PROOF!
MAGAZINE DECEMBER 2003 HOLISTIC DENTISTRY SPECIAL REPORT
by Dr David COWAN
revised and reprinted by kind permission of the editor of Proof!
Dentistry is an enigma.
While there have been many interesting developments, particularly
in the concept of holistic dentistry over the last 30 years,
little appears to have changed in day-to-day practice. In spite
of the known potential toxicity of mercury, for instance, amalgam
probably still accounts for the majority of restorations placed,
and gum disease is still at epidemic proportions. The idea
of holistic dentistry can probably be traced back to a 1985
conference held in Cambridge, UK, on the hazards of mercury
in dentistry. At that time, Sam Ziff, PhD, had just written
a book called The Toxic Time Bomb, which was a plea for more
research into the "potential toxicity of mercury and dental
amalgam" mercury being approximately 50 per cent of what
makes up amalgam `silver' fillings. The conference brought
into focus a contentious subject that had been simmering ever
since amalgam was introduced into dentistry in 1819. At around
the same time, Dr Jean Munro had demonstrated how toxins in
our environment could contribute to `new' disease states which
did not appear to respond to treatment by orthodox methods.
Clearly, what goes on in the mouth can have implications for
the health of the rest of the body.
Why holistic?
Dentistry has the ability to deal with many symptoms that, at first sight,
may appear to be unrelated to the mouth. A patient who, for instance, has chronic
headache or migraine may really have a problem with his jaws. Someone who complains
of having a `metallic' taste in the mouth may have leaking fillings or a reaction
between saliva and metals. An altered taste sensation may be due to a `coated'
tongue, which may be indicative of an ongoing gut problem. Tooth wear abrasion
and erosion-may be due to acid regurgitation from the stomach or a chronic
grinding/clenching habit. Unsightly and uneven dentition may impact upon a
person's self-esteem. Food debris and plaque deposits contribute to gum disease.
All of the above are seen by dentists
everyday.
So, how might holistic dentists approach these problems? Take the patient with
the chronic headache. After taking a thorough history and excluding other causes,
it would be prudent to investigate the possibility of temporomandibular joint
TMJ dysfunction. [The temperomandibular joints are the areas where the jawbone
meets the skull in front of the ears]. Not only are the TMJ's probably the
most used joints in the body but, due to their complexity, they are also able
to cause, or be associated with, many problems. Although this joint is believed
to stop growing by about age 20, it is constantly adapting to physiological
or functional changes in the surrounding tissues. Factors that can affect the
joint include stress, ageing and an associated decline in muscle activity,
loss of teeth and, of course, changes in occlusion (Ide Y et al., Anatomical
Atlas of the Temperomandibular Joint, Tokyo: Quintessence, 2001).
Stress can be not only mechanical,
but emotional as well. Nowadays, we are told to `grit our teeth
and get on with it', so we develop the habit of grinding our
teeth [bruxism], which causes tension in many of the chewing
muscles, resulting in TMJ problems, headache, migraine, tinnitus,
earache, pain in the cheek or temple areas and generalised skeletal
pain. Long-standing TMJ dysfunction has been linked to depression
and can restrict movement of the upper neck (J Am Osteopath Assoc,
1991; 86: 512-85).
How many people do we know who
complain of a stiff neck and neck pain? An holistic dentist would
check the action of these joints in relation to how the teeth
meet during chewing and talking, and whether for instance the
ears are in alignment,the size and position of the eyes and if
there are any complex bridges crossing the midlines in either
jaw. This last observation is important because all the bones
of the skull move and if this movement is restricted even fractionally,
it may cause physiological stress leading to headache and migraine,
changes in body posture, and pelvis alignment.
A coated tongue would require careful examination of the patient's lifestyle-in
particular, eating habits, water consumption and amount of exercise. The possibility
of fungal overgrowth or parasitic infections would also be considered and,
if necessary, the appropriate lab tests carried out. The presence of such pathogens
can have a major impact on the immune system and health, so treatment planning
would also need to take this into account.
Alternative
prevention
Prevention is a term often heard in dentistry, and prevention of oral disease
is particularly important. Holistic practitioners seek to use dietary methods
or supplementation as a preventative measure, rather than apply-or ask the patient
to consume-substances such as fluoride. Time spent analysing the patient's diet
before arriving at a treatment plan is time well spent. Advice on correct brushing
technique as well as the recommendation of specific toothpastes play a major
role-patients using homeopathic remedies need spearmint and peppermint-free
pastes, but these also need to fulfil the proper cleaning criteria. The use of
proprietary mouthwashes should be avoided because they can upset the balance
of microflora in the mouth. Any patients prescribed a course of antibiotics,
by a doctor or dentist, are advised to take probiotics throughout this period
and for some time afterwards.
|
 |
As an adjunct in the treatment
of gum disease, the use of coenzyme Q10 is particularly helpful
(Res Commun Chem Pathol Pharmacol, 1976; 14: 729-38).
Appropriate homeopathic and herbal remedies can also be used, and the use
of diet and nutrition supplements is especially important before, during
and after any procedure than involves changing restorations in the mouth.
Conservative dentistry
Modern dentistry ranges from the provision of single restorations to complex
full mouth rehabilitation, where a broken or worn dentition can be completely
rebuilt. It is recognised and known that, while metals are extremely durable
materials-and gold, in particular, can be used in thin sections, thereby
conserving tooth structure-there are some patients who would rather not
have materials placed in their mouths that some consider could upset the
energy balance in their bodies. Some holistic dentists use simple kinesiology
to test for sensitivities and overload. Laboratory tests are also used.
A Kelmer challenge, lymphocyte sensitivity and stool tests for heavy metal
assessment are lab tests that can indicate the level of and sensitivity
to mercury and other toxins. These are important tests to have carried
out when considering amalgam replacement.
Many different restoratives are
available, including porcelain and gold; these materials are
considered to be the most durable, and form the basis of most
of the complex restorations provided by dentists.
Resin-bonded quartz composites
(white fillings) are a relatively new invention dating from the
mid-1960s. Early composites were intended primarily for use in
the front teeth. However, although they were aesthetically good
when initially placed, they had poor wear characteristics. But,
by the mid-1980s, sufficient developments in this field had allowed
their routine use for selected restorations in back teeth as
well. Furthermore, these composite fillings have the ability
to bond chemically with dentine and enamel, allowing for smaller
restorations which can be sealed into the tooth. Fissure sealants
were developed as part of this technology so that the small pits
and cracks in molar and premolar teeth could be sealed soon after
their eruption, before they developed cavities.
Glass ionomer cements can also
bond to tooth substance but, in their present form, they are
not durable enough for permanent restorations in adult teeth.
For direct amalgam replacement, composite materials can be used,
provided that the area of tooth involved is not too large and
that the bite is not too heavy. From an holistic viewpoint, the
least toxic replacement composite should be one with no aluminium
or resin bisphenol-A (an oestrogen-like substance which can `mimic'
hormone effects), and no fluoride.. Where there is no suitable
alternative and metals must be used, either because of the complexity
of the restoration or a heavy bite, they should have the highest
gold content possible. For front crowns where, for aesthetic
reasons, gold is bonded to porcelain, this can be as high as
99 per cent. A similar bonded crown on a back tooth would have
a gold content of 88 per cent. Composite crowns are being developed
but, at present, they do not appear to have acceptable wear characteristics.
Dental phobias
For those patients who are afraid of going to the dentist, there are alternatives
that can provide enough relief from this condition to allow such patients to
attend a dental surgery at least for routine treatment. Homeopathic Aconite
has been used to overcome fear for centuries and works well in the 30 C dose
before dental treatment. Courses in hypnotherapy have been run for dentists
for many years now. A more orthodox approach would use an intravenous derivative
of a tranquiliser such as Valium. Local anaesthetic's are usually based on
lidocaine (xylocaine), articaine or prilocaine. Lidocaine and articaine are
usually given with adrenaline (epinephrine) as a vasoconstrictor (to slow the
time the drug takes to disperse from the injection site), and prilocaine with
octapressin, another vasoconstrictor. There are anaesthetic's that don't need
a vasoconstrictor, and some may find these more tolerable. From a holistic
viewpoint, all anaesthetic's are toxic and have the ability to produce a slight
short-term effect on the dual membrane of the brain so the less used, the
better. (Milne H, The Heart of Listening, California: North Atlantic Books,
1995).
Also, it is advisable for patients
to take vitamin C and N-acetyl cysteine after any local anaesthesia.
Patients undergoing surgery in hospital would find N-acetyl cysteine
effective for removing the after effects of general anaesthesia,
and should consider supplementation to replace important nutrients,
such as folic acid and calcium, which are known to be depleted
by general anaesthetic's (Pelton R et at., Drug Induced Nutrient
Depletion Handbook, Ohio: Lexi-Comp, 1999). Vitamin C (and N-acetyl
cysteine) should not, however, be taken immediately before dental
treatment as they may reduce the effectiveness of the anaesthetic.
The mouth is a sensitive barometer of what is going on elsewhere in the body.
Recently, the American Academy of Periodontology publicly stated its concern
over the link between gum disease and heart disease (see www.
perio.org/consumer/bacteria.htm).
The future direction of holistic dental practice will need to build on such
connections as well as integrate with other specialties, such as craniosacral
therapy, osteopathy, chiropractic and nutritionists. The use of saliva tests,
plaque analysis and other assessments to detect abnormal biochemistry within
the oral cavity needs to be developed to allow easier diagnosis of disease
elsewhere in the body.
Dr David Cowan
BDS(LOND), LDSRCS(ENG)
|
|
