- Functional Medicine -

A Different Kind of Dentistry

Holistic dentists take a whole-body approach to dental care–an approach enthusiastically embraced by a growing clientele, and largely rejected by the conventional dental establishment.

If the idea of a holistic dentist is new to you, you’re not alone. But if holistic dentistry follows the same path that the rest of medicine has been traveling, the concept probably won’t remain unfamiliar to you and other health seekers for long.

It used to be that when someone said they were going to the doctor, it meant only one thing: They were going to see a physician trained in allopathic (conventional) medicine. While there were other professionals who treated problems of the body — alternative practitioners like chiropractors, acupuncturists, osteopaths, naturopaths and even medical doctors who practiced integrative care — many people either hadn’t heard of them or hesitated to seek their help. The medical establishment scoffed at them. Health insurance wouldn’t cover their services.

But things changed, in large part because of growing patient demand and a growing body of evidence that such alternative treatments were not only sought after, but had good clinical outcomes. For the most part, these alternative practitioners are now accepted as part of our spectrum of healthcare. It’s not unheard of for conventional doctors to refer clients to them, and insurance often covers at least some of their treatment costs.

This level of acceptance has not yet reached dentists who offer an alternative approach to conventional dental care. But their profession seems to be following a path not unlike those that other alternative-care models have already tread, and their methods may be destined for a similar measure of public acceptance and success.

Like alternative medical practitioners, holistic dentists approach care in ways that depart from conventional treatment, employ methods culled from other complementary approaches and reject some traditional procedures — especially root canals and the installation of amalgam “silver” fillings — they perceive as being potentially harmful or downright dangerous.

And as it was 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 Web site: “‘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 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 receptacle and processing station for food. Indeed, the health and structural integrity of the mouth both influence and are influenced by everything else going on in the body — from skeletal mechanics to nutritional biochemistry.

Beyond those basic tenets, there is great diversity in how holistic dentists practice their craft. They may employ a wide variety of approaches to support and improve their patient’s overall health — and they may define health as comprising many aspects of physical, emotional and even spiritual well-being.

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 depression, digestive trouble, skin irritation or difficulties breathing. They might ask if 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 multi-factorial,” says Steve Green, DDS, a second-generation dentist who practices in Miami, Fla. “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.”

Recent studies support the connection between oral and overall health. Researchers at the State University of New York at Buffalo — funded by the National Institute of Dental and Craniofacial Research — 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.

“Aggressive dental boards try hard to find something wrong [with what we do],” says Ron King, DDS, a former president of the Holistic Dental Association who practices in Minneapolis. He recently served on Minnesota’s state dental board, including a stint on its complaint committee, and says 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 material disagreements about protocol and some important philosophical arguments about what types of dental treatments are best for patients.

Perhaps the best way to understand such differences is to look at a few representative areas where conventional and holistic dentists part ways.

Different Takes on Orthodontia

In conventional dentistry, otherwise healthy teeth are often removed to make space for straightening crooked front teeth. Most frequently removed are permanent side teeth (bicuspids) and baby teeth that serve important functions in the mouth.

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 jaws. 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, DDS, a past president of the Holistic Dental Association who has been practicing what’s called orthopedic or nonextraction orthodontia for more than 20 years in River Falls, Wis. “And we do our best not to amputate teeth.” (For more on Laughlin’s approach and the logic behind extraction avoidance, see “The Domino Effect,” below.)

Laughlin practiced as a conventional dentist for several years after he graduated from dental school, 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. So he began to explore other approaches.

At around the same time, he became interested in the work of cranial osteopaths Viola Frymann, D.O., and  John Upledger, D.O., who teach 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,” says 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, D.O., and M. B. DeJarnette, D.O., D.C., 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 of 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 — about 400 worldwide have been trained — will later use light, flexible braces to straighten the teeth after the jaw has properly developed. But they consider this more-cosmetic work to be the completion of a task that must begin with foundational, functional work on the jaw.

“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, 44, had a root canal three 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.

“You think, ‘seek and ye shall find,’ but I kept seeking and 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 Ron King, 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 ran-corous 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 Web site 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, which have chewing patterns more like that of humans. Summers not only found that the mercury leached out, but that the bacteria in the monkeys’ intestinal tracts had become resistant to both mercury and antibiotics. Bacterial genes that resist mercury, she explains, are in the same DNA package as the ones that resist antibiotics. In other words, if your bacteria become mercury resistant because of your fillings, they’re likely to become antibiotic resistant, too.

“Frankly, I think the use of amalgam fillings in the developed countries is the public health sleeper of the century,” says Summers, who notes that mercury’s complex and varied toxicology make it “an epidemiological nightmare.”

Holistic dentists and others who argue for eliminat-ing mercury amalgams compare the shifting weight of research and opinion about them to public health battles of the past regarding 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 their favor: In June 2008 the U.S. Food and Drug Administration (FDA) changed the information on its Web site about amalgam fillings. It is widely thought that the agency is likely to reclassify dental amalgams later this year.

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 far more measured stance. Its carefully worded statement now reads: “Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses. When amalgam fillings are placed in teeth or removed from teeth, they release mercury vapor. Mercury vapor is also released during chewing … Pregnant women … should not avoid seeking dental care, but should discuss options with their health practitioner.”

This shift in position came two 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. They were never told.”

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 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.”

Kristin Ohlson is a writer in Cleveland Heights, Ohio.

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