Do Vegans Get More Cavities?

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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.
      http://tinyurl.com/m9rrazn

      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:

      http://nutritionfacts.org/video/changing-our-taste-buds/

      • 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

            GoingVeganUK,

            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.