Dentistry with Dr. John Sorrentino: The Root Cause Behind Tooth Decay

Tooth-BacteriaAs a practicing clinical dentist for more than 20 years, I have had many experiences and want to share with you some of my ideas about how to better treat dental diseases. Going to the dentist is an activity that has been engrained in us since childhood. The American Dental Association recommends that everyone see a dentist twice a year. Why is this so, and is it really necessary?

Although dentists today do much more, there are basically only three diseases we treat:

  1. Tooth decay (scientifically called “caries”)
  2. Periodontal (“gum”) disease
  3. Malocclusions, or crooked and overlapped teeth

For all of recorded history, these three diseases have been fairly common in human populations. In dental school, students are taught in detail how to manage and treat these conditions. I was content doing that for a long time, but then I was exposed to some facts that changed the way I looked at disease.

A wise man once said that just because something is common does not mean it is necessarily normal. Since dental disease has been around since the beginning of recorded human history, we have records of disease and treatment going back to the time of the Egyptians and Ancient Babylonians. This makes dental disease common. Unfortunately the paradigm of treating it rather that understanding what caused it became established, and civilization after civilization has had to deal with decay, gum disease and the rest. From the Babylonians, Egyptians, Chinese, Greeks, Romans, Middle Ages and through today, it is a given that decay just happens.

Here is a major truth bomb: NO ANIMAL ON THIS PLANET EATING ITS NORMAL DIET GETS DECAY. Period. Yet we are animals, and we get decay. Connect the dots. See where I am going here?

Sometime in your first year of dental school, they show you a Venn diagram that looks like this:


Tooth decay is the interaction on the teeth between bacteria, which is naturally occurring in the mouth, and fermentable carbohydrates. In a healthy person, nothing else is involved decay. As a dental student, they drill this stuff into your head to the point where it haunts your dreams. What they fail to do is make the case that carbohydrates are not an obligate nutrient for humans. Dentistry has done an excellent job of getting the message out that sugars cause decay. What we have failed to do is get people to understand that starches are metabolically the same currency. The fat phobia that started in the second half of the twentieth century that continues today has only compounded the problem as people have replaced healthy fats with carbohydrates. When viewed this way, the solution is self-evident: Carbohydrate restriction.

Why am I so certain and how do we know this? Several lines of evidence converge to lead to this conclusion.

Clue 1

Back in 1990 when I was a newly minted dentist, I had a friend that was working on a Ph.D. in anthropology and human evolution down at SUNY Stony Brook. Since tooth enamel is the hardest substance in the human body, it is most likely to survive, and my friend spent a lot of time studying it. My friend gave me the understanding that humanity is 2 ½ million years old and gave me a tour of the “skull room” at his school. I was amazed that every single skull in that room was over 10,000 years old yet demonstrated a full complement of 32 teeth with no decay, impactions or gum disease. We had remarked on it but thought no further about it for 20 years.

My friend’s name is Dr. Peter Ungar. He is now the chair of the Anthropology Department at the University of Arkansas, world-renowned experts on dental micro wear and the author of numerous publications on the subject, including a book titled Evolution of Human Teeth, the Known, Unknown, and the Unknowable.

Clue 2

Dr Weston Price’s book Nutrition and Physical Degeneration is a tour de force that documents the results of ancestral diets. Most convincing are his pictures of large families that document healthy teeth in older kids while the younger ones, on a modern diet of rice, wheat flour and sugar (or as he termed it, “The displacing foods of modern commerce”) are crooked and riddled with decay. You can actually tell within a year or two when the family stopped eating a traditional diet. This would also suggest that excessive carbohydrate consumption might be linked to growth disorders that lead to malocclusion and need for orthodontics. Unfortunately for the world, Dr. Price took a few stands in dentistry that made him (not entirely without cause) unpopular. Compounding the problem, his book was published on the eve of World War II. This was a notoriously bad time for science, unless you happened to be working on rockets or jet engines.

More evidence may be found by looking at current populations, such as the Inuit of the far north or the Masai of Africa. While the traditional Inuit diet contains very little plant material and is heavy in fish and sea mammals such as whales and seal, the Masai eat tubers as well as cattle and some dairy, nothing from the ocean. The Inuit have almost no fiber in their diets. The Masai have some but not nearly as much as we are advised to eat, so this does not appear to be the issue. Neither does much sugar, refined or otherwise. No surprise that both groups living thousands of miles apart in completely different climates, but both have perfect teeth.

Clue 3

The work of Dr. Ken Southward and The Systemic Theory of Dental Caries is a somewhat wonk-ish and esoteric work, but it firmly shows that dental decay is the result of a chronic inflammatory response. It also demonstrates that the dental profession is working with an incomplete understanding of what causes decay and the body’s protective mechanisms. Did you know that the parotid gland has an endocrine function and is a dual use gland like the pancreas? Me neither, and I have a degree in dentistry. It is not taught in dental school but to make a long story short, the parotid gland secretes a hormone that helps teeth fight off plaque. Want to guess what blocks that hormone signaling at the level of the hypothalamus? That’s right, sugar! If you read the article you will also have a greater understanding of how fluoride use became prevalent in dentistry and why it may be useful but is generally not needed. I will have more to say about this in the months ahead.

Link these three lines of evidence, and it becomes clear that dental diseases are in fact Neolithic diseases. Modern dentistry is designed to treat these conditions and sees them as somewhat “normal.” I have spent a considerable amount of time and energy trying to convince dentists of our need to change, but you, as a consumer of dental services, are the vanguard of that chance. In the months ahead, I will have plenty to say on these and other subjects in the sphere of dentistry.


About Dr. Sorrentino

Dr. John Sorrentino started his dental practice in 1991 with a commitment to patient care through education. He believes that with proper care, everyone can maintain their teeth for a lifetime. Dr. Sorrentino grew up in the Hudson Valley. He received his Bachelor’s degree from the State University of New York at Binghamton and his Doctor of Dental Medicine (DMD) degree from the University of Connecticut School of Dental Medicine. In 2003, he was awarded a Fellowship in the Academy of General Dentistry. This award is earned by less than 5 percent of all general dentists and is symbolic of Dr. Sorrentino’s commitment to life-long learning and bringing the highest quality dental care to his patients.

Dr. Sorrentino is a member and past president of the Dutchess County Dental Society. He is also a member of the New York State Society of Forensic Dentistry and was actively involved in the identification of victims of the World Trade Center disaster and Flight 587. In addition, he was selected as a co-director of the National Evolutionary Synthesis Center’s Catalysis Meeting titled “Evolution of Human Teeth and Jaws.”

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Evolution of the Human Diet: The Known, the Unknown, and the Unknowable Weston A. Price's Nutrition and Physical Degeneration
Peter S. Ungar’s Evolution of the Human Diet: The Known, the Unknown, and the Unknowable book Weston A. Price’s Nutrition and Physical Degeneration

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