Reading the paper in the article the thesis seems to be based on the lack of historical dental health recommendations such as brushing your teeth people didn’t have cavities because they ate low carbohydrates foods. However tooth decay was rampant and instead of filling cavities people just extracted teeth. My grandmother was a public health nurse and she talked about before fluoridation tooth decay was an endemic scourge to the extent that it was considered common to be virtually toothless in old age. Comparatively she fluoridated her children, and helped organize dental clinics for migrant families in rural areas. All her children have every tooth in their head intact, which was a point of pride for her since her generation and prior generations lost most their teeth over their life. She talked about observing a huge change in her public health dental clinics over the rollout of fluoridation.

All in all, the paper seems to provide very little quantitative data on tooth decay rates. It’s based on historical recommendations and a lack of focus on tooth decay prior to dietary recommendation changes. That can also simply be attributed to a lack of focus on public health in general. An example of this was during the early conscription in WW2, a huge percentage of young men in the south east had rickets due to malnutrition and were unfit for service. That was what prompted providing public supported lunch programs in school - a realization that we did so poorly at maintaining a healthy populace we couldn’t effectively muster an army. Around this time came a general awareness of poor public health outcomes and a tracking of data leading to decisions like recommending tooth brushing, flossing, and fluoridation of public water supplies, as well as the rise of mass vaccination.