by Cathy Hester Seckman, RDH
What is holistic dentistry? You don't have to look very far to discover there are many answers — or no answers — to that question. "Holistic dentistry," says Dr. Robert Baratz of Boston, "is a marketing term. It has no specific meaning. There's no recognized specialty; it's just a vague, nice-sounding name. People who call themselves 'holistic dentists' need to define the term. They need to establish clearly defined standards, but they haven't."
There is, however, a Holistic Dental Association (HDA), which was founded in 1978. HDA defines holistic dentistry as "an awareness of dental care as it relates to the entire person." HDA members believe in "an interdisciplinary approach to health that facilitates the individual's innate ability to heal themselves."
Here are some of the ways holistic health-care practitioners describe themselves and their philosophy of practice:
Bill Wolfe, DDS, NMD, Albuquerque, N.M.: "I provide information without making recommendations. I let [my patients] have informed consent. They're made aware of what they have in their mouth and the issues about it, both anti- and pro-. Holistic dentistry is about realizing the mouth is connected to the rest of the body. Dentists are not just tooth mechanics; they're oral physicians, affecting the systemic physical health of patients with their treatments whether they realize it or not."
Jack Bynes, DMD, Coventry, Conn.: "I treat the entire person, emotionally and psychologically, as well as their teeth. I examine all of the physical problems, but unless you determine their emotional makeup as well, you don't have a basis to make a judgment. That's what I call 'holistic dentistry.' "
Mark Breiner, DDS, FAGD, Orange, Conn.: "Whole-body dentistry means realizing the systemic impact dentistry can have on the body, either positively or negatively. [As a dentist], you only see what you know. Once you're trained in holistic dentistry, you see it and you know it. There is no training that I'm aware of for what I know about mercury, specifically. It's taken me 25 years to pick up what I know from seminars and bits and pieces of information. We need to update dentistry, absolutely."
John Hunter, DDS, Washington, D.C.: "I've been exposed to many different philosophies and practices over the years, and I've filtered down my concept. It's different from the norm. I create an environment in my office that is holistic. Every aspect of the senses is engaged. There's aromatherapy and sound therapy. I use feng shui. It's all stress reduction and improvement of the office experience. As far as actual practice goes, I focus on mental health as well as physical health. I also educate my patients with a holistic approach about how their mouths can impact their bodies. The materials I use have to have science behind them."
Here are some of the ways traditional health-care practitioners describe holistic dentistry:
Robert Baratz, DDS, MD, PhD, Boston, Mass.: "Holistics has nothing to do with the practice of dentistry. Sure, you can buy supplements that are supposed to build a stronger immune system, but air and water help build a stronger immune system. What they believe in most is making money, often doing things that are inappropriate. Taking out teeth? What's holistic about that? It's called battery and mutilation."
Stephen Barrett, MD, Allentown, Pa.: "Holistic dentistry is convincing only to people who believe it is possible for a few hundred maverick dentists to know more than the other 100,000 put together, including the thousands of dental educators who train dentists. And you have to believe that Consumers Union doesn't have the ability to sort it out either. The anti-amalgamists are delusional. If they were correct, the government would have banned amalgam long ago. You should believe Dr. Baratz. He probably knows more about the subject than anyone in the world."
OK, it's clear that holistic dentistry is a touchy subject. The proponents seem to be the underdogs — misunderstood, often insulted, and genuinely worried that dental consumers are being misled. The opponents seem to be in the clear majority, secure in hundreds of years of standardized research and peer-reviewed journals, and genuinely worried that dental consumers are being misled.
As dental hygienists and educated health-care professionals, we're free to decide for ourselves on which side of the holistic fence we stand, but, of course, we are not always free to broadcast our opinion to our patients. Hopefully, a holistic hygienist can match up with a holistic dentist, thereby acting as a resource for dental consumers. Conversely, a traditional hygienist should have no trouble finding a traditional dentist, also acting as a resource.
How do we make our decision? Research, of course. We're really good at that.
After a lot of reading, a lot of Internet surfing, and a lot of interviewing, I've observed that holistic dentists seem to fall into two categories. To avoid labeling them, let's just call them One Type and Another Type.
One Type of holistic dentist believes in kinder, gentler dentistry. He believes in asking questions and in trying new approaches. He believes his patients' comfort and confidence come first.
Dr. Hunter practices in Washington, D.C., just a few blocks from the White House. "Realizing how stressful this city is, I've come to the conclusion that what affects people most is stress and mental attitude. I try to diagnose and treat my patients in regard to that."
In a soothing office environment, complete with vanilla candles, a calming decor, and special comfort cushions in the chairs, Dr. Hunter and his staff welcome patients to the most nonstressful environment possible.
"Most of my focus is on educating patients. In my initial exam, I try to get a feel for their lifestyle, an impression of their needs. Then I teach them about nutrition, give them pointers for behavior modification, suggest consultation with a therapist, and recommend yoga. I try to effect an attitude change."
Dr. Hunter uses himself as an example. "Several years ago I had a medical problem. I'd eat, then throw up. After thousands of dollars worth of tests and sonograms, it was still a mystery. I finally realized I was causing the problem myself by taking a prescription medication in the morning before I ate. Stomach irritation — it was a simple resolution. Had my physician asked some questions and pursued something more than symptoms, he would have diagnosed me sooner, perhaps."
Knowing a patient and building a trusting relationship benefits not only the patient, but the practitioner, Dr. Hunter believes. "We talk about the patient's stress, but it's stressful for me too. If you're very empathetic, your stress level follows theirs. I can't stand to hurt anybody. I can't work on someone who's not comfortable."
Dr. Bynes believes holistic dentistry means treating the entire person, but he does not believe in following unproven treatment modes. "That's not science. That's not in the patient's best interest. I always ask myself, 'Is there science behind this, or is it anecdotal?' If so, I'm not interested. Don't give me crystals or magnets. Things like that divert attention from proven treatment methods. Cancer patients will risk their lives by following treatment with no proof of efficacy."
Dr. Bynes compiles exhaustive medical-dental histories. "I try to find out if there's an emotional base to their problem. Do they have a lot of stress? Do they handle it poorly? How do they relax? Do they do meditation, yoga, or biofeedback? Once I gather the information, I have a better idea where they're coming from.
"Then we look in the mouth and palpate the TMJ and the masticatory muscles. We examine the occlusion and look at centric relation. It's like detective work, putting the pieces of a puzzle together.
"I know one patient pretty well — she's been coming in more than a decade. Every time something goes bad at work, she comes in with a muscle spasm. How do I treat it? I try to get her to follow any form of relaxation. I bring that to a conscious level, saying, 'You're damaging your teeth, your bone, your periodontium.' I explain the long-term effects of stress on the body and immune system, giving patients a broader base of knowledge so they want to take those 20 to 30 minutes a day to relax. I can't make them do it, but by educating them I've fulfilled my obligation as their dentist.
"Other people have true physical problems. It's not just muscular, but bone- and joint-related. You have to separate all these factors."
Another Type of holistic dentist is more aggressive about what he believes and practices. Those beliefs are unconventional and unsupported by established dentistry. Most Another Types agree with these statements:
• Mercury is harmful and should not be placed in the mouth.
• Many metals are harmful and should not be placed in the mouth.
• Fluoride is harmful and should not be placed in the mouth or ingested in the body.
• Root canal treatment is harmful and should only be considered under certain parameters.
• Cavitations, or voids in bone at extraction sites, act as a breeding ground for bacteria and should be treated.
Dr. Wolfe became interested in the mercury issue in 1979, after he had tumor surgery. "I went to a course on balancing body chemistry, and there was an OSHA rep present using a mercury vapor tester. I held my hand up to it, and vapor was coming from my skin in an amount high enough for an OSHA fine. I quit using mercury fillings on the spot."
In his practice, however, he doesn't remove amalgam fillings lightly. If a patient decides to have his amalgams removed, Dr. Wolfe follows a strict protocol to avoid further contamination.
"The patient has a dental materials biocompatibility test performed to determine what would be the least reactive materials to place in his mouth. I believe this test is very important, especially for the chemically sensitive patients physicians refer to me for dental treatment. Supplements are provided to assist the patient's immune system to handle the procedure.
"During dental treatment, the patient is on oxygen. We isolate the teeth with a rubber dam and use copious amounts of water. We have a vacuum system in addition to suction. There are negative-ion generators in the operatory and air filters throughout the office."
Dr. Wolfe believes that, energetically, teeth influence other organs at a distance through acupuncture meridians that run through the mouth. "Incompatibility of dental materials — whether from mercury fillings, nonprecious crowns, or composite/ceramic materials — can create what is called an 'energetic focus,' whereby the associated organ acupuncture meridians coursing through the area are obstructed, interfering with the 'energetic nourishment' of these organs." [Reinhold Voll, MD, developer of the Electro-Acupuncture according to Voll (EAV) system of diagnosis, taught this theory.]
During surgery, Dr. Wolfe might use homeopathy to stimulate those meridians. "If a tooth remains in an inflamed condition, there may be a challenge to a corresponding organ. Lower molars, for instance, are energetically connected to the large intestine.
"These are issues commonly known in acupuncture, and this knowledge is readily available to those practitioners interested in discovering the energetic relationships of organs and teeth."
Homeopathy and dentistry have a great future together, Dr. Wolfe believes. He has developed a line of homeopathic products that includes remedies for toothache, trauma, infections, and other dental conditions. He also markets aloe vera oral gel, toothpaste, and mouth rinse. The products contain no fluoride, no soap, no alcohol, and no sugar. More information is available at www.drwolfe.com.
Dr. Breiner believes so strongly in holistic dentistry that he's written a book. (See sidebar)
"My practice treats people who are chronically ill — people with asthma, multiple sclerosis, allergies. One patient came in with testicular pain that had lasted five months. He'd been to every medical specialist and had every sort of test. A naturopathic physician referred him to me."
Breiner used an EAV, a controversial electronic dermal screening instrument that he predicts will be as common as an X-ray machine in a few years. The EAV identifies the meridians, or energetic pathways, used by acupuncturists and others. The EAV linked the patient's testicular area to a cavitation left behind at an old extraction site.
"I drilled a 30-gauge hole into the bone, put anesthetic into the cavitation, and it immediately took away his pain. We cleaned out the cavitation, and that took away his problem."
Dr. Breiner often works with multiple sclerosis patients who have amalgam fillings. "We check energetically to see if mercury is a problem. We get the fillings, the major source of the mercury, out of the body, then work on detoxing the patient with various supplements. Very often, they improve."
Dr. Breiner has a word of caution specifically for hygienists: "Don't polish amalgams. Any time you stimulate a filling you have huge amounts of mercury vapor given off. Masks don't protect you; mercury goes through them."
Endodontically treated teeth can also cause health problems, Dr. Breiner believes. He once determined a connection between a patient's pain in her coccyx and a root canal on the upper right lateral. "Energetically, number 7 relates to the coccyx. I removed the tooth, and the problem disappeared."
Dr. Breiner says gutta percha is to blame for some endodontic problems, because it shrinks over time and allows room for bacterial growth. He recommends BioCalex instead, a root canal sealant used in Europe.
Fluoride, he says, is also a problem. "We're overfluoridated. As hygienists, you see a lot of children with white enamel spots from fluorosis. Fluoride affects collagen formation in the tooth — why would anyone think it wouldn't affect the rest of the body? It can cause skeletal problems, gastrointestinal problems, increased hip fractures, birth defects, cancer ... there's a whole list. It's a toxic poison."
Physician and dentist Dr. Baratz practices the two disciplines together. "I have an oral medicine practice, a specialty where one looks at the interrelationship between oral conditions and systemic conditions."
That might sound like a holistic outlook, but Dr. Baratz is very much opposed to holistic dentistry.
"I'm a skeptic," he says. "I don't base what I say on belief, but on data. That's the difference between me and those who hold rather bizarre and out-of-place ideas. We live in a free society, but dentistry is a regulated environment. We're expected to comply to a standard of care. That doesn't mean have a free-for-all. I wouldn't want my practitioner to do what he felt like without being able to defend it scientifically.
"What gives them the right to say, 'I'm taking out amalgam and bone because there are cavitations'? There's no science behind that. It's assault and battery by a delusional dentist."
Dr. Baratz blames journalism for giving holistic dentistry credibility. "Their studies are published, yeah, in the journal of junk science. But the person reading them has to realize that what they say isn't peer-reviewed, and there wasn't a double-blind study. If what they're stating was any good, it would be in a decent journal."
Now you've seen both sides of the story. Proponents believe they are on the cutting edge, and their philosophy of dentistry will inevitably gain ground as they help more and more consumers. Opponents believe they must fight dangerously unscientific holistic ideas to protect the consumer.
To make up your mind about which side of the fence is most comfortable for you, start with the Web sites and phone numbers listed here. Read both the pro and con positions carefully, and remember what you know about controlled research. Talk to your employer about which philosophy he or she wants you to impart to the patients in the practice. If you're not comfortable with the answers, it's probably best to look for a more compatible office.A review of Whole-Body Dentistry
by Mark A. Breiner, DDS
Quantum Health Press, LLC, (888) 277-1328
A basic, but comprehensive, outline of holistic dentistry philosophy is available in Whole-Body Dentistry. The book is intended for the general public, but dental professionals won't be bored. At the outset, Dr. Breiner says, "People have a right to know the implications of dental procedures on their health. Traditional dentistry," he maintains, "has yet to understand how essential the whole-body approach to treatment is to the patient's well-being."
Dr. Breiner's concept of holistic dentistry is laid out logically and completely in easy-to-read fashion, beginning with Chapter 1 — "How I Got Here From There." He covers everything from the mercury amalgam controversy to kinesiology to hair analysis. If you've ever wondered about concepts like neural therapy or electro-acupuncture, here's one place to look for explanations.
Something that fascinated me was Dr. Breiner's description of cavitations. I'd heard the word before, but had no idea what it meant. Have you ever seen, a year or so after an extraction, an outline or "shadow" of the missing tooth within bone on an X-ray? That's left-behind periodontal membrane, Dr. Breiner says, and is almost always indicative of a cavitation.
He defines a cavitation as incomplete healing after an extraction in which a hole or spongy place is left in the bone. Cavitations can also happen for other reasons, he says, including localized trauma, poor circulation, clotting disorders, and the use of steriods.
Dr. Breiner says research has shown that cavitations are breeding grounds for bacteria and their toxins, causing stress throughout the body and blocking energy meridians. To treat them, he recommends homeopathic injections, low-level laser light therapy, and sometimes surgery to clean out the area.
His patients, he says, have been cured of such problems as acne, shock-like pains in the lips, scalp sensitivity, and atrophied calf muscles after treatment for cavitations.
Dr. Breiner presents dozens of anecdotes that support his ideas, but the scarcity of scientific proof makes the reader a little uneasy. For 215 pages of text, there are only 27 endnotes citing studies and articles. Some of the references are familiar, including the New England Journal of Medicine and the Journal of the American Dental Association, but others are obscure, like Health Action Press and Bion Publishers.
Some of the most outrageous statements have no endnote at all. For instance: "Worldwide studies have proven that adding fluoride to your drinking water is not at all effective in reducing or preventing tooth decay."
Dr. Breiner devotes part of the book to a basic dental primer for patients — how to floss, when to start orthodontics, and what do to in a dental emergency. Though all of the advice comes from his unique whole-body viewpoint, most hygienists would probably agree with most of what he says in this section.
Overall, Whole-Body Dentistry presents an intriguing picture of the alternative pathways that some dentists follow. I'd recommend it to any hygienist who wants to explore those pathways, for whatever reason. However, I would not recommend the book to a patient because so many of Dr. Breiner's statements are unsupported by documentation.
Cathy Hester Seckman, RDH, is a frequent contributor who is based in Calcutta, Ohio.