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Letters: Evolution and decay

November 20, 2017

Kudos to Dr. Mark Koday on his Viewpoint column, "Access: Only One Part of the Solution," in the Oct. 16 ADA News. His conclusion that despite the manpower and money the current system is failing to solve, the access to care problem is correct. My research with anthropologists has led me to conclude that this approach will never work because we are looking at decay through the wrong paradigm.

Every first-year dental student is shown a Venn diagram with three interlocking circles. One is labeled teeth, another bacteria and the third sugars and starches. Where they interlock is labeled decay. The model, or treadmill, that Dr. Koday has spent his career on is about outreach, education and prevention. Sealants, brushing and fluoride only attack two of the circles. An understanding of evolutionary biology is the key to opening the door that will collapse the third circle, the one with sugars and starches.

Homo sapiens have walked this planet for about 250,000 years. Decay was infrequent until we started farming and eating grain products about 12,000 years ago. Humans have been making tools for longer than we have existed as a species, yet no one invented a toothbrush until about 3,000 years ago. Why? They did not need them. They were eating a species-appropriate diet. Today, we do not. No other animal eating its proper diet gets decay. We would not either.

We must examine this paradigm that evolution has given us. The human daily obligate need for carbohydrates is exactly zero. You have an enzyme in your mouth called amylase that breaks starches into sugar. Yes, bread and grains cause decay. This is why we first see the rise of decay in grain-consuming civilizations such as Egypt and Mesopotamia. They were not eating Snickers bars.

To win the war that we are fighting and live up to the public trust that dentistry has we need to get off the treadmill of more dental schools, more clinics, more public funding and more failure. A cynic might even call the current model of dentistry self-serving. To move forward, we need to look back on human evolution and examine what we are adapted to eat and promote that as a profession. That is how we solve access to care. That is how we bring costs down. That is how we win.

John A. Sorrentino, D.M.D.
Hopewell Junction, New York