Living Longer with Your Own Teeth

Everything you wanted to know about dental health and hopefully preventing dentures in the future.

UPDATED: July 10th, 2025

Welcome to the Healthy Aging Newsletter, a free publication that turns trustworthy medical research into simple habits so adults in their 30s and 40s can stay healthy and avoid common chronic conditions.

As with anything in mainstream medicine it’s a good idea to dive into the research from time to time to make sure that you’re not just following old dogma. Things like brushing with fluoride and soft vs hard brushes and biannual dental cleaning are fairly mainstream, but are they evidence based?

Quick word about “evidence-based”: one research evidence doesn’t make for evidence. We either have no conclusive evidence or we have some theories or we have multiple studies that all point to the same conclusion. Everything else, as far as actionable items, is noise.

1. Your Diet is The Biggest Factor

Let’s slay this dragon: what is the most effective way to have super healthy teeth? By having a healthy diet. What’s a tooth-healthy diet? The same as a heart-healthy, brain-healthy, bone-healthy, and longevity-healthy diet. They are all the same.

More sugar, more alcohol, more acidic sodas and you’ll slowly erode the enamel, feed the cariogenic bacteria and create inflammation that can harm your gums. Even snacking constantly without giving your mouth a break is harmful.

I would put diet above flossing, brushing, fluoride, and dental cleaning. Dentists will disagree and I’d love your comments below. But remember that if your body’s insulin and sugar levels go up from a bad diet, even with the best oral hygiene, you’ll have a lot of other jaw bone, gum, and tooth nerve problems.

2. Brushing - Even Without a Toothbrush

I had to do a deep dive on this one and filter out the Colgate sponsored studies and consistently, the duration of brushing and the act of mechanical disruption of natural plaque on the teeth is far more important than what sticky stuff you smear on your bristles.

Again, the most important thing is to avoid the sugars and alcohol, as we said above. The second goal is to disrupt the plaque (we all have it) just a little to allow some oxygen in there and make it less habitable for bacterial like Streptococcus mutans.

If you’re going to brush, set a timer. If you don’t set a timer it’ll be like balancing your checkbook in your head or counting your calories in your cabesa. 2-3 minutes is good, light pressure, and soft or medium bristles. Can hard bristles damage your teeth and gums? Maybe, if you have a tiger grip on your toothbrush.

3. Flossing or Waterpicking

#1. Diet, #2. Brushing, #3. Flossing. Because when you floss you are removing food particles that get stuck between your teeth - well, you know the story, no need to repeat it here. Is it dangerous if you don’t floss every day? Unlikely, unless your diet is bad, in which case flossing more frequently may even be a good idea.

If you’ve had a lot of dental work done in the past or have the kind of dental anatomy where food collects easily, your dentist might even recommend more frequent flossing and/or a water pick.

One way to know is how frequently you pull out a head of broccoli or a rib eye with your floss. A lot? Then you probably should floss regularly. But if your floss is relatively clean and odorless when it comes out, missing a day or two here and there may not be dangerous.

For me, it’s one of those things that if I don’t floss every night I’ll lose the habit. So I do it daily. As for a water pick, I haven’t found the data to be convincing, but better than not flossing at all, maybe?

4. Toothpaste Options

This is a very sensitive topic and usually gets bloods pumping and boiling. As always, I’m not giving medical advice, I’m just a family medicine physician who believes in prevention over treatment and who wants to keep his teeth as long as possible, but not forever. Toothpaste is the least important of all.

Fluoride, fluoride-free, toothpaste tablets, powders, baking soda, salt, or whatever else that’s out there, they are all incredibly safe and can help the bristles get a little deeper into the plaque if your brushing duration and technique isn’t the best.

I don’t use fluoride not because I think it’s unhealthy but because I haven’t found the data to justify it. Just as I don’t use toothpaste with 85.5 ingredients. Why? I won’t tell you what I use as to keep my 12 subscribers but I’ll double down on the safety profile of most commercial toothpaste products. I don’t think they are dangerous or harmful.

You can try brushing dry and every few times use a little toothpaste. If you use something that’s more abrasive such as powders or clay type material, you should have a good brushing technique, not starting on the same teeth every time, brushing lightly, and ask your dentist if they notice any excess wear for whatever reason.

5. Mouthwash and Mouth Rinses

Never.

Okay, I don’t know. I wasn’t able to find good studies that were done to my liking to recommend these things. The idea that a liquid “kills 99.9% of harmful bacteria” is a little suspect. How is it able to target the good and not the bad? Why can’t we use it in an IV - our ICU docs would love it!

6. Dental Cleaning

In the US, hardly anyone will argue with you if you say “everyone needs routine dental cleaning.” In the rest of the world, people will give you blank stares? Routine? Why? Don’t you brush and floss.

There are definitely groups of people who would greatly benefit from dental cleaning. I hope by now it’s clear that I’m not talking about the average person but someone who is proactive about their dental health.

I told my dentist that the last time I had a cleaning was 8 years ago, she said no way. And because she’s an awesome dentist and a great friend, she told me in no uncertain terms no to pull that crap with her - from now on, I’ll be getting at least annual dental cleaning. I insisted that I hadn’t developed any cavities, she walked away fanning with her hand. Fine.

7. Dental X-rays & CTs

It was 2016, I was a patient at Kaiser Permanente in the PNW where they have dental clinics. I told the dental assistant I didn’t want x-rays for my routine visit. She told me to wait and came out with the dentist in the waiting room, hands on her hip standing in front me, in front of the rest of the patients, “Are you the one who doesn’t want x-rays? That’s not the way we do things here. You need x-rays before being seen.”

Fair enough. That dentist has the right to say that she can only effectively see someone if they have x-rays, I won’t rob her of that. But … the data shows otherwise. In high-risk people, as all other interventions above, routine x-rays and CTs do find more cavities, though the data is unclear if that also means fewer tooth suicides/homicides because of these discovered cavities.

In other countries where people still have most of their teeth, routine x-rays don’t exist.

8. Xylitol Chewing Gum

If diet is #1, brushing #2, flossing #3, then xylitol gum is #18. If it doesn’t give you gas, chew it. Some people already grind their teeth at night or have bruxism, so chewing more during the day might make their TMJ pain act up.

Other Dental Myths Worth Busting…

1. Dirty toothbrush: I have never treated someone in the urgent care or in my private practice who had some infection from a contaminated toothbrush. I understand the fear, but it’s not substantiated. I keep my toothbrush in my gym bag and I haven’t died.

2. Brushing right after meals: If you’re not having something very sugary or acidic and want to get your brushing out of the way, do it. But, it’s always best to wait 30-45 minutes because the enamel gets a little delicate after certain types of food. But you’d need to be routinely brushing immediately after every meal to cause real damage.

3. Oil pulling: It’s not done for oral health but if you’re doing it for oral health. Nay.

4. Brush BEFORE breakfast: Don’t like brushing until after your coffee or bfast? Don’t. As long as you brush, you’re good.

5. Brush 4x per day: You should brush based on your individual risk factors. That’s how clinical medicine works. Eat healthy? Don’t get a lot of plaque? You don’t need to brush that often.

6. Swap toothbrush every 3 months: Not only does nobody follow this but as long as the bristles seem fairly straight and aren’t bowing excessively, it’s unlikely that you’ll prevent many more cavities from this action.

7. Regular dental visits are a waste: Not so, grasshopper! In fact, if you’ve paid attention, having a fantastic, open-minded dentist who can help assess your risk is critical. They can assess your bite, catch things early, give you flossing tips, and help identify concerning signs in your oral cavity.