There’s nothing more important for health than preventing problems from occurring in the first place.

Below is everything you need to know to guide you/your child towards making the best decisions to achieve & maintain excellent oral health, as well as information about the dental treatment which No Smile Left Behind typically provides.

Quick Tips

  1. Tooth decay is caused by one thing alone: sugar. If you want to avoid almost all dental problems, you simply have to avoid sugar. In some cases of high sugar consumption, even frequent brushing won’t be enough to prevent dental disease. Reduce your sugar intake!
  2. Only drink water, unsweetened tea, or unsweetened coffee. Avoid juice, fruit drinks, and soda. These cause the majority of all tooth decay. It cannot be stressed enough that juice is not healthy in any way, and it should not be a part of your/your child’s diet.
  3. Eat healthy, “whole” foods, such as vegetables, unprocessed meats, fish, poultry, nuts, eggs, fruits, white whole milk, and so on. As a rule of thumb, if it comes in a box or has an ingredients list containing anything you can’t pronounce, it isn’t healthy.
  4. Brush after breakfast and before bed. If you only brush once per day, make it before bed. Each time you brush, gently brush every part of every tooth for at least 2 minutes, all the way down to the gumline.
  5. Anyone over the age of 12 should floss daily if they want to avoid gum disease and adult tooth loss.


Diet is the single most important factor in determining not just oral health, but the body’s health. For good oral health, sugars and processed starchy carbs should be limited.

Sugar and some starches, which are both types of carbohydrates or “carbs”, lead directly to tooth decay and are a major factor contributing to gum disease, the two most common oral health problems.

Sugar is found in sweet foods and drinks and can be hidden in foods that do not taste sweet, especially foods which are processed. Starches are usually not sweet but are found in foods like bread, pasta, crackers, and many snacks, like chips & pretzels.

A common meal which demonstrates starch, sweet sugar, and sugar snuck into a food is a peanut butter and jelly sandwich. The bread is starchy, the jelly is sweet and sugary, and the peanut butter may have had sugar added to it by the manufacturer. Eaten frequently, this is a recipe for oral health problems.

This does not mean that you/your child can never enjoy sugar or starch! Instead, the diet must be balanced with other types of foods including proteins and healthy fats. Examples of foods which will promote oral health are vegetables, lean meats, fish, nuts, eggs, beans, and more. When eating or drinking sugar, do so as part of a meal – not as a snack – because chewing the non-sugary foods in the meal will help to clear the sugary food off the teeth, much like tooth-brushing does. This prevents the sugar from remaining on the teeth for a long period of time and feeding the plaque which causes tooth decay.

Foods to Eat/Foods to Limit

In general, sugary and starchy foods should be limited, but some common foods/drinks which are generally thought to be healthy are actually unhealthy and contribute to both tooth decay and poor general health. Whole foods should be the core of the diet.

The best foods to include in the diet do not have an ingredients list. In fact, the best foods to eat couldn’t have an ingredients list because they don’t come in a bag or a box! Whole foods – foods which are purchased in their original & unprocessed form – are the best foods to eat not just for oral health, but for general health, too. This includes most foods you would find in the produce section at a grocery store or at a farmers market, such as whole vegetables, fruits, nuts, beans, unprocessed meats, fish, and so on. As a general rule of thumb, when at the grocery store, stick to shopping on the outside walls where the produce and meat sections are and avoid/limit purchases in the aisles in the middle where almost everything is processed and unhealthy.

In general, sugary and starchy foods should be avoided to prevent tooth decay, but there are some foods worth mentioning which are often marketed by their manufacturers as being healthy when they are actually unhealthy. Juice, energy drinks, and sports drinks are often considered healthy by some, but in fact, there is nothing in any of the above which contributes to health. Instead, they are very high in sugar and other chemicals which are harmful.

Sugar is often added to packaged, processed foods and may be present even if the food itself doesn’t taste sweet. Check the back label of the food packaging under the “Total Carbohydrates” section to see if there are any “Added Sugars.”Ideally, the “Added Sugars” should be 0g or as close to 0g as possible. Selecting foods with “Total Sugars” as close to 0g as possible is another important step towards preventing tooth decay.


When you eat sugar or starch, the plaque on your teeth overgrows and can cause tooth decay.

Plaque is a film which forms on the teeth and is made up of a community of many different bacteria (germs) which naturally live in the mouth. Plaque does not always cause oral health problems. Some germs in the plaque community can cause oral health problems while others cannot. When certain conditions in the mouth change, the amount of some of the germ members of the plaque community can change, too. When sugar and starches are eaten, the plaque becomes unbalanced with too many germs that can cause oral health problems.

Sugars and starches feed certain members of this plaque community and not others. When the sugar-eating germs are fed, they overgrow and cause the total amount of plaque on the teeth to increase rapidly. This is what the furry or fuzzy feeling is which the tongue may feel on the teeth after a sugary meal or drink. There may be so much plaque on the teeth that you can even scrape off large amounts with your fingernail!

When certain germs in the plaque eat the sugar you’ve fed them from your own diet, they turn this sugar into energy for themselves to keep growing in number and spit out acid onto the teeth as a waste product. This acid softens the teeth and usually leads to tooth decay.

The most effective way to reduce the amount of plaque is proper oral hygiene – tooth-brushing and flossing. The most effective way to keep the germ members of the plaque community in a healthy balance is to wisely approach and limit sugars and starches in the diet.

Tooth Decay

When the germs in plaque are unbalanced and overgrown, teeth begin to decay and break down.

Tooth decay is the softening and eventual breakdown of the hard, mineralized parts of the tooth. This is the result of an unhealthy balance and amount of plaque in the mouth due to improper diet. The outermost layer of the tooth is the enamel, which is the hardest part of the body. Despite its hardness, it can be softened dramatically by sugar-eating germs. This softening can advance to the point that parts of the tooth break away or dissolve. This advanced form of tooth decay is known as a cavity.

The same germs in plaque which eat sugar and cause tooth decay will continue to invade further into a tooth after a cavity forms. This causes the cavity to grow in size which destroys more of the structure of the tooth. Once the cavity reaches a certain size, it will contact the center of the tooth, known as the pulp. The pulp contains the tooth’s nerve and blood supply. Because the nerve is affected by the tooth decay, severe pain is likely to occur. Because the blood supply is affected, the tooth may “die” and end up becoming a melting pot of even more bacteria which can cause an oral infection. Such infections can cause extreme pain, severe facial swelling, illness, and even death.

In most patients, tooth decay is 100% preventable with proper diet and hygiene, as well as with regular dental office visits to ensure that your approach to achieving and maintaining excellent oral health is on track.

Gum Disease and Its Consequences

The body’s response to plaque and tartar at and below the gumline can lead to permanent bone loss, loose teeth, and missing teeth.

Gum disease is caused by the body’s natural inflammatory response to sugar-eating bacteria in plaque when they invade into the tiny, pocket-like space between the gums and tooth. The long-term inflammation which the body puts up to prevent this germ invasion from becoming an infection ends up destroying everything around it, much like the destruction seen on and around a battlefield. The body’s unintentional result of preventing a much larger infection leads to the destruction of the bone which surrounds a tooth’s root and anchors it into the jaw. When this anchoring bone is lost, the tooth gradually becomes looser until it falls out. This is a disease process which is different than how baby teeth normally fall out, and it can lead to the permanent loss of adult teeth.

Usually starting in pre-teens and continuing throughout adulthood, the spit/saliva in the mouth will slowly deposit calculus (“tartar”) on the teeth. This tartar is a hard, mineral complex in which the sugar-eating germs in plaque live. Tartar cannot be brushed away. Its accumulation is slowed by regular tooth-brushing and flossing. Once it accumulates, it can only be removed by a dental professional trained in calculus removal.


Brushing every part of every tooth 2 times per day for 2 minutes each time is crucial for reducing plaque and preventing tooth decay.

It’s unrealistic to expect anyone to completely avoid all sugar and starch in their diet, so proper oral hygiene is essential to ensure that the sugar and starch you do eat doesn’t end up causing tooth decay. Tooth-brushing and flossing are effective at preventing tooth decay because they remove the plaque which causes it in the first place.

Proper oral hygiene is simple. For most patients, gently brushing 2 times per day for 2 minutes each time, ensuring that every part of every tooth is brushed, is enough. Patients with a significant tooth decay problem should gently brush their teeth 3 times per day for 2 minutes each time. Patients who are pre-teens and older should begin to floss between every tooth once daily in order to prevent gum disease.

Most often, child patients with tooth decay whom Dr. Nathan has treated report that they brush once per day, usually before breakfast. This is essentially the same as not brushing at all, and this is why patients who brush only before breakfast are so likely to have tooth decay. This is often the case because the children are eating breakfast at school, and schools rarely allow children to brush their teeth once at school. In this scenario, tooth-decay-causing plaque is removed only once per day, immediately before a meal (often sugary and starchy cereal) which will restore the plaque that was just brushed away! In most cases the most important recommendation Dr. Nathan can make is to ensure that you/your child eat breakfast at home, not at work/school, and brush immediately after breakfast and just before bedtime.

Procedures, Materials, and Our Commitment to Safety

No Smile Left Behind delivers comprehensive dental care with an uncommon attention to detail and safety.

No Smile Left Behind is dedicated not only to you/your child’s oral health, but also to their overall health.

We use a unique, top-quality, non-toxic filling material to restore the form, function, and health of teeth which have been affected by tooth decay. Some dental offices use materials which contain mercury (amalgam or “silver” fillings) or BPA, a known cancer-causing agent. No Smile Left Behind is sensitive to the controversies which exist and concerns some may have with respect to these chemicals. As such, we have designed our treatment around ensuring that the safest, most bio-compatible filling materials are used. We never use mercury or BPA-containing filling materials which sets us apart from the vast majority of dental practices.

To ensure a thorough examination, No Smile Left Behind uses digital X-rays which lead to the smallest possible amount of exposure time, as well as ensuring proper shielding of the body with a lead apron. The X-rays taken at a typical exam are equivalent in radiation exposure to less than a day of natural radiation exposure (such as a normal amount of sunlight) or a 2 hour airplane flight. Neither of these real-world examples are a cause for alarm. The radiation exposure of our X-rays is, in a word, insignificant.

To ensure both tooth decay and gum disease are addressed, we thoroughly clean the teeth both above and below the gum line at each hygiene appointment. When tartar (“calculus”) is present, it is removed by hand. In the unlikely event that significant gum disease (periodontitis) exists, a deep cleaning will be done with a special instrument called an ultrasonic scaler which ensures that stubborn tartar is removed from all parts of each affected tooth. At all cleaning appointments, oral health education will be provided and reinforced so that the patients will be equipped to make decisions which lead to excellent oral health.

As an added measure to prevent tooth decay, we place sealants on the biting surfaces of adult molar teeth. Decay-causing foods in the diet are extremely difficult to brush out of the deep grooves in the biting surfaces of teeth. Sealants slightly fill these grooves which helps brushing to be as effective as it possibly can be. Sealants do not permanently alter the tooth in any way, and they naturally come out of the tooth with time without causing any damage. Sticky, hard candies tend to dislodge sealants prematurely and should be avoided in order to maximize the effectiveness of sealants.

We use topical fluoride at the end of the cleaning procedure to strengthen the enamel of teeth in an effort to prevent future tooth decay. This is a nearly universal practice among dentists. Still, No Smile Left Behind is sensitive to the concerns some parents may have regarding fluoride consumption. Because we apply fluoride directly to the teeth (“topical” application) and remove any excess fluoride, we ensure that no fluoride is swallowed or consumed (“systemic” application). Topical fluoride application has no known risks, while there is a small controversy regarding systemic fluoride application.

Teeth in pain or with an infected pulp, often the result of tooth decay or trauma, are treated with a pulpotomy and/or root canal. The infected pulp is gently removed, and in most cases, a non-toxic material called calcium hydroxide is placed to ensure that the infection does not return. The tooth is then restored to a natural form and function with a BPA-free filling material as described above.