Oral health – a holistic approach
Trishul Vadi explores the connections between the mouth and the body.
There are two definitions we need to consider when thinking about taking a holistic approach to oral health:
- (Oral) health: the way I see health is the body’s ability to heal
- Holistic: to consider the whole (not what is commonly misunderstood as alternative).
After engaging with numerous dentists, I noticed that we can do more to appreciate a more holistic view of dentistry and the impact it has on a patient’s overall health.
Dentists are typically often quick to diagnose a condition based solely on looking in a patient’s mouth, without taking a wider view and looking at the patient as a whole. The root cause of the problem is therefore rarely addressed.
As an example, Figure 1 shows how malocclusions can affect the overall posture of a patient.
The backbone of bruxism
Bruxism and jaw clenching are becoming increasingly common problems that dentists face. This is partly due to increasing levels of stress and anxiety faced by patients.
Prescribing a soft or hard mouthguard to patients is the most common treatment provided. Of course, this may help to reduce tooth wear. However, it will do nothing for the over activation of the grinding or clenching habit. This will invariably continue or potentially worsen.
To resolve this, we must look to the root cause of why the patient is grinding their teeth in the first place.
The father of modern medicine Hippocrates is famously quoted for saying: ‘Look well to the spine for the cause of the disease.’
This philosophy can also be applied to patients suffering with bruxism.
When examining a new patient, chiropractors and osteopaths will look at the whole patient – not just their whole body, but all aspects of their lifestyle. This includes their sleep patterns, occupational stresses, posture, nutrition and much more. A busy dental team rarely has the time or expertise to delve deeper into these areas of a patient’s lifestyle.
I recently had a patient referred to me by their dentist. Over the last five years she had chewed through two hard mouthguards, and knew there was something else that needed to be done. The reason she visited the dentist was to have muscle relaxants (botulinum toxin) delivered to her masseter and temporalis muscles. This approach would provide temporary relief for her symptoms and had previously worked very well for her.
This particular dentist was familiar with my work, and referred her to me knowing that a more permanent solution was needed.
As part of my initial consultation, I found out that the bruxism was a result of her work stress. As a young, ambitious person in her late twenties, she wanted to take on a promotion and achieve career progression. However, the thought of not coping with the additional stress had put her off for many years.
That is the reason she was seeking help. Not the tooth wear, not the jaw ache, but the fact that she could not progress in her career.
As part of my clinical examination, I examined the spine and found a number of lesions, particularly in her cervical spine. The last point of compensation in the spine is not the top of the neck, but the temporomandibular joint (TMJ).
Therefore, I traced back the compensation patterns to find the underlying lesions – ones the patient said no one else had looked for, let alone detected.
After going through a complete treatment plan – consisting of spinal facet mobilisation, prescriptive massage therapy, stretching advice and stress coping strategies – not only did her bruxism stop, but she was also able to focus on her passion. This allowed her to progress further in her career.
There are thousands of dental patients in the UK just like this patient who need the right help.
In my experience from the dentists I have met, there simply isn’t enough taught or known about holistic approaches to oral health.
Because there is no certified specialty for disorders like this in either dentistry or medicine, finding the right care can be difficult. Before considering more invasive methods of treatment such as a long-term night guard, which can potentially exacerbate the symptoms, or routine muscle relaxant injections, which need to be repeated at cyclical intervals, it would be beneficial to look for conservative options.
Look for a healthcare provider, such as an osteopath or chiropractor, who understands neuromusculoskeletal disorders (affecting muscle, bone and joints) and who is trained in treating conditions like this.
As a profession, we treat the body as a whole, by optimising the patient’s health. In other words, we don’t take anything out of the body and we don’t put anything new into the body. Instead, we increase the body’s ability to heal.
By going to the root cause of the problem of a condition, we can see that the definition of health (as stated at the start of this article) can be met. A patient’s ability to heal improves.
The health of the mouth depends on the health of the body. The mouth is part of the body after all, and it all comes together in synergy.
Got a patient that suffers from bruxism? Ask them these questions:
- How long have you noticed grinding your teeth?
- What has brought you to seek help for this now?
- Has anyone (eg your partner) noticed you grinding your teeth at night?
- What is it stopping you from succeeding in your lifestyle?
- When did you last dedicate time to do what you love?
- When did you last have a spine check?
This is by no means an exhaustive list of questions. It serves as a good starting point to help unravel the deeper reasons for a patient’s bruxism.