Jack KruseCEO of Optimized Life PLC
For decades, physicians and dentists have paid close attention to their own respective fields, specializing in medicine pertaining to the body and the oral cavity, respectively. I happen to be lucky to have both a dental and a medical degree and have had the benefit to see how both of these fields overlap with respect to redox potential and mitochondrial health. I have known for 25 years that the oral cavity is the canary in the coalmine for physicians to gain clues to how healthy or ill their patients really are without invasive testing or diagnostics. Recent findings in the literature have strongly suggested that oral health may be indicative of systemic health. Currently, this gap between allopathic medicine and dental medicine is quickly closing, due to significant findings supporting the association between periodontal disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, adverse pregnancy outcomes, and osteoporosis. Significant effort has brought numerous advances in revealing the etiological and pathological links between this chronic inflammatory dental disease and these other conditions. Most of these links occur due to mitochondrial energy flux in tissues. Therefore, there is reason to hope that the strong evidence from these studies may guide future clinicians and researchers towards greatly improved treatment of dental diseases that might also ameliorate chronic neolithic systemic illnesses. I am getting ready to speak to a group of dentists about these issues and this blog is for them to read before I come to speak to them.
SO WHAT INFORMATION IS BURIED IN TOOTH COLOR?
Can we use tooth color as a measure of redox potential and overall health?? Redox potential is a measure of the voltage that our tissues contain. A healthy mitochondria is known to have 25,000,000-30,000,000 million volts of electric charge in our inner mitochondrial membrane. This is the same power in a bolt of lightening. On average, 30% of most human cells are made of mitochondria by dry weight. The tissues that support the voltages in teeth are buried in the jaw bone and periodontal ligament to act like an electric socket. The tooth, is like a light bulb that plugs into this socket, so when the current to the light bulb is weak the color the bulb emits is different than normal. So tooth color can definitely be used as a measure of redox potential for a clinician. The more negative charges are present in cell water, collagen, and the calcified tissues in teeth, the more vital they look because there will be more voltages present in their mitochondria to support the flow of energy in tissues. The picture above show teeth on the left with a blue hue. Teeth with a blue hue appear very white in most lights. When teeth and the periodontal ligament have a lowered DC electric current, teeth take on the complementary color of blue which is yellow. Most of us think that the yellowing of teeth is due to surface staining but this idea needs to be challenged based upon the physics of tooth anatomy. This blog helps explain this process.
Essentially all man made optical brighteners used the same trick. They absorb light in the ultraviolet spectrum and emit it back as light in the blue-violet range. This is also true with dental brighteners. The whitening effect is two-fold. The extra bluish light that is emitted is a complementary color to yellow, and as such, counteracts any yellow hue present, masking dinginess. It also generates the illusion of "new light". Consumer products and dental products not only look clean, they become beacons of manufactured versions of white/blue light. The increasing use of fluorescent brighteners has “changed our perception.” Many dental brighteners make unhealthy teeth give off a healthy facade. The truth, can ususally be found with co-morbid periodontal disease. In my own patients, I now look at their periodontal health more than their tooth color to give me insights on their health risks because of what I know about the physics of tooth organization. When someone's health is in decline, what was white in the past, now looks dingy or yellow, and that is a big clue to a clinician paying attention to their patient's health. It also means their periodontal pockets are going to be larger than 6 mm in depth. Let us consider drugs that affect bone and tooth color.
Tetracycline is a broad spectrum antibiotic, and its derivative minocycline is common in the treatment of acne. The drug is rarely used in clinical medicine in the USA compared to previous decades. The drug is able to chelate calcium ions and is incorporated into teeth, cartilage and bone to discolor all of them to various degrees. Ingestion during the years of tooth development or pregnancy can cause yellow-green discoloration of dentin visible through the enamel which is fluorescent under ultraviolet light at 360-370 nm. Later, the tetracycline is oxidized and the staining becomes more brown and no longer fluoresces under UV light. The loss of fluorescence is a sign of a loss of excitation of electrons in fluorophore proteins within teeth. They no longer emit blue light. As a result, light release occurs to the local environment and not to dentin or enamel.
Fluorescence occurs when an orbital electron of a molecule, atom, or nanostructure, relaxes to its ground state by emitting a photon from an excited singlet state. This usually ocurs on rapid timescales. Fluorescence shifts energy in the incident illumination from shorter wavelengths to longer (such as blue to yellow) and thus can make the fluorescent color appear brighter (more saturated) than it could possibly be by reflection alone.
Fluorescence is the emission of light by a substance that has absorbed light or other electromagnetic radiation. It is a form of luminescence. In most cases, the emitted light has a longer wavelength, and therefore lower energy, than the absorbed radiation. Fluorescent substances absorb the ultraviolet light and then re-emit it almost instantaneously. Some energy gets lost in the process, so the emitted light has a longer wavelength than the absorbed radiation, which makes the emitted light have frequencies in the visible light range and causes the material to appear to be brighter or glow.
Fluorescent molecules tend to have rigid structures and delocalized electrons.
Common materials that fluoresce: Vitamin B2 fluoresces yellow. Tonic water fluoresces blue due to the presence of quinine. Highlighter ink is often fluorescent due to the presence of pyranine.
Plants also fluoresce. Sir David Brewster described the phenomenon for chlorophyll in 1833. Do teeth fluoresce too? Teeth can be made whiter with natural sun exposure.
Dentin of teeth is three times more phosphorescent than enamel. Phosphorescence is a specific type of photoluminescence related to fluorescence. Unlike fluorescence, a phosphorescent material does not immediately re-emit the light radiation it absorbs. The slower time scales of the re-emission are associated with "forbidden" energy state transitions in quantum mechanics. As these transitions occur very slowly in certain materials, absorbed radiation may be re-emitted at a lower intensity for up to several hours after the original excitation. When exposed to light sources containing UV components, the fluorescence of human teeth gives them the quality of vitality, and they exhibit a fluorescent emission with a peak of 440 nm observed peak light (bright blue hue). To get this blue hue teeth need a signal that is stronger than blue. The only part of the visible spectrum more powerful than blue light is the purple/violet light of UVA and UVB light from the sun.
Because of dentin's, phosphorescence allows it to collect light photons slowly to change tooth color. In this way, I believe natural tooth color can be used as a measure of oral health and health of the brainstem. This is why in my Redox Rx blog I have used pulp testing of teeth as a redox variable for patients. It is from the stem cells in dentinal pulp where light is released from these cells and collected into the atomic lattice of dentin to change its frequency and this changes its color we observe. Tooth color can be used a health metric because of this atomic arrangment in teeth. Bone is not as accurate sensor, in my view, for several reasons.
Bone and dentin have similar molecules in them, so scientists have assumed they may have the same function in both tissues, but this is too simplistic given a few observations. In contrast to bone, there is little or no remodeling in dentin post formation. Bone constantly remodels because its collagen is different than that of dentin. Consequently dentinogenesis provides an excellent model to study the biomineralization processes of skeletal tissues because it is MORE STABLE and LESS DYNAMIC than bone and provides us a better way to assess redox potential trends in our patients, in my opinion. Bone and dentin do not heal, they undergo complete regeneration in mammals and this makes them one of the unique few tissue types in humans where total regeneration occurs. Bone and dentinal healing is a misnomer as Dr. Robert O. Becker proved in experiments the 1960's.
Collagen is the major protein found in dentin. It constitutes ~90% of the organic matrix. All collagen is piezoelectric to varying degrees. The majority of the collagen in teeth is type I, although trace amounts of type III and V have been reported. Type I collagen and results from the self-assembly of two alpha1(I) chains and 1 alpha 2 (I) chain. These chains are assembled in a triple helix with a coiled coil conformation, provided the environment is hydrated and there is a proper DC electric current in the tissue in question.
On a weight basis, dentin is less mineralized than enamel (96% in weight), but more mineralized than bone or cementum is (about 65% in weight). Physiologically and anatomically, dentin is a complex structure. Within what is named as a “whole dentin”, different types of dentins have been identified, even within a single species. To make conclusions about teeth as redox sensors, the study on dentin variations we need to consider the following: depending on the type and the location of the dentin, at least three different physiological mineralization processes occur.
Firstly, the dentin outer layers result from cell-derived events involving the presence of matrix vesicles and their enzymatic equipment. This process may or may not be associated with odontoblast apoptosis.
Secondly, the active transformation of predentin into dentin is the origin of intertubular dentin formation. This is a matrix-controlled process, type I collagen playing a major role, at least as non-collagen protein carrier.
Thirdly, a passive deposit of blood serum-derived molecules along the tubule walls leads to the formation of peritubular dentin. This is why, under a generic name of dentinogenesis, different types of mineralization are producing specifically very different tissues. The blood plasma is critical in bring sunlight frequencies to the dentin substrates. People forget blood plasma is 93% water and it is in the exclusion zone of water than the sun energy is stored. Water is an ideal red chromophore, but the EZ extends deeply to all UV frequencies as well. You need to think of a chromophore like a "light antenna". All chromophores have different optics, phosphorescence and fluoroescence.
The unanswered scientific question is why is it necessary to have three totally different processes involved in the formation of dentin in a single tooth? I believe the answer is tied to movement and stability of the overlying enamel to maintain large occlusal forces. This is based upon the same logic why the ancient Greeks used wood pegs and boxes in building the columns of Parthenon to handle loads of a shifting landscape below due to tectonic solitons from Earthquakes. The lack of scientific conclusions in this area leads to the question of what are the determinants for selecting one of the three pathways in dentin or why is one chosen over other? My belief is it has to do with the redox potential of the socket that the tooth sits within. My deeper hunch is that the electrostatics of the microenvironment and the mitochondria in those areas determines which dentin is formed on a bio-energic basis. This is why tooth color and mitochondrial health can be linked in quantum fashion in my opinion. I have some pictures below to illustrate why I believe as I do.
ENAMEL AND CARIES FROM A QUANTUM VIEW POINT:
Caries can result from an imbalance between the naturally occurring processes in our mouths that degrade and dissolve enamel, and those that restore it. When we consume food or drink, plaque bacteria on our teeth take up sugars and produce acids. These acids lower pH in the mouth and dissolve enamel, which consists primarily of the mineral hydroxylapatite. The lowered pH also effects the dentin, cementum, salivary flow and the amount of EZ water in all these structures. The EZ decreases with a lowered pH and can be raised by ELF-UV release, and the liberation of UV and IR light from cells in the socket or from the blood serum that bathes the pulp chamber where the dentinal stem cells reside. This implies that decay is not "just a carbohydrate disease" as we currently believe. This idea will offend many sensibilities in dentistry, but I like that. I want to disturb dogma with curiosity. Developing dental caries may also require a lack of UV/IR light assimilation by the body to lower the redox potential of the oral cavity in many ways we do not realize. This all manifests because of the local effects of the EZ inside of tooth structures to change the appearance of teeth in the mouth. Unlike most tissues in our bodies, once enamel is made, it’s not repaired by cells, but the surrounding structures and saliva support the physiologic function of enamel provided all aspects that support a strong EZ is present. This implies even enamel anatomy is a variable we ignore.
Luckily, our salivary glands produce enough saliva with a high EZ will return the pH to normal values within a short period of time if we get physiologic solar exposure usually less than an hour per day. Many people do not know the human salivary glands are innervated by the hypothalamus of the brain where sunlight interacts via the central retinal pathways of the eye. I consider tooth decay a disease of darkness like rickets, tuberculosis, and sleep apnea. This is why decay is not prevalent in ancient skulls as studied by Dr. Peter Ungar. Decay is a modern neolithic disease according to the fossil record of humans.
Saliva contains the chemical ingredients of hydroxylapatite: calcium, phosphate, and hydroxide ions and carries its own voltage that can vary based upon our overall health. Those with inflammation and a low pH will have a lower voltage and DC electric charge in their blood plasma, saliva, and pulp chamber. These are all molcular proxies for the redox potential. Our teeth are designed to be constantly bathed in these building blocks, therefore the enamel is regenerated and altered dynamically when the mouth is at normal pH and there is a minimum voltage to support a DC electric current. But there are many factors – including foods high in certain sugars, poor dental hygiene, lack of solar exposure, low vitamin D3, dehydration, and certain medical conditions – that can shift the balance towards net loss of tooth biomineral. All of these variables tie to mitochondrial function because all are associated with low melatonin cycles, low DC electric currents, which both increase mtDNA mutations. This lowers energy flow in the oral cavity and fosters a disease state. The electrostatic environment of the mouth is a proxy for overall health. It is quite accurate neurologically because it links the trigeminal system directly to the brainstem via the eye, and to the CSF surrounding the brain, and the circumventricular organs which have no blood brain barrier. This allows the sunlight signal direct access with no barriers to the brain by water networks. All are connected via water's hydrogen bonding network and the size of the EZ present in each region. When the electrostatic effect is lowered, the EZ drops, and this leads to caries, periodontal disease, and crowded occlusions, and the development of many dental diseases.
Scanning electron microscope image of inner enamel from the mouse incisor.
Enamel is made up of slender rods packed together in layers, as shown above. The rods – each smaller in diameter than a red blood cell – are woven together as in a basket. In between these rods is what’s called the inter-rod enamel.
Each rod is made up of about 10,000 tiny hydroxylapaptite crystals that lie side-by-side like a bunch of uncooked spaghetti. Of course in enamel the crystals don’t rattle around like spaghetti in a box; they’re stuck together electrostatically, the way spaghetti clumps when you boil it in not enough water. The areas where neighboring crystals stick to each other are called grain boundaries.
We know from exposing polished enamel to an acid bath that the sides of the crystals – the grain boundaries – dissolved much more rapidly than the ends. The resulting structure looks like a forest of nanowires, as shown above on the right. Researchers had suspected this had to do with the presence of magnesium and other ions at the grain boundaries. But it had been impossible to prove why the grain boundaries were more vulnerable to acid than the ends of the crystals.
Atom Probe Tomography Cracks The Case of why this occurs
Researchers turned to atom probe tomography (APT) to answer the question. Atom probe uses ultraviolet laser pulses to evaporate single atoms or small clusters from the surface of the material one wants to analyze, and a very high electric field that strips electrons from the evaporated atoms and creates ions. Then the ions are projected onto a position-sensitive detector and their mass-to-charge ratio is determined by their time-of-flight. Using atom probe, we can make distinctions that are as small as a fraction of a nanometer – very tiny, considering a human hair is about 100,000 times wider than that.
By picking apart enamel specimens atom-by-atom and layer-by-layer, we are now able to build a 3-D map of millions of different atoms in small pieces of rat and mouse enamel (commonly used as model systems for human enamel). Best of all, we can see where all the different ions – for example, magnesium or fluoride – are in the enamel’s structure to try understand what they do.
We have found that in mouse enamel, the magnesium ions are almost all at the grain boundaries, or ‘between the spaghetti’ like rods pictured above. We've also discovered that there are special grain boundaries where three or more crystals meet that have an even higher magnesium concentration. We were surprised to see that the environment around the magnesium ions is not ordered as in a crystal. In this way, it is very similar to what we see in chlorphyll molecule in a leaf. This finding is evidence that there’s a different kind of material or ‘phase’ in between the crystalline nanowires, gluing them together electrostatically. This implies the redox potential of the local environment is critical in teeth as it is in a leaf under sunlight's power. Right now most dental professionals are unaware of these connections. We call it magnesium-rich amorphous calcium phosphate (Mg-ACP) in teeth.
What properties of enamel would depend on this amorphous glue? From the initial experiments in the literature I have reviewed it looks like the Mg-ACP dissolved much more rapidly in acid, which is not a good thing, because it weakens enamel electrostatically. Acids lower the exclusion zone (EZ) of water.
A beaver skull, showing reddish-brown incisors due to their thin layer of iron-rich pigmented enamel. Michael Graydon, Toronto, CC BY-NC-SA
Rats, beavers and other rodents also have a different kind of enamel, called pigmented enamel. It’s a thin, iron-rich layer that’s harder than regular human enamel. Rather than Mg-ACP, we've found that the material at the grain boundaries in the pigmented enamel consists of the mineral ferrihydrite and amorphous iron-calcium phosphate (Fe-ACP). There is practically no magnesium at all. This is interesting because in human hemoglobin iron replaces magnesium of chlorophyll to change sunlight into a DC electric current. It appears mammalian teeth may use the same idea with different mechanistic steps to achieve electrostatic bonding. Bone does the same thing using two copper ions between the collagen and appatite to mineralize.
When researchers exposed the pigmented enamel to acid, they found that its grain boundaries did not dissolve at all! Over time, pigmented enamel dissolved much more slowly than regular enamel, and even more slowly than enamel treated with fluoride. In fact, since the magnesium-rich glue dissolves much more readily than the iron-rich one, we now suspect it is the atomic Achilles heel of rodent enamel. This Mg-Fe paradox is also seen in plant chlorophyll and animals hemoglobin in humans. I suspect it has to do with the differences between nocturnal animal enamel and diurnal enamel and the light frequencies they face in their respective environments. On the other hand, the magnesium-rich material likely acts as conduit for fluoride diffusion into the tooth in vivo, and may thus this might be why we continue to falsely believe it may contribute to its protective effects. This view is static by looking at the crystal and not dynamic by considering how saliva and electrostatics work to maintain the EZ of saliva. Fluoride's effect on water is deterimental to the formation of a strong EZ in living tissues because of its electronegativity.
Human enamel has seven hierarchical levels of the microstructure found by experiment, using a scheme representing a complete spectrum of the organization in detail, covering a range from microscale to nanoscale: hydroxyapatite crystals (Level 1) at first form mineral nanofibrils (Level 2); the nanofibrils always align lengthways, aggregating into fibrils (Level 3) and further thicker fibres (Level 4); prism/interprism continua (Level 5) are then composed of them. At the microscale, prisms assemble into prism bands (Level 6), which present different arrangements across the thickness of the enamel layer (Level 7). Analysis of the enamel and bone hierarchical structure suggests similarities of scale distribution at each level. These levels are likely all bound by complex optics and electrostatics. There is now evidence that fluorosis may set the stage for human caries. In fact, it is well-published that porosity and hypomineralization may develop due to retention of amelogenin proteins by fluoride deposition in human enamel.
HOW DOES THE ELECTRIC PULP TESTER REFLECT OUR HEALTH?
All human pulp cells regenerate using the DC electric current. In electricity electromagnetism, the electric susceptibility = χe mathematically (latin: susceptibilis = “receptive”) is a dimensionless proportionality constant that indicates the degree of polarization of a dielectric material in response to an applied electric field. Now think about EZ water in cells versus regular water from your faucet. Regular un-fluoridated water has a dielectric constant of 78 and EZ is 160. Where are electric fields found in cells? They are found in cell membranes and in mitochondria. Human cell membranes are loaded with DHA, better known as "fish oil". The greater the electric susceptibility present in dentin, the greater the ability of dentin to polarize light in response to the electric field generated from the dental pulp, and thereby, it reduces the total electric field inside the dentin and this gives dentin the ability to store more light energy for phosphorescence. It is in this way that the electric susceptibility in teeth can influences the electric permittivity of the material in dentin, (EZ) and thus influences many other phenomena in that medium, from the capacitance of capacitors that work the speed of light in teeth. Most people forget sunlight is un-polarized. It appears dentin in our teeth are supposed to polarize it properly to give the health hue of teeth. Man made light is polarized.
In many materials the polarizability starts to saturate at high values of electric field. Recall that the measured voltage on some membranes within mitochrondria are 30,000, 000 VOLTS! This saturation can be modelled by using nonlinear susceptibility. These susceptibilities are important in nonlinear optics and lead to effects such as second harmonic generation. Why? When you use light this way you can change its color and when color changes in teeth it means that frequency of light within dentin also had to change. Did you know this? Most dentists do not even dentists know this. Second generation harmonics is used in lasers to convert infrared light into visible light. I have a sense this effect occurs in dentinal cells. Currently there is still a debate in dental science about whether peritubular dentin (PTD) is non-collageneous or collageneous tissue in the pulp tooth interface. The chemical composition and structure of human PTD and intertubular dentin (ITD) has been studied by Raman spectroscopy. The differences between PTD and ITD were small in these studies, but still detectable.
A white surface treated with an optical brightener can emit more visible light than that which shines on it, making it appear brighter. The blue light emitted by the brightener compensates for the diminishing blue of the treated material and changes the hue away from yellow or brown and toward white. The blue light emitted also has another untoward effect in dentistry. It dehydrates the tooth and this lowers the redox potential of the tooth because it affects the exclusion zone of water. Many dental experts believe this is harmless, but there are no good studies that make me feel this way. Dehydration is never a good thing in a biologic system.
Almost all whitening products use in dentistry contain the same active ingredient, either carbamide peroxide or hydrogen peroxide as optical brightening agents. These chemicals penetrates the microscopic pores in the enamel that coats your teeth, producing reactive oxygen molecules that react with and break apart the grime-causing compounds. Dentists can shine a LED lamp on the teeth to speed up the chemical reaction (the light also dehydrates your teeth and makes them chalky, so they look temporarily whiter in the mirror afterward). The process is generally beleived to be safe, but aggressive bleaching can leave teeth sensitive and gums irritated, and some studies I've read suggest it can slightly soften or erode enamel making it more brittle. Bleaching certainly doesn’t make our teeth healthier. It is pure vanity move. It also affects the dentists ability to use tooth color as a redox sensor.
Autofluorescence is the natural emission of light by biological structures such as mitochondria and lysosomes when they have absorbed light, and is used to distinguish the light originating from artificially added fluorescent markers (fluorophores).
The most commonly observed autofluorescencing molecules are NADPH and flavins in our mitochondria; the extracellular matrix can also contribute to autofluorescence because of the intrinsic properties of collagen and elastin as N-type semiconductors. Since teeth are made of these proteins they also have intrinsic emission. All semiconductors are capable of emitting light frequencies.
Generally, proteins containing an increased amount of the aromatic amino acids tryptophan, tyrosine and phenylalanine show some degree of autofluorescence. The benzene ring of aromatic amino acids all make them a light trap for sunlight.
NEW DIAGNOSTIC REDOX MEASURES
Optical coherence tomography (OCT) is based on low-coherence interferometry, typically employing near-infrared light as its source because it deeply penetrates tissues with water. Water is the ideal chromophore for red light. The use of relatively long red wavelength light allows it to penetrate into the scattering medium. Using light this way, OCT can provide “optical biopsy” without the need for excision and processing of specimens as in conventional biopsy and histopathology. Application of OCT in dentistry has become very popular especially for dentin related diseases.
The traditional diagnosis of caries is based on examination using dental exploration and radiographs. The diagnosis of periodontal disease needs the examination of periodontal probes. The poor sensitivity and reliability of periodontal probing make it difficult for dentists to monitor the progression of periodontal destruction and the treatment outcome. Radiography may still be the most popular diagnostic tool. However, radiography provides only two-dimensional images. OCT may provide a solution to these problems. Dental OCT detects qualitative and quantitative morphological changes of dental hard and soft tissues in vivo. Furthermore, OCT can also be used for early diagnosis of dental diseases, including caries, periodontal disease and oral cancer, because of the excellent spatial resolution. This also make OCT valuable for the quantum clinician because OCT can be a very accurate measure of redox potential in the oral cavity.
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