Biological Dentistry
***Disclaimer: This blog is not meant to be used as legal or medical advice. It is written as my person perspective on how medical professionals could blend western medicine with other modalities***
Today's topic is biological dentistry. This may sound like a misnomer at first. All dentists work on biological patients, right? This term refers specifically to dentists who recognize dental work and the mouth as an important part of the whole body. These dentists also call themselves holistic or integrated dentists. From what I have found, there is a strong emphasis on how issues in the mouth can affect the entire body.
This outlook makes sense to me, because the mouth is like a gate to the rest of the body. If you think about it, we really only have two holes that are built to allow something into the cavity of the human - the nose and the mouth. If we allow foreign objects to sit in the mouth, it doesn't take too much effort for it to get down the throat and into the stomach and on to the intestines where absorption takes place. If the mouth isn't working properly, food doesn't get broken down well, so the stomach must work harder to digest it. The quality of food that gets passed the mouth affects the micro- and macro- nutrients the rest of the body gets. And although this entry to the body is heavily guarded from infection, a diseased mouth can quickly extend to other parts of the body.
One of the major concerns that biological dentists focus on revolves around issues that come with putting metal in the mouth. A major service provided by biological dentists is silver/mercury amalgam filling removal. We do know that mercury can be very toxic even in low quantities and we also know that amalgams contain mercury. Theoretically, this is of grave concern. It could lead to immunological, mental, and digestive complications and it could damage internal organs. In 2011, a research group reanalyzed a moderately large trial's data. The parent trial included children 8-12 years old with no history of mental disorders. They were randomly assigned to receive amalgam or composite fillings and followed for 8 years to determine if the their urine biomarkers for mercury exposure would increase. Although the parent trial failed to detect a difference, some researchers hypothesized that a better understanding of exposure to mercury related to the biomarker might evoke more significant results. When they ran new statistical models based on a more significant accounting of the variables, they found statistical significance in biomarkers for patients who were given amalgam treatments. Not only did the trial demonstrate that exposure to amalgam fillings produces mercury-specific biomarkers, but it shows dose dependence. The more fillings the children had, the higher their biomarkers read.
The hard question here is: Was the original study flawed in its understanding of the biomarkers, or was this a post hoc reworking of the numbers to force the results they were looking for? Still, trials like this have raised enough concern in the wider population that it's hard to find dentists who still use amalgam fillings today.
That being said, you may be wondering what services biological dentists provide that's different from standard dentists. Those of us who are old enough to have gotten amalgam fillings when we were kids could get those fillings removed and replaced with composite fillings. Other interventions include neural therapy, oral acupuncture, cold laser therapy, homeopathy, mouth balancing, and nutrition support. Neural therapy recognizes an energy flow throughout the body that can be affected by damage or infection in the teeth. Neural therapy involves injecting a local anesthetic like procaine around the offending tooth to treat disease somewhere else in the body. Oral acupuncture uses meridians that run through the mouth to affect the rest of the body using injection of saline or anesthetic or by using laser stimulation. Mouth balancing uses oral braces to adjust the patient's bite which in turn causes minute changes in the skull which can lead to relief of symptoms of pain in the jaw, eyes, head, neck, and even the back. Biological dentists will often coach the patient in their diet to detoxify from mercury exposure as well as making adjustments that are better for oral health like the avoidance of alcohol, tobacco, caffeine, and soft drinks.
I'd like to talk in more depth about cold laser therapy. As I mentioned before, this is used in oral acupuncture. Although the intervention involves shooting a laser into the mouth, it is a low level energy that does not cause thermal damage to oral tissue. It has historically been used to re-balance a patient's meridians, treat TMJ, promote healing, and reduce muscle spasms following wisdom tooth extraction. I decided to explore this treatment option a little deeper. I found a trial that researched the use of cold laser therapy for post-orthodontic tooth-related pain. The researchers acted based on understanding the positive attributes of previous trials while recognizing the need for harder clinical evidence. They produced a placebo-controlled, double-blind study showing statistically significant efficacy for self-reported pain, pain caused by pressure, and pain along the trigeminal nerve. However, it did not show a significant affect for pain due to temperature change, nor pain outside the associated trigeminal nerve (such as in the hand).
Size, again, is an issue with many of the trials dealing with these modalities. Balancing the two arms of the study can be difficult when dealing with such small numbers. This particular study also did not question the patients after the treatment to see if they knew they got a real treatment or a placebo. There was no explanation of what the placebo was or how it was presented compared to the real treatment, so this is difficult to interpret. However, we do know that the patient's belief that they received real treatment can enhance the placebo effect. Nevertheless, the results of this trial are intriguing.
Now, where does biological dentistry fit into western medicine? Research is still vague on whether mercury amalgams have a direct affect on health, but the option of removal is available if a patient is concerned about it. Also, with the opioid epidemic, any alternatives to opioids seems like a good move to me. Although I'd like to see bigger studies on it, it looks like cold laser therapy might benefit many dentist's practices and reduce societal pain medication requirements. If it can be validated in bigger studies, that is. On the other hand, there are practices of biological dentistry that do not hold up to scientific scrutiny. Many of the tools I listed here have not been validated by strong clinical trials. I urge caution when approaching biological dentists who may support methods that have not been validated by science such has homeopathy, neural therapy, and skull adjustment (those bones are fused, folks). If they practice nutrition, see if they have a certificate in nutrition.
This is an area where the buyer really needs to beware of what they're buying. If you come across a patient who is interested in biological dentistry to enhance their overall health, https://iabdm.org/ is the website for the International Academy of Biological Dentistry and Medicine. Again, be aware that this website is biased for many unproven methods, but it may provide more information about the current practices and practitioners.
Before I go, I'd like to shout out to some other podcasters out there. If any of you listeners would enjoy podcasts about clinical pharmacy, you might like Dr. Mike Corvino's CorConsult Rx, Rosalind Franklin University's HelixTalk, Dr. Eric Christianson's Real Life Pharmacology, and Pharmacy Joe's The Elective Rotation podcasts.
That's it for now. If you like what you heard, please subscribe, leave a positive review, and tell a friend about this podcast, and stay tuned for next week's episode of the Integrated Pharmacist Podcast.
References:
Geier DA, Carmody T, Kern KK, et al. A significant relationship between mercury exposure from dental amalgams and urinary porphyrins: a further assessment of the Casa Pia children’s dental amalgam trial. Biometals (2011) 24: 215.
Wu S, Chen Y, Zhang J, Chen W, Shao S, Shen H, et al. Effect of low-level laser therapy on tooth-related pain and somatosensory function evoked by orthodontic treatment. Int J Oral Sci. 2018;10:22.
Today's topic is biological dentistry. This may sound like a misnomer at first. All dentists work on biological patients, right? This term refers specifically to dentists who recognize dental work and the mouth as an important part of the whole body. These dentists also call themselves holistic or integrated dentists. From what I have found, there is a strong emphasis on how issues in the mouth can affect the entire body.
This outlook makes sense to me, because the mouth is like a gate to the rest of the body. If you think about it, we really only have two holes that are built to allow something into the cavity of the human - the nose and the mouth. If we allow foreign objects to sit in the mouth, it doesn't take too much effort for it to get down the throat and into the stomach and on to the intestines where absorption takes place. If the mouth isn't working properly, food doesn't get broken down well, so the stomach must work harder to digest it. The quality of food that gets passed the mouth affects the micro- and macro- nutrients the rest of the body gets. And although this entry to the body is heavily guarded from infection, a diseased mouth can quickly extend to other parts of the body.
One of the major concerns that biological dentists focus on revolves around issues that come with putting metal in the mouth. A major service provided by biological dentists is silver/mercury amalgam filling removal. We do know that mercury can be very toxic even in low quantities and we also know that amalgams contain mercury. Theoretically, this is of grave concern. It could lead to immunological, mental, and digestive complications and it could damage internal organs. In 2011, a research group reanalyzed a moderately large trial's data. The parent trial included children 8-12 years old with no history of mental disorders. They were randomly assigned to receive amalgam or composite fillings and followed for 8 years to determine if the their urine biomarkers for mercury exposure would increase. Although the parent trial failed to detect a difference, some researchers hypothesized that a better understanding of exposure to mercury related to the biomarker might evoke more significant results. When they ran new statistical models based on a more significant accounting of the variables, they found statistical significance in biomarkers for patients who were given amalgam treatments. Not only did the trial demonstrate that exposure to amalgam fillings produces mercury-specific biomarkers, but it shows dose dependence. The more fillings the children had, the higher their biomarkers read.
The hard question here is: Was the original study flawed in its understanding of the biomarkers, or was this a post hoc reworking of the numbers to force the results they were looking for? Still, trials like this have raised enough concern in the wider population that it's hard to find dentists who still use amalgam fillings today.
That being said, you may be wondering what services biological dentists provide that's different from standard dentists. Those of us who are old enough to have gotten amalgam fillings when we were kids could get those fillings removed and replaced with composite fillings. Other interventions include neural therapy, oral acupuncture, cold laser therapy, homeopathy, mouth balancing, and nutrition support. Neural therapy recognizes an energy flow throughout the body that can be affected by damage or infection in the teeth. Neural therapy involves injecting a local anesthetic like procaine around the offending tooth to treat disease somewhere else in the body. Oral acupuncture uses meridians that run through the mouth to affect the rest of the body using injection of saline or anesthetic or by using laser stimulation. Mouth balancing uses oral braces to adjust the patient's bite which in turn causes minute changes in the skull which can lead to relief of symptoms of pain in the jaw, eyes, head, neck, and even the back. Biological dentists will often coach the patient in their diet to detoxify from mercury exposure as well as making adjustments that are better for oral health like the avoidance of alcohol, tobacco, caffeine, and soft drinks.
I'd like to talk in more depth about cold laser therapy. As I mentioned before, this is used in oral acupuncture. Although the intervention involves shooting a laser into the mouth, it is a low level energy that does not cause thermal damage to oral tissue. It has historically been used to re-balance a patient's meridians, treat TMJ, promote healing, and reduce muscle spasms following wisdom tooth extraction. I decided to explore this treatment option a little deeper. I found a trial that researched the use of cold laser therapy for post-orthodontic tooth-related pain. The researchers acted based on understanding the positive attributes of previous trials while recognizing the need for harder clinical evidence. They produced a placebo-controlled, double-blind study showing statistically significant efficacy for self-reported pain, pain caused by pressure, and pain along the trigeminal nerve. However, it did not show a significant affect for pain due to temperature change, nor pain outside the associated trigeminal nerve (such as in the hand).
Size, again, is an issue with many of the trials dealing with these modalities. Balancing the two arms of the study can be difficult when dealing with such small numbers. This particular study also did not question the patients after the treatment to see if they knew they got a real treatment or a placebo. There was no explanation of what the placebo was or how it was presented compared to the real treatment, so this is difficult to interpret. However, we do know that the patient's belief that they received real treatment can enhance the placebo effect. Nevertheless, the results of this trial are intriguing.
Now, where does biological dentistry fit into western medicine? Research is still vague on whether mercury amalgams have a direct affect on health, but the option of removal is available if a patient is concerned about it. Also, with the opioid epidemic, any alternatives to opioids seems like a good move to me. Although I'd like to see bigger studies on it, it looks like cold laser therapy might benefit many dentist's practices and reduce societal pain medication requirements. If it can be validated in bigger studies, that is. On the other hand, there are practices of biological dentistry that do not hold up to scientific scrutiny. Many of the tools I listed here have not been validated by strong clinical trials. I urge caution when approaching biological dentists who may support methods that have not been validated by science such has homeopathy, neural therapy, and skull adjustment (those bones are fused, folks). If they practice nutrition, see if they have a certificate in nutrition.
This is an area where the buyer really needs to beware of what they're buying. If you come across a patient who is interested in biological dentistry to enhance their overall health, https://iabdm.org/ is the website for the International Academy of Biological Dentistry and Medicine. Again, be aware that this website is biased for many unproven methods, but it may provide more information about the current practices and practitioners.
Before I go, I'd like to shout out to some other podcasters out there. If any of you listeners would enjoy podcasts about clinical pharmacy, you might like Dr. Mike Corvino's CorConsult Rx, Rosalind Franklin University's HelixTalk, Dr. Eric Christianson's Real Life Pharmacology, and Pharmacy Joe's The Elective Rotation podcasts.
That's it for now. If you like what you heard, please subscribe, leave a positive review, and tell a friend about this podcast, and stay tuned for next week's episode of the Integrated Pharmacist Podcast.
References:
Geier DA, Carmody T, Kern KK, et al. A significant relationship between mercury exposure from dental amalgams and urinary porphyrins: a further assessment of the Casa Pia children’s dental amalgam trial. Biometals (2011) 24: 215.
Wu S, Chen Y, Zhang J, Chen W, Shao S, Shen H, et al. Effect of low-level laser therapy on tooth-related pain and somatosensory function evoked by orthodontic treatment. Int J Oral Sci. 2018;10:22.
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