The Calculus of Tartar
OnThe first recognizable toothbrush, comprising hog’s hair bristle embedded in a bamboo handle, was constructed by an unsung Chinese genius some 1000 years ago. The historical roots of tooth care run, however, far deeper. 5000 years ago, the Babylonians and Egyptians were keeping their teeth clean with chew sticks made from the twigs and roots of Salvadora persica.
That plant, widely known as the Toothbrush Tree, is still in use to this day.
S Persica has a wide range of medicinal properties (ie 1) and the chew sticks, called Miswak or Siwak, are just about as good as modern toothbrushes (ie 2-4). Sorry, Oral-B. The hero ingredient is benzyl isothiocyanate, an antimicrobial compound (5) also found in brassica vegetables, which enhances the activity of oral lactoperoxidase (6).
This is a natural (and nature-identical) way of maintaining a healthy oral microbiota; and because it primarily works by enhancing local innate immune defenses, it has little effect on symbionts. It is far more selective than today’s more potent but also more indiscriminate antimicrobials such as chlorhexidine, which come with broad spectrum adverse effects (ie 7).
Chew sticks are also traditionally cut from R vulgaris, L trifolia and the neem tree. These sticks contain compounds active against inter alia Strep mutans (7, 8), an important bacterial cause of tooth decay. But although our ancestors clearly knew a thing or two about oral hygiene, not everyone subscribed to it.
Below are a set of 2000-year-old South American teeth which do not seem to have encountered any chew sticks at all and which, as a result, show a good deal of tartar, aka calculus. (Although no caries that I can see, indicating that the local hunter-gatherer tribes of the time consumed little if any sugar).
Through the tartar, and through time, those teeth talk to us. They talk, very specifically, about their previous owner’s diet.
The analysis of tartar shows the signatures of many different bacteria, the proportions of which are linked to dietary inputs such as vegetable and fruit intake (9). Even more directly, it contains identifiable plant micro-debris such as pollen, starch granules, phytoliths, plant fibers and phytochemicals, and animal micro-remains including hairs and feather barbules, together with markers of dairy products such as lactose (10, 11).
Some background dietary data can already be extracted from bones. Carbon and nitrogen isotope ratios provide general information about overall intakes of seafood vs plant food, and animal vs plant proteins; the investigation of tartar, a sort of fossil you make in your own mouth while alive, provides additional detail.
If you add to this the analysis of middens, coprolites, blood traces left on stone knives and the designs of grinding stones and fireplaces, it is possible to get a very good idea as to what our ancestors ate.
Such a study of the first Roman settlements (10), for example, in an area in central Italy first colonized 3000 years ago, revealed a population which grew a wide variety of cereals, vegetables, legumes and herbs, raised meat animals and poultry, hunted, caught fish, kept bees, drank beer and wine, snacked on olives … who consumed, in other words, the ur-Mediterranean diet. This is entirely consistent with early texts such as Homer’s Odyssey, referred to in a recent post (12).
(The scientists who generated this paper are based at La Sapienza, one of the oldest and most architecturally chaotic of universities, and one I am very fond of. One of my proudest possessions is a Sapienza necktie, gifted to me when I lectured there in 2017.)
The same team of researchers investigated the diet of the early Phoenicians (13). Others have used tartar analysis to characterize the diets of Neanderthals (14) and, going even further back in time, some 1.2 million years, the diets of the earliest European hominids (15).
Taken together, these findings provide a fascinating insight into our historical consumption of, amongst other nutrients, the omega 3 fatty acids.
The Sapienza team, for example, found traces of EPA and DHA derivates in ancient Roman tartar (10), and linked it to their high consumption of seafood and garum. Garum, as gourmets know, is a condiment made from fermented fish guts. This might not sound appetizing, but the taste is half-way between soy sauce and Thai fish sauce and it adds delicious umami notes, if handled with care.
Not everyone has access to fresh or even fermented fish. Algae, which are the source of the omega 3’s in all seafood, are more widely available. They have a longer shelf life, and are more easily transported.
A multidisciplinary team of historians, archeologists and biologists from 6 different European countries (7 if you include Scotland) has just published a wonderful and very scholarly paper on traditional consumption patterns of marine and fresh-water algae (16). It changed my views about the consumption of omega-3 HUFA’s in human history.
The scientists identified a group of biomarkers in tartar linked to algal consumption, which included specific alkyl pyrroles and some slightly less specific lipid derivatives. (An additional set of putative amino acid markers was, I thought, unpersuasive).
They studied human remains from 28 European sites, some far from the ocean’s current boundaries, and found algal biomarkers in tartar from 15 sites. This indicated widespread consumption of marine, intertidal /estuarine and freshwater macroalgae, and possibly microalgae also.
Some of these algae are significant sources of omega 3 HUFA’s. The microalgae Crypthecodinium cohnii and Schizochytrium species produce large amounts of DHA, rather less of EPA (ie 17). Both species grow in brackish water, and the Schizochtyrium species in particular grow well in fresh water (17, 18). Other macroalgae (seaweeds) are good sources also (19).
Our history of consuming such foods can be seen not only in our teeth, but also in our genes.
Consuming extremely large amounts of omega 3 HUFA’s (as did the Inuit) creates an evolutionary pressure to reduce the activity of the FADS genes (20), which code for the elongase and desaturase enzymes that catalyze the endogenous synthesis of the HUFA’s.
People from traditionally vegetarian populations, from tropical zones where cold-water omega 3 PUFA’s do not occur, and from inland areas where seafoods are not consumed, have FADS variants which are more active (21, 22). This improves their ability to produce HUFA’s from the essential fatty acids LA and ALA in plant foods. Those from coastal but non-Inuit communities are likely to be intermediate (23).
One reason the genetic gradients are not as steep as they might otherwise be, is likely because even inland, consumption of marine and fresh water algae containing omega-3 HUFA’s (and plant seed oils and freshwater algae such as spirulina which contain the omega-3 intermediate stearidonic acid), may have blunted the evolutionary pressures to up- or down-regulate FAD activity.
Which brings us back to oral health care, both ancient and modern.
The tool-fashioning Neanderthals (24) used toothpicks (25), patched their cracked teeth with beeswax (26) and displayed excellent oral hygiene, as shown by their lack of periodontal disease (27). Their stone age tartar tells us that they chewed the bitter roots of Cyperus rotundus, a plant which contains actives that inhibit Strep mutans, likely to keep their teeth healthy (28).
In an age before dentists our ancestors understood, somehow, the importance of brushing, if not flossing.
We do too, even more so because periodontal disease has been linked not only to tooth loss but also to increased risk of neurodegenerative disease (29, 30) and a range of cancers (31). And we have learned that if we wish to prevent periodontal disease, and protect our oral and general health, we must stop the vicious cycle of oral dysbiosis.
The gum line is intrinsically vulnerable to dysbiosis. It provides shelter and food to a wide range of bacterial species which happily settle there and, via chronic inflammation and resulting tissue erosion, deepen the gingival pockets and corrode the dental ligaments.
Falling levels of oxygen in the deepening pockets encourage the growth of gram-negative proteolytic anaerobes, and the destructive process accelerates. These and other bacteria produce acids which leach minerals from dental enamel, which encourages the formation of mineralized plaque (aka tartar), which provides the bacteria with extended shelter (32, 33).
Standard oral hygiene is generally insufficient to break this cycle, partly because it relies on a very restricted selection of actives. In my experience, a pharmaco-nutritional (and hence multifactorial) approach to oral ecological management yields better results.
Such an approach combines actives which inter alia inhibit chronic inflammation, prevent adhesion of pathogens to dental surfaces (an action which reduces plaque and thus tartar formation), rebuild dental enamel and positively modulate the oral microbiota.
It starts with the systemic delivery of omega-3 HUFAs with their polyphenol chaperones, a combination which packs a potent anti-inflammatory punch. Add the topical delivery of anti-adhesins such as the fucoidans (34) and additional polyphenols (35). Apply a promoter of dental re-mineralization such as the peptide Matrix SAP11-4, which is more effective than even tricalcium fluoride phosphate varnish (36).
Finally, throw in a pinch of benzyl isothiocyante – remember the toothbrush tree? – to ensure that lactoperoxidase, the mouth’s natural microbicide, is keeping the microbiota in order. (I will write in more detail about this fascinating enzyme in a future post on antibiotic resistance).
Completists should also consider the other end of the gut.
Colonic dysbiosis is linked to an increased incidence of autoimmune disease (37), and recent research finds, in some cases, an autoimmune reaction to ameloblast-derived (dental) proteins which likely contributes to dental decay (38). Composite prebiotic fibers are therefore a worthwhile prophylactic add-on, and the autoimmune element makes an anti-inflammatory regime even more important.
This shotgun approach to oral health should keep your teeth and gums healthy for decades. This is a worthy goal in itself, but it will do much more than that. Fluoride-containing toothpastes are too toxic to be ingested (39, 40). The natural actives in my proposed oral health care regimen will, if swallowed, promote good health throughout the body (ie 41, 42).
Do the calculus!
Next week: Magic Bullets, Smart Bombs.
Copyright of the pictures: Poster promoting good oral hygiene. Federal Art Project, between 1936 and 1938. Prints and Photographs Division, Library of Congress;
Encyclopedia of Global Archeology: https://link.springer.com/referenceworkentry/10.1007/978-3-319-51726-1_3200-1#:~:text=The%20remains%20that%20are%20typically,were%20eaten%20in%20the%20past
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