A Different Kind of Dentistry

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Holistic dentists take a whole-person approach to dental care — and an integrated view of the mouth’s connection with the rest of the body.

If the idea of a holistic dentist is new to, are not alone. While many folks have embraced alternative medical practitioners like chiropractors, acupuncturists, osteopaths and naturopaths, few people have heard of dentists who offer an alternative approach to conventional dental care.

Like other alternative medical practitioners, holistic dentists practice their profession in ways that depart from conventional treatments, employ methods culled from other complementary approaches, and reject certain widely accepted procedures (like root canals and the installation of amalgam “silver” fillings) they perceive as being potentially harmful or downright dangerous.

And, much as it was initially with the chiropractors and acupuncturists who preceded them, their progressive perspectives are not looked upon kindly by the establishment.

The American Dental Association (ADA) declined to comment for this story, instead pointing to a policy statement on its website:

“Unconventional dentistry” is defined as encompassing scientifically unproven practices and products that do not . . . conform to generally accepted dental practices or “conventional” methods of evaluation, diagnosis, prevention and/or treatment of diseases, conditions and/or dysfunctions relating to the oral cavity and its associated structures. . . . The dental profession advocates an evidence-based approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence. . . .

But alternative practitioners insist that there’s scant science behind some of the standard procedures of conventional dentistry, as well as a long history of problems and health complications caused by some conventional dental treatments. They can also point to plenty of research that supports their own pioneering work and articulate the need for progress in a profession that they suggest has for too long been mired in traditions that have not always served the best health interests of its patients.

“All dentistry should be evidence based,” says David Kennedy, DDS, past president of the International Academy of Oral Medicine and Toxicology, which promotes scientific research on biocompatible dentistry (basically, the avoidance of toxic compounds in dental materials). “Dentists think they are doing evidence-based work when they get out of dental school. But unfortunately, dental schools just teach ADA dogma.”

The Whole-Body Connection

The basic tenets of holistic dentistry are simple: Dentistry should do no harm, and dentists must look at the mouth, teeth, gums and jaws as integral parts of a larger, whole-body system.

Holistic dentists see the mouth as more than just a processing station for food. Indeed, the health and structural integrity of the mouth powerfully influence and are influenced by everything else going on in the body, from skeletal mechanics to nutritional biochemistry.

First visits with a holistic dentist generally involve comprehensive examinations and inquiry sessions that may last two hours or more. The intake forms might ask what other healthcare providers the patient is seeing, including herbalists and acupuncturists. They might ask the patient about health issues that are seemingly unrelated to the mouth: for instance, whether the patient has had disorders of the nervous system — from epilepsy to chronic nerve pain — or suffers from digestive trouble, skin irritation or difficulties breathing. They might ask whether the patient is sleeping well, has any phobias or has been dealing with an unusual amount of stress.

All these questions originate from the core belief that the health of the mouth and the overall body are connected. “Disease is always multifactorial,” says Steve Green, DDS, a second-generation dentist who practices in Miami. “When someone comes to me with a toothache, I see two problems. One, there’s a sick tooth. And two, the patient is rundown. A healthy person can carry a sick tooth for years, but if they go through a divorce or lose a job, their immune system suffers, and the tooth quickly becomes intolerable.”

Many studies support the connection between oral and overall health. For example, researchers at the University of Buffalo in New York showed that people with periodontal disease have a two- to four-times greater risk of suffering a heart attack. This tie is acknowledged by even conventional dentists, many of whom employ the heart-disease angle to encourage their patients to floss. But even though the health profession overall is moving toward a greater appreciation of the connection between the mouth and the body, the attention holistic dentists pay to medical issues discomfits the conventional dental industry.

Biting Criticism

All holistic dentists have completed the same professional training that conventional dentists undergo to earn their Doctor of Dental Surgery (DDS) degrees. Many also practiced as conventional dentists long before they decided to shift their practices in a more holistic direction and complete additional training to support what they saw as more promising and productive methods.

The criticism or even outright betrayal implied by holistic dentists’ rejection of certain aspects of their early conventional training — which many of them later come to see as incomplete or just plain wrong — may have something to do with the professional animosity that brews between the two camps.

To the ADA (and the state licensing boards closely tied to the organization), holistic dentists inappropriately blur the line between medicine and dentistry. Conventional dentists resent the aspersions holistic dentists cast upon certain conventional methods, and they are highly skeptical of the companion therapies their holistic colleagues recommend or employ. These may include immune-building and detoxifying nutritional programs, chiropractic, hypnosis, and acupressure or craniosacral therapy (a very gentle form of massage intended to ease tension in the tissue around the head and spine).

This integrated treatment approach attracts holistic-minded clients and produces many glowing and grateful patient testimonials, but it can also open holistic dentistry practitioners to a host of professional liabilities. Often, all it takes is one patient complaint to the state dental board to create trouble. Some holistic dentists have had their licenses revoked based on a board’s conviction that dentists simply shouldn’t be talking about — much less treating — anything but teeth and gums.

Many holistic dentists believe that they are being aggressively hunted by dental boards intent on finding wrongdoing. They say that a license-endangering dispute can ensue over issues as minor as the use of certain clinical terms. “Using the wrong word in a patient’s file can be enough” to put a holistic dentist on the wrong side of a review board, says Mac Lee, DDS, author of Nothin’ Personal, Doc, But I Hate Dentists! (IHD Publishing, 1999).

Underlying such technical quarrels over vocabulary, however, are some important differences between conventional and holistic dentists.

Different Takes on Orthodontia

In conventional dentistry, healthy teeth are often removed to make space for straightening crooked front teeth. Holistic dentists tend to take a more conservative and patient approach, preferring to keep removal of teeth to a minimum because they see them as an important structural component within the jaw and cranium, and may feel that removal of healthy teeth presents unnecessary risks to the patient.

Some holistic dentists avoid extraction entirely and employ a range of expansion and realignment techniques to create space in an overcrowded mouth and promote proper development of the teeth and jaw. Others give cautious approval to limited tooth extraction when they feel it is merited.

Many employ a variety of dental appliances, including braces and retainers, to realign the teeth for healthy jaw positioning, but they may recommend unconventional designs and materials and employ a wider range of devices over a longer period of time to achieve an ideal cosmetic and structural result. Some prefer “invisible” braces or metal appliances that contain the least amount of nickel possible; they want to avoid the potentially carcinogenic properties of the nickel in most conventional metal braces.

“We try to preserve the mouth in as natural a condition as possible,” says John Laughlin III, DDS, a past president of the Holistic Dental Association who has been practicing what’s called orthopedic or nonextraction orthodontia for more than 25 years in River Falls, Wis. “And we do our best not to amputate teeth.” (For more on why Laughlin tries to avoid extraction, see “The Domino Effect,” below.)

Laughlin practiced as a conventional dentist for several years, but he started rethinking this approach when a patient came in after an oral surgeon had removed four bicuspids. The patient’s facial structure was so collapsed that he “looked as if he’d been hit in the face with a baseball bat,” he recalls. It was clear to Laughlin that a more sensitive, conservative approach would have served the client better.

At around the same time, he became interested in the work of cranial osteopaths Viola Frymann, DO, and the late John Upledger, DO, who taught that the bones of the skull never fuse, an opinion consistent with current science but counter to most conventional dentists’ training. “Even though the bones look fused in an x-ray or MRI scan, they actually allow for minute movement that is difficult to see with today’s technology,” said Upledger, adding that the flow of cerebrospinal fluid that nourishes the brain and spinal cord can be blocked by stiffness among the skull bones. As a result of his exposure to the foundational teachings and research of Frymann, as well as William Sutherland, DO, and M. B. DeJarnette, DO, DC, Upledger developed craniosacral therapy to eliminate these blockages.

Rigid wire braces and other standard orthodontic devices can limit the flexibility among cranial bones, Laughlin learned. In looking for better options, he discovered the Alternative Lightwire Functional (ALF) appliance. Invented by Darick Nordstrom, DDS, the ALF appliance encourages the jaw to develop properly so that it can better accommodate all its original teeth. Laughlin now uses the device on patients as young as 3 or 4 years old, gradually expanding the jaws as children grow, preventing overcrowding of incoming teeth.

The ALF appliance snaps around the molars and fits along the inside of the teeth, like the inner tube inside a tire. The appliance moves when the patient swallows and works in accord with the natural movement of the skull. Many holistic dentists who use the appliance — more than 400 worldwide have been trained — will later use light, flexible braces to straighten the teeth after the jaw has properly developed.

“For years, orthodontists thought their job was only to straighten teeth,” says Nordstrom. “But we know it’s not just about making teeth straight and attractive. It’s about helping the patient swallow and breathe properly and about the long-term stability of the face and body. Just straightening the teeth doesn’t always make a healthy patient.”

Root-Canal Concerns

Many holistic dentists won’t do root canals, a process by which a decayed or infected tooth is stripped of its nerve and pulp, cleaned and sealed. They feel it’s impossible to sterilize the interior of the affected tooth and that it becomes an incubator of bacteria that cause problems throughout the body.

Concerns about root canals date back to studies conducted in the 1920s by a former National Dental Association (which preceded the ADA) research director named Weston Price. He implanted teeth from the root canals of people with heart and kidney disease in healthy rabbits and found that the rabbits contracted the same diseases. Price’s ideas were later ridiculed, but even some conventional dentists voice concern about the practice.

“I have sometimes had to remove a patient’s root-canal tooth that’s gotten cracked or reinfected,” says Lee. “When you look at the hole where the tooth came from, it often doesn’t look right. There seems to be more debris and infection. That’s why I give [Price’s] whole line of thought some credibility.”

Biochemist Boyd Haley, PhD, professor emeritus at the University of Kentucky, shares Lee’s concern. “Root canals harbor toxic bacteria,” Haley says. “No blood flows to that tooth, no antibodies can get to it, and the bacteria morph into more toxic forms. And every day, bacteria come out of that root canal and you swallow them. If the gums bleed, the bacteria go into the capillaries.”

Kathrine Aaberg, 48, had a root canal six years ago and began suffering unceasing pain in the area of the affected tooth. Her conventional dentist told her it could take up to a year for a root canal to heal properly. When the pain didn’t abate after a year, she saw an ear, nose and throat specialist who decided that the problem was a blocked parotid (saliva) duct and operated. When the pain persisted, her dentist decided she had a TMJ (temporomandibular joint) problem and sent her to a physical therapist. Still in pain, she consulted a renowned parotid duct specialist who told her she was in perfect health.

“No one could find what was wrong,” Aaberg recalls. “No one would listen to me. They just kept telling me I’d be fine, because they couldn’t find the source of the pain with their technology.”

Finally, an alternative health practitioner told her that he thought the root-canal tooth was poisoning her and recommended she go to a holistic dentist. She found a holistic dentist who diagnosed a chronic bone infection around a normal-appearing root canal and recommended extraction. When the tooth was removed, her pain disappeared. “I was so happy and grateful,” Aaberg says. “I fill up with tears every time I think of it. It’s been a long road.”

Disagreements About Amalgams

Perhaps no issue in the dental world has been more rancorous than amalgams, the “silver” cavity fillings that contain up to 50 percent mercury. As far back as the 1800s, some dentists have argued that it was dangerous to put mercury, a known neurotoxin, into the mouth. This tends to be the position taken by holistic dentists, many of whom advise against the use of amalgams and also specialize in the safe removal of amalgams placed by other dentists.

The ADA, conversely, has steadfastly asserted its belief in the safety and stability of these fillings, noting on its website that “Dental amalgam (silver filling) is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans.”

The ADA cites studies that bolster this position. But a growing number of studies suggest that the mercury in these fillings leaches into our bodies as we chew, and when we brush or grind our teeth. There is no scientific consensus about the effect of these small bursts of mercury over a lifetime, but some researchers believe it’s a significant health issue.

In the 1980s, University of Calgary researchers placed amalgam fillings compounded with radioactive mercury to track its dispersal in the bodies of pregnant sheep (chosen for their frequent chewing). After a month, they discovered the mercury had leached into the sheep’s vital organs.

More recently, University of Georgia microbiologist Anne Summers, PhD, conducted a similar study using monkeys and again found that mercury leached out into the vital organs. “Frankly, I think the use of amalgam fillings in the developed countries is the public health sleeper of the century,” says Summers.

Holistic dentists and others who argue for eliminating mercury amalgams compare them to smoking and asbestos, which were once considered safe and are now known to pose serious health threats. And they predict that the amalgam controversy may be the first of many protracted battles ultimately destined to go holistic dentistry’s way.

The most recent shift in its favor came in 2009, when the U.S. Food and Drug Administration (FDA) changed the information on its website about amalgam fillings. The FDA had previously stated that amalgams were safe and listed them in the same category of medical devices as Band-Aids. Today, the agency takes a more measured stance and classifies the amalgams as Class II (moderate risk).

This shift in position came three years after the FDA’s Dental Products Panel voted to reject the agency’s conclusion on the safety of mercury amalgams and demanded further research and public testimony. Panel members were especially concerned that dentists did not even tell patients that amalgam fillings contained mercury.

“The physicians and PhDs on the panel were incredulous,” says Michael Fleming, DDS, who is serving a four-year term on the panel (and stressed that he was speaking for himself and not as a representative of the FDA). “Prior to 2006, dentistry managed to escape scrutiny on informed consent for the products installed in patient mouths. In the case of amalgam, patients had no idea their dentists were putting mercury in their mouths.”

This shift in the tide on mercury is an important victory for holistic dentists, who for decades endured ridicule and even fury from their colleagues on this issue. They hope it will prompt critical examination of other issues important to dental health and boost the holistic philosophy into the mainstream. Some already see this happening.

“If you live long enough, the old guard retires and goes out of power,” says Craig Zunka, DDS, a past president of the Holistic Dental Association who practices in Front Royal, Va. He notes that demand for holistic dentists far outstrips the supply of practitioners, many of whom maintain lengthy waiting lists and book appointments several months in advance.

Meanwhile, even some conventional dentists are expressing interest in the methodologies and philosophies with which their holistic counterparts seem to be having the most success, from treating TMJ to saving broken or badly decayed teeth.

“Twenty years ago,” says Zunka, “I considered closing up my practice and going to osteopathic medical school — I’d get to do some of the things I wanted without getting rocks thrown at me. But now, some of the people who used to throw rocks are coming around and asking me how the holistic approach works.

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Kristin Ohlson is a writer in Cleveland Heights, Ohio. This piece was originally published in Experience Life magazine in September 2009.

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