dental decisions

Your Practical Guide For Dental Decisions – Part 2

A guest post by Eva Twardokens (the famous “Eva T.”): two-time Olympian, coach, and Registered Dental Hygienist

As promised in Part 1, I am going to elaborate on the basic advice I gave you there, and share with you the most important information I have learned in the last ten years of my dental hygiene career. This is information and advice I would give to my best friends and family.

Today, I will talk about periodontal disease, a prevalent and silent inflammatory inducer, as well as homecare tools and medicaments to make your life easier. I hope this information will help you through your dental journey with a little more empowerment.

Periodontal Disease 

Periodontal disease is the breakdown of the three supporting structures that hold your teeth in your jaw—the cementum, periodontal ligament, and jawbone. The cementum is mineralized connective tissue that covers the roots of the teeth and serves as an anchor for the periodontal ligament, which in turn suspends and holds the tooth in its bony socket and acts as a shock absorber to cushion the impact of chewing. The jawbone is of course, the foundation of your teeth.

A precursor to periodontal disease is gingivitis. This condition is characterized by inflammation of the soft tissue surrounding the tooth. However, while gingivitis is an infection, periodontitis is an auto-immune disease.

Destruction of the periodontium is caused by  an overactive immune system calling in white blood cells to the infected area. The white blood cells act on the culprit, but cause damage to healthy tissue as well. On a chronic basis this breaks down all of the periodontal structures, leaving gaps for more bacteria to accumulate. The deeper the gaps, or pockets, the more apt the bacteria are to become anaerobic (oxygen fearing), so they run for cover by going deeper and causing further damage.*

*How does one avoid this scenario? As mentioned in part 1, the first step is periodontal charting and getting your teeth cleaned at least three times a year.

Treatment of Periodontal Disease 

If you have periodontal probe readings less than 6 millimeters, the dentist might prescribe a treatment called “root planning.” The hygienist will inject a local anesthetic and then clean either half or one quarter of your mouth at a time. She will then do a deep cleaning with the goal of removing deep bacteria, plaque and tartar, and any dead or halfway healed tissue (granulation tissue). This will give your periodontium the optimum chance to heal, and your pockets a chance to shrink. This process will take two to four appointments.

If you have periodontal probe readings greater than 6 millimeters, the ability of the hygienist to reach areas greater than 6 millimeters deep is unlikely. Failure to reach the base of the pocket can stir bacteria up causing the shallow tissue to heal and tighten up and the missed area to become inflamed resulting in a periodontal abscess. At this point, you will probably need a referral to a specialist called a Periodontist.

The bottom line is to have healthy supporting structures to keep your teeth in your head! Create a milieu for healing and health through maintenance, consisting of regular visits to your hygienist and adherence to a daily homecare protocol.


Don’t think you are fooling the hygienist by flossing like a madman two days before your cleaning. She will know what you’re up to by observing the condition of your tissue, the amount of bleeding you have, and the amount and location of tartar and plaque buildup.

Statements like “my gums always bleed” and “my bad teeth are genetic” are just like saying “I have diarrhea every day” and “I am fat because my grandfather was.” Take some responsibility and realize that if your gums are bleeding there is an underlying problem; 99% of the time it will be residual plaque.*

*The difference between plaque and tarter are that plaque is removable and soft, whereas tartar is a calcified version of plaque, and occurs when plaque is left untouched for around 24 hours or so.

That is why the term “daily” is used—so you rid yourself of the debris on your teeth before it becomes a carpal tunnel situation for your hygienist!

Five Jewels of Prevention 

Mouthwash. First, do not use mouthwash in place of flossing. Most importantly, stay away from alcohol-based products, as the incidence of oral cancer is higher in folks who use alcohol based mouthwash than those who don’t. Alcohol-based mouthwash is also an irritant and also causes dry mouth. Stick to non-alcohol mouthwash if you decide to incorporate this into your daily regimen.

Tongue cleaners. Yes, a clean tongue is important, and tongue cleaners are good. However, you can save money by just dragging your floss down your tongue and cleaning it that way.

Fluoride. Many people fear fluoride. They say it causes their bones to get brittle, and won’t allow their children to have it. What I see in kids not getting fluoride is a lot of decay and lifelong visits to the dentist full of injections, fear, drilling, and pain. In the end, the trade-off is significantly poorer oral health for what amounts to a minute amount of fluoride.

What about adults and fluoride? Well, I see a lot of crown replacements in the folks that insist on “natural” toothpastes, and that involves the same kind of consequences. It is a cost/benefit situation similar to x-rays. A little of the perceived “bad” goes a long way for good!

For kids with undeveloped teeth, they must have some systemic fluoride (they must ingest it, so talk to your dentist for a prescription). For adults, topical fluoride is all that will work. I really like “ACT” rinse for everyone. Follow the directions on the bottle, please.

Toothbrush. Use a soft one, always. All other brushes are only good for scrubbing tile grouting and will scratch your teeth! Electric toothbrushes are great, but not the cheesy spin brushes. Sonic types are best, but don’t push too hard. You need to let them vibrate to work, so don’t squish the brush against your teeth. A “flute-like” grip is best.

Floss. The diamond of the jewels. The thicker and more yarn-like the floss, the better. The objective of a good floss is not that is slides between your teeth, but that it removes plaque efficiently once you get it there. I know Costco has cases of “Glide” for a great deal, but use it to sew up the holes in your socks, because this stuff is, for the most part, downright ineffective. I am not even going to debate this. So there.

Stay Tuned for Part 3

In Part 3 of this series, I’ll be talking about the materials that a dentist uses, root canals, and my thoughts on dental insurance—when and when not to take advantage of it.

Untitled13Eva Twardokens (also known as “Eva T.”) is a two-time Olympian and six-time National Champion in Alpine Skiing. In 2012, she was inducted into the U.S. Ski and Snowboard Hall of Fame. She graduated from Cabrillo College Dental Hygiene School in 2001 and has been practicing in a general dentistry setting for 12 years. She teaches her patients how to aquire oral health, and how good oral hygiene practices contributes to overall health and quality of life.

She is also the founder of Eva T. Strength and Conditioning, a consulting site encouraging  strength, health, and happiness through the integration of  lifestyle choices, exercise, and functional medicine.

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  1. Water Lily says

    My periodontal disease was horrible for a long time. I am doing quite well now. I recommend Perio Protect.

    Three years ago, I avoided a second $5000 periodontal surgery by spending $1200 on the Perio Protect plan. It has worked from day one, and continues to work. There ARE alternatives to perio surgery.

    The most important thing imo, is to avoid putting sugar in your mouth.

    Xylitol fluoride toothpaste and mouthwash has worked well for us, much better than fluoride toothpaste did (which is what I’d used for years during my horrible perio disease. Fluoride is a neurotoxin, and nobody should be putting it in their mouth.

  2. says

    I’d strongly encourage anyone who is concerned about their thyroid to research flouride before accepting any treatments as it is extremely toxic to the thyroid gland. And everyone, not just thyroid patients, should insist on a lead shield for both chest and neck during x-rays.

  3. Debra in Texas says


    Hm…turns out that I experienced much the same consequences living in a city that began fluoridating its water supply in the 1950s. What I see in this article is a mainstream viewpoint with no focus on diet or overall health, something I thought was the hallmark of Whole9.

  4. Glenn says

    The fact that flouride is recommended in this articles tells me two things 1) this article is designed for people who do not follow a paleo / whole 30 approach, as lack of processed food and starchy sugary foods creates significantly less (if any) plaque on teeth and thus the recommended dentist approach of using flouride is not needed and/or

    2) That perhaps the whole 30 crew decided to post this article because a friend of theirs wrote it opposed to actually beneficial information to our community. There is no world where Flouride is good for humans. Whether or not its specifically good for the teeth isnt an issue, there is abundance of information / studies showing how bad flouride is for people.

  5. Otto says

    I also stopped using fluoride since 1,5 year or so, since I was doing paleo. The dentist was very happy with the excellent health of my teeth and gums. Still the same amount of plaque though, thought that would have diminished but no change in that. :(

  6. says

    Folks, using fluoride is a personal decision, just like what you eat. Just like with “Paleo”, we have made a logical decision to eat the way we do because we see or do not see the benefits. That is what the Whole30 program teaches you. Just as we have seen many people recover from symptoms of disease with good eating, I have watched the folks that use fluoride avoid drilling and tooth decay, especially the kids. The kids who did not get fluoride were in the office for painful and unnecessary treatment.I simply saw it with my own eyes. I am not saying you must take fluoride, but give it some study. A small amount can help you avoid expensive treatment, drilling and anesthetic.
    Obviously, if you are sensitive to it do not use it. Make a logical choice for yourself.

  7. says

    Toni, The standard of care for x-rays is a shield with a thyroid collar.
    If your office does not use one, there is a big problem.

  8. Toni says

    I’ve always been automatically given the torso shield, but I’ve never been given a thyroid shield without requesting it myself, even at different practices. Clearly the docs here need to get up to speed. :-)

  9. Alisha says

    Kind of disappointed in this “series”. I also share the same sentiment as Glenn and Debra. I would have liked to see some info about oil pulling, hydrogen peroxide as mouthwash/whitener, the benefits of FCLO and baking soda/clay toothpowders instead of conventional toothpaste. While I am by no means perfect in the choices I make, I do make a conscious effort to look at the products I use in/on my body. And yes, I know this can be a never ending battle and you need to make choices that are right for you…but I think this is one area people are looking for more information on. Maybe you could talk to a dentist or hygienist that believes in these non-traditional ways of caring for your mouth. Just to get their perspective…

  10. Otto says

    Eva, do the kids who eat Whole30/paleo/Weston Price etc also get cavities if they do not use fluoride? Or are you talking about people on a ‘standard diet’?

  11. Water Lily says

    Everyone has to make their own decisions, but there are two sides to the story.

    Fluoride is an Ion of fluorine. Prozac (Fluoxetine) contains fluorine. Like I said before, fluoride is a neurotoxin.

    Tooth decay is from bacteria formed mostly due to a poor diet. If one eats well, there is no need for fluoride. My tooth decay and periodontal problems all happened while eating a high-grain, sugar- laded diet, AND using toothpaste and mouthwash WITH fluoride – at my dentist’s direction.

    Fast forward to today, where I have few dental issues – since giving up sugar and wheat, and using Perio Protect.

    It is highly irresponsible to recommend fluoride treatments for children.

  12. says

    Water Lily,

    Thank you for your opinion. I’m not sure how it’s relevant that Prozac contains fluorine – let’s not get sidetracked with fearmongering and irrelevant associations. We absolutely agree that a diet rich in processed foods and low in micronutrition is a primary driver of tooth decay and periodontal disease, and if you’ve read anything at all that we’ve written, you’ll already know that this is a focus for us. Eva’s perspective does not undermine or contradict the importance of a good diet in any way. You are certainly entitled to your opinion on fluoride, but I’ll respectfully ask you to provide evidence of your claims of irresponsibility before throwing stones like you did. I’ve read a good deal of research on this topic, and while I have some concerns of my own, I’m unwilling to hang my hat on the extrapolations, selected anecdotes, and general fearmongering of contrarians. I look forward to you providing some primary research that supports your claims.


  13. says

    Debra in Texas,

    I think it’s pretty unfair for you to say that we have “no focus on diet or overall health”. We’ve literally written hundreds of articles that focus on just that, and this article addresses an important and often underaddressed component of overall health. From my perspective, drawing attention to this aspect directly addresses and augments “overall health”, rather than detracts from it.

  14. says


    As I’ve said to other commenters, I’d be happy to discuss relevant research on this topic. Feel free to post links to research (not hearsay or casual opinion) here.

  15. Wendy says

    Hi Dallas,
    I’m not a scientific type person but this is only one page (of many) I’ve read on the subject of fluoridation and it has a large list of references at the end of the article which include links to scientific studies:

    It was great having an article on dental health on your site because it obviously is a big part of overall health that can be overlooked. But I was also surprised to have you quoting someone who says that children need to ingest fluoride. I know that Eva said this was through her personal experience (her opinion) but how many of those children followed a really clean diet and how many were just on the usual S.A.D.

    I do love your website, book and articles, keep them all coming!

  16. Mary Conover says


    Where in Eva’s article did you see the word “ingest”? Your big jump to “ingest” implies that you did not understand what was written and perhaps should think twice about commenting.

  17. Wendy says

    Hi Mary,
    I did read the article and here is the quote: “For kids with undeveloped teeth, they must have some systemic fluoride (they must ingest it, so talk to your dentist for a prescription).”

    It doesn’t get more clear than that, perhaps you did not read the entire article before you commented?

  18. Mary Conover says


    Thanks, I read it, but didn’t remember seeing it!! Elder forgetfullness possibly. I’m sure that Eva is backed by current scientific data on this subject that is not always available on the usual search engines. Eva T’s decades of experience with competent dentists, her intelligent and informed research and writings on her web site, and her devoution to Whole9 and a healthy life-style speak volumes. I would trust her with this information.

  19. Wendy says

    Thanks Mary. From what I’ve read, I still don’t like the idea of ingesting fluoride but I enjoyed the rest of the article, (especially since I’m going to have my teeth cleaned today & haven’t been flossing enough!)

  20. Glenn says

    Hi Dallas,

    Thanks for the response. By posting this article on your website it shows that you endorse the thoughts and recommendations of the writer. Is it Whole9’s recommendation that kids eating a paleo diet, low in starches, sugars, and no processed food should ingest and or apply flouride to their teeth? I know I go to great lengths to get it out of my water supply and toothpaste.

    Also I would love to discuss any research that was in this article that pertains to Flouride.

    I feel like the ball was dropped with the posting of this article. I always refer my friends to this site and I would hate them to think that Flouride is a great thing for their kids and/ or themselves. Keep up the great work otherwise. You have certainly changed my family’s eating and health for the better. (i.e. A family member did a Whole 120 and couldnt believe how their health changed for the better during the process. Its all thanks to you guys.)

  21. Craig Jones says

    Hello All,

    It is interesting to read the ongoing debate regarding fluoride. As a practicing environmental scientist dealing with toxicity in a number of water quality issues, it inspired me to look briefly into the literature. While there is published research showing fluoride affecting bone development, the concentrations of fluoride in the case studies investigated out were much higher (many times) than the concentrations allowed by the USEPA (0.7 – 1.2 mg/L). Additionally, cases where calcium deficiency was observed were in actual fluoride poisoning cases (the big one in India). Other acute cases were reported where kids basically ate a tube of toothpaste. I bet we can compare that to kids drinking the bottle of detergent or bleach and find fluoride actually has pretty damned low toxicity in accidental ingestion cases.

    The USEPA regulatory guidelines were also reviewed by the NAS and HHSD. All of these organizations (conspiracy theorists aside) have some pretty talented researchers digging deeply into the larger literature and scientific research. My conclusion, even on a brief literature review, is that the regulatory concentrations are much lower than anything I would ever worry about for my children.

    On a practical and personal note, I grew up in Texas and Oklahoma where fluoride was used in water at higher concentrations during my childhood. Maybe genetics or genetics and fluoride as a kid, but I have one filling and my dentist has nothing but praise for my teeth. At 41, plenty healthy with no bones lost (only broken bone was a lost finger likely not related to fluoride calcium deficiency).

    I think as Eva and Dallas clearly stated, its up to you to make your own choice. If you are scared of fluoride, stay away. If you choose to follow clinical research that shows low acute exposure to fluoride has direct benefit to dental health with no demonstrated chronic effect … Go for it!


    P.S. Seeing the emergent contaminants in our household environment, toxicologist colleagues of mine scare me much more with what’s being seen in things like flame retardants that are very likely coating the chair you’re sitting in, bed you’re sleeping on, and mandated by federal law in some commercial applications. Its has been demonstrated in epidemiological studies to reduce fecundity. When was the last time you remember taking any benefit from a flame retardant? The citizen advocate scientists I know ain’t worried about fluoride folks.

  22. says

    Standard diet or paleo- what surprises me is is the poor oral health I have observed in folks doing all the right things as far as diet and lifestyle are concerned. That being said, for everyone, prevention is key and context matters.

  23. Hilary says

    I have no comments about my thoughts on this article or fluoride. But, I am disappointed in Dallas’ reactions to other’s thoughts on these topics. I do see some evidence of restraint in his response to Water Lily, but it was still a complete turn off to me (and I’m a fan of Whole9/30). I have a master’s degree in Conflict Resolution and many certifications, so I am an authority on the subject. I think Mark Sisson takes a great approach to let his readers hash it out and rise above it all, rather than dropping to the level of argumentation. I would encourage Dallas to not get emotional about it. Calling someone’s thoughts “irrelevant” and accusing them of “fearmongering” (even if it is true) is not going to win more supporters or lend itself to an air of professionalism. In life, reputation is often as important as your ideology.

  24. says


    Dr. Mercola is the Dr. Oz of natural/unconventional/contrarian information; that is to say utterly useless to me as a valid source of legitimate, respectable information. That being said, the key point that most anti-fluoride activists miss or gloss over is the dose-response concept, central to toxicology. Yes, high-dose fluoride in mammals in the context of mineral imbalances and/or deficiencies is problematic, but that cannot be extrapolated out to say that all fluoride is problematic for all people.

  25. says


    Thanks for your comments. To clarify, I did not call a commenter’s thoughts “irrelevant”. I commented that whether Prozac contains fluoride or not is irrelevant, and I asked the commenter not to fearmonger, which I feel is a reasonable thing to ask on one’s blog. Other bloggers may choose not to respond to criticisms or public attacks, but that sort of defeats the purpose of allowing blog comments altogether, IMO. Perhaps we should simply take Seth Godin’s approach: or Sam Harris’ approach instead:

  26. Toni says

    Could tea be rich in fluoride because it is often brewed using FLUORIDATED WATER? Maybe?

    Just a guess.

  27. Hilary says


    You do make some interesting points. However, you are not just a blogger. You are a respected member of the Primal/Paleo community. You are what I would consider a professional in the area of Paleo life. As a professional, it is important to conduct yourself in a professional manner. I can tell from your responses that you let things get to you on an emotional level and respond from a restrained but emotional place. I would encourage you to not let my response (or anyone else’s) make you upset, and to try to avoid arguing or responding from an emotional place with your commenters/followers. When you use pragmatics that include words like “unfair,” “irrelevant,” and “fearmongering” you are putting your readers on the defensive. You can respond to your followers/commenters, even misguided ones, by using less emotional and more considerate/respectful communication. Your followers will only respect you more for it. You have set yourself up for considerable future success, don’t stand in your own way!

    Just food for thought… Best wishes to you in your blogging future.


  28. says

    Eva, thanks so much for this I found it really useful and quite frankly fascinating. I’m always intrigued in what a qualified dentist thinks of fluoride as there certainly is a mixed reaction to it in many areas. I’m of the belief that it’s beneficial if used in the right way. As you put the benefits outweigh the small cost in this scenario.

  29. Water Lily says

    My previous comments were merely my opinion, which I formed by doing extensive research into both sides of the issue. In no way was it intended as “fearmongering.” Many people don’t know the chemical makeup of fluoride, and knowing that fluorine is a component in an SSRI drug as well as in fluoride dental medications might peak their interest to do some research.

    When I comment on a blog, I don’t think it’s necessary for me to list all of the research I’ve done that assisted me to reach my conclusions in order to back up my comments.

    I’ve been around the Whole9 and Paleo/Primal community for years. The frequent demand for scientific evidence when an opinion is given in a blog comment can get downright wearisome and disappointing. I have neither the time or inclination to get into a scientific discussion about fluoride. If people are interested in learning about it from all points of view, then they are free to do that themselves. We’re all adults here.

  30. Daniel Schaefer says

    As a dentist myself i would say there is no inconsistency between different dentist in question of fluoride, everyone working based on evidence-based medicine know that fluoride is beneficial. When it comes to side effects, it only applies if you swallow it or taking it as a supplement. And to swallow the toothpaste would just be stupid.

    I would like to see a single well performed study where it was possible to demonstrate that normal doses fluoride, that is not swallowed down, could be dangerous for an adult.

  31. Brendan says

    Fluoride strengthens tooth enamel, reducing the risk of cavities and fillings. It does nothing to kill bacteria or promote healthy gums. If you don’t remove the bacteria and sugar, the gums and jawbones get diseased, and your nice hard strong teeth will fall out.

    If you do effectively and consistently remove the bacteria and don’t eat sugar and starch, strengthening the tooth enamel is not as important to preventing cavities and fillings.

    The slick effects of fluoride on the tooth enamel can reduce adhesion of gums to the teeth, increasing recession, pockets, and consequently bacteria in the gums and jawbone.

    Doctors like easy one-size-fits-all answers from $$$well perfomed$$$ studies. They usually work for most people.

  32. Amber says

    I’m a dental hygienist as well, and I’d have to disagree with how confidently Eva promotes fluoride as a cure all for dental decay. Most of my patients use fluoride toothpaste, and yet many of them continue to get new cavities. I think a healthy diet is far more important than fluoride.