‘No fluoride for me thanks’: a brief guide to holistic dentistry
Asha Pandya-Sharpe discusses holistic dentistry, what it involves and what conventional dentists should be aware of.
It is not entirely uncommon to stumble across a patient who refuses to use fluoridated toothpastes.
The use of fluoride has for years been considered to be the holy grail of dentistry, having played the most pivotal role in reducing caries rates (Kanduti, Sterbenk and Artnik, 2016).
It is our job as dentists to promote the best oral health and hygiene practices for our patients. So an adamant rejection of fluoride is frustrating.
A conversation that initially starts as routine oral hygiene instruction fast becomes a ‘debate’. These anti-fluoride views often belong to those with an interest in holistic dentistry.
When taught conventional methods at dental school, understanding the beliefs of such patients is difficult. This in turn makes it challenging for us to continue to provide good treatment to all of our patients.
The uptake of holistic dentistry is increasing in popularity over recent years. So it is important that as conventional dentists, although we may not share all the same views as holistic dentists, we have a sufficient enough understanding to converse with and understand the questions that patients with holistic views may pose.
What is holistic dentistry?
Holistic dentistry is also termed biological dentistry or alternative dentistry. It is based on a belief not too dissimilar to that of conventional dentists that there is a link between the mouth and the body, and that an improvement in diet, hygiene and lifestyle will benefit oral health.
Evidence-based dentistry shows conditions including periodontitis has associations with diabetes and cardiovascular disease (Blaizot et al, 2009; Preshaw et al, 2012).
Some of the core ideologies of holistic dentistry include the use of only certain dental materials. It also includes the avoidance of some dental treatments and may entail the use of adjunct therapies including hypnosis, herbology and nutrition education.
Following the Minimata convention in 2013, dentistry is gradually phasing out the use of amalgam. This is primarily due to environmental concerns.
As a strong and cheap material with good longevity, amalgam continues to play an important part of NHS dentistry. There is limited evidence to suggest the mercury within amalgams poses direct risk to health.
Holistic dentistry entirely avoids the use of amalgam due to concerns surrounding toxicity to the body.
Instead, the goal is to use more ‘biocompatible’ materials, including porcelains, gold and composites.
Conventional dentists discourage removing amalgam fillings due to the damage it can cause to the tooth and the large release of mercury that occurs during its elimination (Rathore, Singh and Pant, 2012).
However, many holistic dentists continue with the removal procedure using strict protocols. These include the use of rubber dam, high volume ejection tips, air purification systems and nasal hoods that provide an alternative air source during the treatment (Colson, 2012).
They may also encourage amalgam sensitive patients to commit to an organic food diet, avoid caffeine, fish, sugar, dairy products and refrain from smoking prior to the amalgam replacement. This is done in an attempt to eliminate mercury trapped within the cells of the body.
Holistic dentistry encourages the use of composite as a direct restorative material. The composite used, however, is often required to be bisphenol A (BPA) free.
BPA is a chemical added to many products and is found in polycarbonate plastic and epoxy resins. It is used to coat the inner lining of canned foods to prevent metal corrosion and is added to plastics to increase their strength.
BPA has a chemical structure very similar to that of oestrogen. This enables it to bind to oestrogen and other hormone receptors (Repossi et al, 2016). As a result, since 2011, the European Union has banned BPA use in baby bottles (Dursun et al, 2016).
The potential toxicity of BPA however is a widely controversial issue amongst scientists. The long-term effects of these monomers remains uncertain.
Composites do not contain pure BPA, but its derivatives, namely bis-GMA and bis-DMA.
During the degradation process of bis-GMA and DMA via salivary esterase, bis-GMA resists hydrolysis, but bis-DMA releases BPA.
A 2016 study however shows the BPA concentration in urine to increase for the first two weeks following the placement of a bis-GMA containing composite in children.
The BPA-free composites in holistic dentistry refer to composites that use UDMA or TEGDMA monomers instead (Dursun et al, 2016).
Root canal treatments have recently been subject to a lot of negative media.
The American Dental Association suggests that there is ‘no scientific evidence linking endodontically treated teeth with systemic disease’. However, many of those interested in natural dentistry believe in avoiding root canal treatments. This is due to their understanding that despite efforts to disinfect the canals, some bacteria and toxins persist within the dentinal tubules and may permeate through the tooth into the body.
Others believe that multiple tooth extractions can result in emotional stress and problems with occlusion. So they believe that root canal treatments are occasionally appropriate if the dentist uses holistic methods.
Patients who require more ‘natural’ remedies may mention their use of different herbs to help certain oral conditions. These could include the use of oregano oil or liquorice root for their antimicrobial properties, clove oil, the substance that produces the characteristic sedative effects of zinc oxide eugenol (Mohammadi Nejad, Özgüneş and Başaran, 2017) or herbal chewing sticks, namely the Miswak, a traditional oral hygiene aid that has been used for centuries (Dahiya et al, 2012).
Conventional dentists approve of the dental treatments and materials they provide because of a lack of sufficient evidence to suggest harm. Especially in the quantities in which we use them.
Those with holistic beliefs attempt to avoid things that have harmful potential.
After learning conventional methods, materials and protocols at dental school, it is difficult for us to treat patients with strong views in a science that may seem alien.
In learning a little of their beliefs and practices, we may be able to better understand and communicate with all patients that walk through the door.
Blaizot A, Vergnes JN, Nuwwareh S, Amar J and Sixou M (2009) Periodontal diseases and cardiovascular events: meta-analysis of observational studies. Int Dent J 59(4): 197-209
Colson DG (2012) A safe protocol for amalgam removal. J Environ Public Health 517391
Dahiya P, Kamal R, Luthra RP, Mishra R and Saini G (2012) Miswak: A periodontist’s perspective. J Ayurveda Integr Med 3(4): 184-7
Dursun E, Fron-Chabouis H, Attal JP and Raskin A (2016) Bisphenol A Release: Survey of the Composition of Dental Composite Resins. Open Dent J 10: 446-53
Kanduti D, Sterbenk P and Artnik B (2016) FLUORIDE: A REVIEW OF USE AND EFFECTS ON HEALTH. Mater Sociomed Apr;28(2): 133-7
Mohammadi Nejad S, Özgüneş H and Başaran N (2017) Pharmacological and Toxicological Properties of Eugenol. Turk J Pharm Sci 14(2): 201-6
Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K and Taylor R (2012) Periodontitis and diabetes: a two-way relationship. Diabetologia 55(1): 21-31
Rathore M, Singh A and Pant VA (2012) The dental amalgam toxicity fear: a myth or actuality. Toxicol Int 19(2): 81-8
Repossi A, Farabegoli F, Gazzotti T, Zironi E and Pagliuca G (2016) Bisphenol A in Edible Part of Seafood. Ital J Food Saf 5(2): 5,666