11 Research-Backed Tactics to Improve Your Teeth and Gums

My dad lost most of his teeth in his ’20s. Growing up, I remember him warning me to take care of my teeth or I’d end up like him. After this, he’d usually drop out his false teeth and scare me with 4 rows of choppers.

The experience made an impression and I swore to take care of my teeth. But even with my two brushes a day, religious flossing and liberal use of mouthwash, I have dental issues.

While I do have all my teeth (for now), over the past year I’ve had 7 cavities filled. I also have significant gum recession and am a gum graft candidate.

It’s frustrating to feel I’m doing everything right without the expected results. I would give up but dad scared me straight.

So I dug into the peer-reviewed research. I wanted to find scientifically proven ways to improve the health of my teeth and gums. It turns out there is a lot more I could have been doing. Here’s what I found (or view the results in this spreadsheet):

Diet

1. Switch from coffee to green tea. This is a double whammy for me. Coffee has high acid levels which is bad for tooth enamel. In a Japanese study, researchers found that green tea reduces periodontal pocket depth. Green tea also reduces attachment loss of gum tissue and bleeding on probing of the gum tissue. Researchers believe catechins within green tea are the cause. To maximize catechins, steep your tea longer, avoid decaf varieties and go for loose leaf. Also avoid green teas with added flavors like lemon as these are acidic and wear down tooth enamel. If you must drink coffee, do it through a straw.
2. Avoid ice tea, black tea, fruit tea and herbal tea. Not all tea is good for teeth. A systematical review of 8 articles showed green tea and black tea to have a non-erosive effect. Erosive effects were shown for ice tea, fruit tea and herbal tea. Another study showed an erosive effect for black tea. To be safe, avoid black tea along with the herbal and ice teas.
3. Upgrade to manuka honey. When you start drinking green tea, avoid sugar and go for honey as your sweetener. Not all honey is created equal and manuka honey has the most health benefits. This honey reduces plaque formation as well as chlorhexidine mouthwash and better than xylitol chewing gum. Be sure to get the UMF 15+ rated manuka to experience the plaque reducing benefits. Here’s the one I use and I love it.
4. Avoid fermented foods. This was a tough one for me. Fermented foods are great for gut health which is why I always had sauerkraut and kimchee in the fridge. But the fermentation process also results in an acidic pH. This acidic pH in fermented foods sustains the low pH in plaque. Tooth mineral loss results. Other acidic foods I’ve cut out include apple cider vinegar and vanilla flavored almond milk.
5. Eat salmon. The omega-3s in salmon and other fatty fish can reduce gingival index, sulcus bleeding index, pocket depth and attachment loss. Wait for a sale and stock up on wild salmon. If you go the supplement route, my vote is krill oil which is much more effective than your standard fish oil. Here’s the one I use.
6. Eat onions, mushrooms and chicory. These foods are great at killing cavity-inducing bacteria in the mouth . This study discusses the potency of shiitake mushrooms and red chicory (also known as radicchio). And this study discusses the effect of onions on bad bacteria.

Dental Regimen

1. Wait 30 minutes before brushing. If there is a bad time to brush your teeth, it’s right after a meal. If there’s a worse time to brush, it’s right after an acidic meal. What’s happening when you brush too soon after eating? The brushing pushes acid on your teeth deeper into the enamel and dentin. Not good. So wait at least 30 minutes after eating before you brush.
2. Use a WaterPik. I love my WaterPik. Love. WaterPiks remove 99.9% of plaque after 3 seconds of use. They are more effective than string floss for removing plaque. They are two times more effective than string floss for improving gum health. And WaterPiks are 51% more effective than string floss at reducing gingivitis. Here’s all the research. Use the PikPocket tip to clean periodontal pockets. The classic tip is used for 3 seconds between each tooth. And use it before brushing your teeth so you don’t wash away fluoride.
3. Use an oral probiotic. Probiotics are not only for digestive health. Certain strands of probiotics reduce gum bleeding, plaque formation, inflammation and bad breath. Probiotics stimulate bone formation which helps repair bone loss from advanced forms of gum disease. The results of a 76 person study indicates the use of salivarius M18 strain increases the chances of avoiding new dental caries in children. Here is the probiotic I use once daily after my evening mouth wash.
4. Add some Aloe. Applying aloe vera gel to enflamed gums and periodontal pockets can improve conditions. Aloe vera mouthwash was also shown to be as effective as chlorhexidene in reducing Plaque Index (PI) and Gingival Index (GI). The neat thing is aloe vera is edible so try working it into your morning shake in addition to mouthwashes and gels. You could also put aloe into a WaterPik and use the Pik Pocket tool to reach below the gum line.
5. Buy an electric toothbrush. Cochrane.org did a meta-analysis on the efficacy of manual vs. powered toothbrushes. Powered brushes showed a 21% reduction in plaque after three months of use. There was also an 11% reduction in gingivitis after 3 months of use. I swear by my Oral-B electric toothbrush.
6. Floss. It turns out there is little research on the long-term efficacy of flossing. I did come across this study which saw reduced bleeding and bad bacteria in those that flossed over a 2-week period. The evidence is not overwhelming but enough for me. I floss every night and recently switched to a floss recommended by my periodontist. It does a better job of catching plaque rather than gliding over it.
7. Use NovaMin toothpaste. I’ve been using fluoride toothpaste but studies show that NovaMin infused paste is more effective. NovaMin is a synthetic mineral composed of calcium, sodium, phosphorous and silica releases deposits of crystalline hydroxyl-carbonate apatite (HCA) structurally similar to tooth mineral composition. One study showed NovaMin appears to have a greater effect on remineralization compared to fluoride. I found a few other Novamin studies but it’s unclear if they are peer-reviewed. They speak to NovaMin effectiveness in reducing sensitivity and improving gingival health.
8. Use a tongue scraper. While I don’t have bad breath (nobody has told me I do), I figure a tongue scraper is cheap insurance. Six bucks on Amazon and a few scrapes a night can prevent halitosis.

Extras

Besides the research-backed upgrades, there are best practices I’ve implemented. These best practices are based on common patterns among dental website advice and speaking with my own dentist and periodontist.

• Use a gum stimulator to massage and stimulate gums and to remove plaque and food that brushing and flossing missed. I was amazed that even after my nightly regimen of brushing, flossing and water pik, I still found stuff in my gum pockets and in between teeth using this inexpensive tool. It is an absolute game changer.
• Brush your teeth first thing when you wake up in the morning. This protects your teeth before your first meal of the day. Try to wait 10 minutes before eating or drinking anything.
• To avoid bad bacteria growing on your toothbrush, rinse it with hot water and replace it every 3 months.
• Use an alcohol free mouthwash containing fluoride. Removing alcohol will avoid gum irritation. I use ACT mouthwash.
• Don’t rinse your mouth after brushing or using mouthwash. You want the fluoride to stay on for at least 10 minutes to mineralize your teeth.
• Floss before brushing. When you floss, small holes open in the teeth. When you brush, the fluoride can soak into the pores created by flossing.
• Use ‘C’ technique for flossing and Bass technique for brushing.
• After brushing and flossing, use a GUM disclosing chew. This identifies the plaque you missed. It’s a great feedback loop to know whether your technique is improving. Don’t do it every day. Once a week is fine until you are comfortable with technique.

My goals in writing this were to 1)organize thoughts on my own dental strategy, 2)help others who are looking for credible research/products to improve their dental strategy and 3)get feedback and ideas on how else I can improve my dental strategy.

If you have ideas, please share in the comments. I’d love to see links to research if possible :) I’ll be updating this post when I find new useful research.

Revisions

8/2/17 — Added second aloe vera study on effectiveness of aloe mouth wash

8/6/17 — Added systematic review on teas erosive effects and single study on teas erosive effects. Also added ‘diet’ section for avoiding herbal, ice, fruit and black tea.

8/29/17 — Added Novamin toothpaste with study 1 and study 2 to ‘Dental Regimen’ section. Also added a study about effectiveness of oral probiotics.

9/27/17 — Added tongue scraper with the halitosis reduction study.

10/3/17 — Added to drink coffee through a straw. Thanks Zach Stein for the reco!

10/24/18 — Added gum stimulator to extras section. Thanks to Anthony Ramos for the reco!

UPDATE 9/27/17: I published this post shortly after visiting my dental hygienist for a cleaning. He told me I had plaque and deep gum pockets. I was frustrated but determined so I dove into the research and came up with this post.

I’m thrilled to report that I had my dental checkup yesterday and the hygienist sees significant improvement. Specifically, all gum pockets with depths measuring 5 or 6 have shrunk 4 while several gum pockets with depths measuring 4 have shrunk to 3! In addition, he sees barely any plaque or hard deposits on my teeth. He only spotted some on my lower middle 6 teeth and my wisdom teeth. He also recommended getting a tongue scraper to remove bacteria on the tongue. On his pseudoscientific scale of patient mouth health, he gave me a score of 4/10 on my last visit and 8/10 on this most recent visit!

Undoubtedly this regimen is working extremely well for me. But I still do not know which aspects are working well and which aspects are making no difference. I implemented everything at once. So I will begin taking variables out and measure the results.

The first candidate is my oral probiotic. The research is solid but this probiotic is the most expensive part of my dental health regimen. I will remove it for the next 3 months and report back here with my December results.