Remineralize Teeth: Naturally and According to Science
What is Remineralization?
Remineralization creates stronger, less sensitive teeth, and whiter teeth. Remineralization is a completely natural and normal tooth repair process, that happens in an alkaline oral environment when calcium and phosphate minerals are deposited back onto your enamel.
The two factors that research has shows to promote remineralization:
1. Proper Nutrition
2. An Evidenced-Based Oral Care Routine
Proper Nutrition
The evidence shows that without certain vitamins and minerals that your body will not have what it needs to remineralize your teeth. For example, a study revealed that children who were given a daily vitamin D supplement developed 47 percent fewer cavities than a group of children who were not provided this supplement.
The following vitamins and minerals have been linked to assisting with remineralization of teeth: Calcium, Vitamin D, vitamin K, vitamin C, magnesium, and B12.
Nutrition and Remineralization Research:
2015 Oral health in young women having a low calcium and vitamin D nutritional status
2020 Vitamin D Deficiency and Oral Health: A Comprehensive Review
2022 Beneficial Effects of Vitamin C in Maintaining Optimal Oral Health.
An Evidence-Based Oral Care Routine
An evidence based oral care routine will inhibit bacteria and help with remineralization by creating an alkaline oral environment. Bacteria in the mouth contribute to creating an acidic environment, that can cause demineralization.
What does a research-based oral health routine look like?
The evidence indicates that the order of the oral routine matters. The majority of the bacteria from the tongue and the gums should be removed before brushing because the bacteria removed from flossing ends up on teeth.
Step 1: Clean Tongue
Step 2: Clean Gums
Step 3: Clean Teeth
Step 4: Rinse Mouth
Step 1 : Clean Tongue
Summary of Research:
Tongue scraper - most effective
Brushing tongue with a toothbrush - also effective
Studies have shown that cleaning the tongue improves oral health outcomes and decreases bacteria in the mouth. Removing and inhibiting bacteria is critical for creating an alkaline environment for remineralization. A 2005 study found that adding a tongue scraper to an oral hygiene routine over seven days reduced the presence of two types of bacteria in the mouth: Mutans streptococci and various Lactobacilli. These types are directly linked to both bad breath and dental decay.
An example of a tongue scraper
Left: Before scraping tongue - the tongue is covered in a film.
Right: After scraping -the tongue is clean and pink.
Tongue Scraper Research:
2013 The Comparative Evaluation of the Effects of Tongue Cleaning on Existing Plaque Levels in Children
2018 Tongue coating: its characteristics and role in intra-oral halitosis and general health-a review
2021 The Effect of Mechanical Tongue Cleaning on Oral Malodor and Tongue Coating
Step 2 : Clean Gums
Summary of Research:
Dental Floss - surprisingly little evidence of benefits
Water Flosser - recommended by ADHA over flossing
Dental Floss
There is surprisingly little and contradictory evidence of the benefits of flossing despite it being considered standard practice for gum care. The outcomes of studies on flossing have been varied, some have shown benefits, others have shown no benefits and one study even showed possible negative side effects of flossing, because of these contradictions, several articles have been published about the mixed results.
Articles on Mixed Results of Flossing:
2016 “Tossing flossing?” (Harvard Health Blog)
2016 “Feeling Guilty About Not Flossing? Maybe There’s No Need” (New York Times)
2016 “Guilty No More: Flossing Doesn’t Work” (Mother Jones)
2016 “A big problem with flossing” (CBS News)
Flossing is still recommended by most dentists. However, if you are not happy with your results from flossing alone other evidence-based strategies can be added to your routine to enhance your gum health.
Water Flosser
The American Dental Hygienists' Association recommends water flossing over string floss because studies have shown that water flossers are more effective than dental floss. For example, one study showed water flossers remove 29% more plaque than string floss. Water flossers can also be more gentle for people with gum sensitivity, or gum inflammation. Most dentists still recommend dental floss as well as a water flosser.
Water Flosser Research:
2021 Comparison of Water Flosser and Interdental Brush on Plaque Removal: A Single-Use Pilot Study
2012 Comparison of two power interdental cleaning devices on the reduction of gingivitis
Child using a water flosser
If you want to boost your gum game beyond water flossing, hydrogen peroxide can be added to a water flosser to increase its effectiveness. Research has shown hydrogen peroxide is an effective agent for bacterial growth, inhibiting gingivitis and plaque, and is safe for enamel. Hydrogen peroxide can be added to a water flosser to increase the water flosser's effectiveness.
Research: Hydrogen peroxide 3% is an effective agent for bacterial growth, inhibiting gingivitis and plaque:
1990 Hydrogen peroxide, the effect on plaque and gingivitis when used in an oral irrigator
1995 Hydrogen peroxide: a review of its use in dentistry
1979 Effect of hydrogen peroxide on developing plaque and gingivitis in man
1996 Antibacterial Effects of Hydrogen Peroxide and Methods for Its Detection and Quantitation
2022 Oral streptococci subvert the host innate immune response through hydrogen peroxide
Research: Hydrogen peroxide 3% was shown to be safe for enamel
2005 High levels of hydrogen peroxide in overnight tooth-whitening formulas: effects on enamel and pulp
Step 3 : Clean Teeth
Summary of Research:
Toothbrush - Electric rotating toothbrushes are the most effective at removing plaque
Baking Soda - Effective antibacterial, balances pH, safe for enamel
Botanical Oil - Effective antibacterial and assists in remineralization
Coconut Oil - Effective for gingivitis but more studies are needed
Fluoride - Effective for remineralizing teeth but has serious side effects at certain levels
Charcoal - Not safe for teeth will erode enamel over time
Toothbrushes
Oscillating (rotating) toothbrushes are more effective at removing plaque and gingivitis than a manual or vibrating electric toothbrush. After three months of use of an Oscillating (rotating) toothbrush plaque was reduced by 21 percent and gingivitis by 11 percent.
Toothbrush Research:
Example (b) shows a rotating toothbrush movement
Baking Soda
Studies show that baking soda is one of the most effective and safe means to balance pH in your mouth by neutralizing acids that erode enamel. A 2017 review suggests that toothpaste that contains baking soda may be more effective at reducing the amount of plaque in the mouth than traditional toothpaste and also protects against demineralization and help to improve sensitive teeth. This study also suggests that baking soda can significantly reduce the amount of Streptococcus mutans bacteria, one of the most common causes of tooth decay.
There have been claims made that baking soda is too abrasive and will damage your enamel. When these claims are made, you may notice that no evidence given to support to support these claims. This is because with over 1,500 studies in the NIH database on using baking soda for oral care, none found significant evidence of baking soda damaging enamel.
Studies have that have shown that baking soda is not abrasive enough to damage enamel.
The RDA (Relative Dentin Abrasivity) chart shows the abrasiveness of common toothpastes - the higher the number the more abrasive the agent. You will notice that baking soda has one of the mildest abrasive scores.
RDA (Relative Dentin Abrasivity) Chart
Baking Soda Safe for Enamel Research:
1997 The use of sodium bicarbonate in oral hygiene products and practice,
Botanical Oils
Botanical oils such as clove, peppermint and oregano have antibacterial properties that can assist with remineralizing teeth, and inhibiting a wide range of bacteria including the bacteria that cause periodontal disease, and cavities.
Sea buckthorn
Benefits: Research has shown that Sea buckthorn is an effective mouthwash for chronic periodontitis with an anti-inflammatory for inflamed gums as well as effective at eliminating bacteria causing cavities and promising wound healing capabilities. Seabuckthorn contains anti-inflammatories for gums and overall oral health and an abundance of active ingredients such as omega 3, 6, 7, and 9 essential fatty acids, vitamin C, E, provitamins A and B, beta carotene, carotenoids phytosterols, and rare palmitoleic acids.
Sea buckthorn Research:
2019 Benefits of sea buckthorn (Hippophae rhamnoides) pulp oil-based mouthwash on oral health
2016 Role of sea buckthorn oil in management of chronic periodontitis: follow-up study
2022 Seabuckthorn--Nature's Boon against Periodontal Pathogens: An Ex vivo Study.
2020 The bioactive components as well as the nutritional and health effects of sea buckthorn
2022 Sea buckthorn against periodontitis: A clinical and microbiological study
2017 Abundance of active ingredients in sea-buckthorn oil
Peppermint
Benefits: A lab study published in the 2013 European Journal of Dentistry noted peppermint oil, along with four others, as effective antimicrobial agents to kill an assortment of oral pathogens, as well as Staphylococcus, the most common bacteria associated with cavities. Recently it was found that peppermint oil is one of the most effective agents in killing anaerobic bacteria (bacteria that thrive in a low oxygen environment) such as the bacteria below the gum line that causes gum disease.
Peppermint Research:
2019 Antibacterial and anti-biofilm activities of peppermint essential oil against Staphylococcus aureus
2010 Effects of oral care with essential oil on improvement in oral health status of hospice patients
2020 Effects of Labrador Tea, Peppermint, and Winter Savory Essential Oils on Fusobacterium nucleatum
2012 Physical and Antimicrobial Properties of Peppermint Oil Nanoemulsions
2015 Antibacterial and antioxidant activities of Mentha piperita L.
Sweet Orange
Benefits: Sweet orange has a pleasant taste, rich with antioxidants and anti-inflammatory properties beneficial for sensitive gums. It also has shown to be an effective antimicrobial agent used to treat infections and dress wounds
Sweet Orange Research:
2016 Essential oil components of orange peels and antimicrobial activity
2012 Application of orange essential oil as an antistaphylococcal agent in a dressing model
Oregano
Benefits: Oregano oil has anti-inflammatory and antioxidant properties to soothe inflamed gums and oral tissues, and an array of antimicrobial properties to inhibit oral thrush (candida) and gingivitis. Oregano has also been shown to be effective against other cavity-causing bacteria and periodontal pathogens such as Actinomyces naeslundii, and Veillonella parvula (caries-associated bacteria) and Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans (Aa) (gram-negative periodontal pathogens) and antibiofilm agent against the Streptococcus bacteria which is one of the main causes of cavities
Oregano Research:
2020 Oregano Oil is Highly Antimicrobial Against Oral Pathogens
2021 Oregano essential oil inhibits Candida spp. biofilms
2021 Efficacy of Oregano Essential Oil Extract in the Inhibition of Bacterial
2017 Antimicrobial Activity of Basil, Oregano, and Thyme Essential Oils
Cinnamon
Benefits: For teeth and overall oral health: Cinnamon oil is useful in combating tooth decay, because of its antibacterial properties which include inhibiting the following bacteria: Streptococcus mutans, Streptococcus salivarius, Streptococcus sanguinis, Porfiromonas gingivalis, Prevotella intermedia, Actinobacilus actinomycetemcomitans, Enterococcus faecalis, Candida albicans and Lactobacilli which are involved in dental degradation, periodontal disease, bad breath, endodontic lesions, and other oral infections. Cinnamon has also been shown to be an effective anti-plaque agent.
For gums: Cinnamon has been shown in studies to have strong anti-inflammatory properties to soothe inflamed gums and inhibit the bacteria that cause gum disease.
Cinnamon Research:
2013 Antibacterial activity of cinnamon oil on oral pathogens
2020 Effects of Cinnamon (Cinnamomum spp.) in Dentistry: A Review
2011 Comparative study of cinnamon oil and clove oil on some oral microbiota
2017 In Vitro Anti-Cariogenic Plaque Effects of Essential Oils Extracted from Culinary Herbs
Clove
Benefits: Clove oil has been shown to help promote remineralization and inhibit decalcification of teeth, which in turn helps sensitive teeth from becoming sensitive to hot, cold, and even sweet food. This is because as the insulation layer of enamel erodes, teeth can become more sensitive. It was observed that the clove essential oil and its two lead molecules inhibit the decalcification and/or promote remineralization.
Clove Research:
Eucalyptus
Benefits: Studies have shown that eucalyptus oil has strong antimicrobial effects against many bacteria, including Mycobacterium tuberculosis and methicillin-resistant, Staphylococcus aureus (MRSA), viruses, and fungi (including Candida). Surprisingly for an antimicrobial substance, there are also immune-stimulatory, anti-inflammatory, antioxidant, analgesic, and spasmolytic effects.
Eucalyptus Research:
2010 Immune-modifying and antimicrobial effects of Eucalyptus oil and simple inhalation devices
2003 Antibacterial Activity of Extracts from Eucalyptus Leaves on Periodontopathic Bacteria
2009 The effect of Mentha spicata and Eucalyptus camaldulensis essential oils on dental biofilm
2008 Effect of eucalyptus extract chewing gum on periodontal health: a double-masked, randomized trial
2012 Anticariogenic and phytochemical evaluation of Eucalyptus globules Labill.
2018 Efficacy of eucalyptus oil over chlorhexidine mouthwash in dental practice
Tea tree
Benefits: Tea tree has shown to be an effective cavity disinfectant helping to minimize secondary cavities and render long-term restorative success. Specifically, the ability to inhibit cariogenic bacteria like P.gingivalis and S.mutans. As well as being helpful in the treatment of aphthous ulcers, herpes simplex virus, dental pain, periodontitis, oral thrush, and refractory oral candida infections.
Tea Tree Research:
2013 Antimicrobial efficacy of five essential oils against oral pathogens: An in vitro study
2006 Melaleuca alternifolia (Tea Tree) oil: a review of antimicrobial and other medicinal properties.
2015 Essential oils, their therapeutic properties, and implication in dentistry: A review
2004 The effects of a tea tree oil-containing gel on plaque and chronic gingivitis
Fluoride
To Fluoride or not? This is up to you and your dentist to decide if this is for you. Some studies show fluoride to be effective at assisting in remineralizing teeth/ hardening enamel. Generally, the current research suggests fluoride is safe when exposure is low but studies have shown serious side effects (including lowering children's IQ, and neurotoxic properties) at higher doses, especially when swallowed.
Research on Fluorides' Potential Side Effects:
2019 Developmental fluoride neurotoxicity: an updated review
2020 Fluoride in Drinking Water and Skeletal Fluorosis: a Review of the Global Impact
2018 We add it to drinking water for our teeth — but is fluoride hurting us?
Coconut oil pulling
Not many studies have been done on oil pulling with coconut oil. Preliminary studies have shown a beneficial effect for gingivitis but more studies and research are needed for an evidence-based recommendation.
Coconut Oil Pulling Research:
2015 Effect of coconut oil in plaque-related gingivitis — A preliminary report
Charcoal
Research has shown that charcoal can damage teeth and cause erosion to the enamel and is not safe for daily use.
Charcoal Research:
Step 4: Rinse Mouth
Mouthwash is generally considered to be an optional step but can be effective at assisting in balancing pH, cleansing the mouth of bacteria in hard-to-reach places, and even aiding in remineralizing teeth depending on the type of mouthwash.
Botanical Oils Rinse
One study found that botanical oils used as a mouthwash were more effective than dental flossing for gingivitis. Botanical oils are effective against antibiotic-resistant bacteria, inhibiting gingivitis, and gum disease/periodontitis that leads to receding gums, anti-inflammatory, and help rebuild tissue and wound healing for inflamed and receding gums.
Conclusion and Personal Experience
I hope this helps you to create an oral health routine that addresses your needs, from remineralizing teeth to healthy gums. After reviewing the research I altered my oral care routine to the following:
Step 1 - scrape my tongue (daily)
Step 2 - water flosser with water or hydrogen peroxide (daily)
Step 3 - string floss (every other day)
Step 4 - brushing with botanicals and baking soda powder (daily)
Step 5 - botanical oil rinse (daily)
I have been doing this new routine for the last couple months and I have been very pleased with the results, my teeth are whiter, less sensitive and my no longer bleed when I floss.
Additional Remineralization Research:
2019 State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management
2018 Recent Advances in Remineralization Therapies for Caries Lesions.
2014 Enamel Regeneration - Current Progress and Challenges
2019 Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature
