible issue. Maybe some others will chime in.

        I did a search for studies on dental outcomes from K2 supplementation and did not find anything but Price data. I suspect many studies may be underway in dental education centers, but nothing is published yet that I could find.

        I understand why you are following what Price did- it seems to be some of the only data we have to go on right now and since he got good outcomes and we cannot for sure know all the involved components/factors it makes sense (there are like 10 versions of Vitamin K2- so does just taking Mk-4 and Mk-7 work? Or even just one of them? We don’t know yet.)

        I personally feel a reasonable strategy for Vegan people might be to make sure they are getting both currently available varieties of K2 supplements (Mk-4 the synthesized analog to what is found in eggs and Mk7- the bacteria formed version from Natto fermentation….maybe some strict Vegans would object to bacteria as source of the Mk7). There is also reference to adequate Vitamin D levels being important.

        Vitamin D supplementation is a hot medical focus right now: an easy blood test can reveal if you are in the therapeutic range or below normal and would benefit from supplementation. We are understanding more about Vit D levels as they relate to disease every day so its smart on many levels of health to know you have what medicine currently calls therapeutic blood levels and supplement if you do not. I’m not sure that there is a lab test yet to specifically test for Vitamin K2 levels- your doctor may be able to find out. There are many lab tests for Vitamin K in blood but that mostly relates to K1 and its role in clotting.

        Sorry I didn’t have any direct experience of study data to help answer this. I hope what you are doing helps.

        • Bob Dorris

          Thanks for the thoughtful response. Yes, it really seems that this is one issue for people following a plant-based whole foods diet that’s not very well covered. I just wish that the Price protocol wasn’t such a radical deviation from everything presented on this site. It feels like having to choose between tooth decay & heart disease!

          • Puppy the Guinea Pig

            I understand :) I think it will get better as more data is published, now that this is a big area of interest for many.

          • Bob Dorris

            Hey Puppy – Can you suggest a brand for the K2 – MK4 & MK7? Lots of different ones out there to sort through.

            BTW, I keep re-reading your & Thea’s posts. both have been very helpful. I’m leaning towards stopping the CLO & Butter oil and going with K2 and timing of rinsing & green tea mouthwash. (The CLO almost made me vomit yesterday. That can’t be good!)

            BTW, I’m trying out mactin gum. Studies have shown it to be pretty effective, as well.

          • Puppy the Guinea Pig

            So sorry my friend. I have not done my homework here. I pretty much just pick them up at the vitamin store on the corner.

      • Thea

        Bob Dorris: I don’t have an answer to your exact question, but I have some ideas for you that are relevant.
        First, I have also been vegan for about 6 years, and while it sounds like your diet is way healthier than mine, my teeth are not having the problems your teeth are having. I know lots of people who have been vegan for years and even decades and their teeth are just fine. I don’t think there is any evidence to support the idea that your diet (per say) is missing some key ingredient (K2) which in turn is causing your teeth to go bad.
        While I’m no expert, I can think of two potential explanations (not saying that either of these are correct. Just that these are potential explanations) for your current situation: one is that whatever problem you are having with your teeth, you would have had anyway, regardless of your change in diet. Another idea I have is the one touched on by this video and other pages on this site: Vegans who eat healthy foods usually include sour foods which end up softening tooth enamel. Brushing your teeth while your enamel is soften can result in the enamel being brushed away. You mention excessive brushing, which makes me think this is part of your problem. My dentist recommends brushing once a day. And using the advice on this site, you could make sure you brush at least an hour after eating anything. You might consider swishing with baking soda water after eating anything acidic or sour. And you might consider swishing (maybe even swallowing!) Dr. Greger’s recommended mouthwash between times/throughout the day to both kill bacteria and even help prevent plaque from forming in the first place.
        Second, I suggest that you think about the source of your information: The Weston Price foundation. That group is notorious for disseminating false information, backed by pseudo science and unscrupulous “experts”. They don’t even follow their founder’s advice (which was pretty much to be vegetarian). While even a stopped watch is right twice a day and thus maybe the Foundation knows something about healthy teeth, their track record suggests that you would do better to get your information elsewhere.
        If you want some proof about the flaws in the Weston Price website and their set of “expert opinions”, you can learn a great deal from the scholarly work done by Plant Positive. Here is the Plant Positive general website: Here are some videos that mention Weston Price: The first link is an entire video devoted to the topic of Weston Price. This second link is a general search of the site as there are multiple videos covering Weston Prince to various degrees. You might also just spend some time watching some of the videos in the various series in order. The researcher does an amazing job of debunking cholesterol deniers in general. Once you learn how easy it is to twist the science, you might find yourself questioning the information about teeth on the Price site.
        I recognize that your question was specifically on how to re-mineralize teeth and that I don’t have any ideas on that topic at this time. I hope others have (actual science-backed) ideas for you on that specific topic. At the same time, I hope my post has given you some ideas to work with. Good luck. Good teeth are so important. I hope you find some solutions that will work for you that don’t involve raising overall health risks.

        • Bob Dorris

          Thank you very much for your response, Thea. I checked out the material you referenced… good stuff.

          Do you think it’s likely that the Cod LIver Oil / Butter Oil / Weston Price protocol is very good at remineralizing teeth, but simultaneously very bad for our health otherwise?

          There’s so many positive review of the book I’d like to hear some thoughts from anyone here on why there’s so many positive comments about the book “Cure Tooth Decay” on Amazon that it seems likely that it actually is helping a lot of people with their teeth.

          • Thea

            Bob Dorris: You asked, “Do you think it’s likely that the Cod Liver Oil / Butter Oil / Weston Price protocol is very good at remineralizing teeth, but simultaneously very bad for our health otherwise?”
            The key word in your question is “likely”. I do not think it is *likely* that the protocol is very good at remineralizing teeth given how much the foundation gets wrong in so many areas. But I do think it is *possible* they got this one thing right. I don’t know enough to say any more than that. Instead, I submit to you: Knowing that those foods *are* simultaneously bad for our health otherwise, wouldn’t it be prudent to find another solution even if the Price idea is a possible solution?
            One more thought for you responding to your last sentence, “There’s so many positive review of the book … that it seems likely that it actually is helping a lot of people with their teeth.” There are also lots of people who give glowing reviews to books like say Grain Brain and Atkins’ book. But we know that the eating protocols in those books lead to bad long term health for the majority people, despite the many glowing reviews. So, I don’t think it is a given that many people are being helped by the book you referred to. (I’m not saying people haven’t been helped. I’m just saying that you can’t judge by Amazon reviews.)
            Best of luck to you. Eating food should be enjoyable among other goals, and it’s hard to enjoy one’s food with bad teeth!

          • Puppy the Guinea Pig

            I would just add to this that a VAST AMOUNT of reviews on amazon are now purchased/bribed through free product deals and services that go on behind the scenes (I have direct knowledge of this- I know the companies that offer these services and people who do the reviewing). The majority of our consumer public is not aware of this. Once upon a time, Amazon reviews were real and very helpful to consumers. Until sellers figured out that the positive reviews help their products in the search rankings…then the corruption began. I still utilize them for deciding between things like air conditioners by comparing the negatives. But I am sad to share that pages of glowing reviews on Amazon are highly suspect these days.

          • Thea

            Thanks for the info puppy. Good to know.

  • Katherine Toledo Macedo

    I’ve been vegan about 1 year and I never had cavities (caries) in my whole life. Yesterday I saw a small cavity in one of my molar tooth and I feel very upset. I started thinking about something that has changed in my routine because I don’t believe that is something wrong with my diet. (I always had a good diet with lots of plant based food, no much sugar and regularly brush my teeth.)
    So, I moved to the UK a year ago and I’ve stopped to drink water with fluorite (I’m from Brazil and they artificially fluoridate the water) and also haven’t been using toothpaste with fluorite since I moved.
    However, I’d like to discuss about the uses of fluorite for health. Because many people say that it’s terrible for your health, but I guess the problem is how much you are exposed (inside your body) by fluoride (ej drinking fluoridate water), not in the toothpaste. (water fluoridation in the UK:
    Now I started to look for vegan toothpastes with fluorite (for treatment and prevention) but it’s so hard to find. Why do some vegan people avoid products with fluoride? And why don’t the UK fluoridate the water?
    Obs: Vegan Brazilians also are against the widespread use of fluoride. I read some articles about cancer(?) and fluorosis (yes, this can be happen). But I agree with the NHS article bellow (
    Please, share your knowledge and experience with me. Thank you :)