“Holistic” Dentistry

Fads vs. Evidenced-Based Practices

By definition, a holistic dentist is concerned with a person’s complete (“whole”) health rather than strictly focusing on teeth. Every modern dentist should offer a “holistic” approach to patient care—especially given all we know today about the connection between oral health and overall health. The issue with “holistic” dentistry is that the term has taken on a different meaning. Rather than referring to the whole-person approach, “holistic dentistry” for many has come to mean a form of dentistry that avoids certain treatments which have been used safely and effectively for decades.

Unfortunately, you don’t have to look far to find people questioning the validity of accepted science even though the “proof” offered doesn’t stand up to closer scrutiny. Social media is teeming with controversial claims: A celebrity declares that vaccines cause autism; a politician asserts that global warming is a hoax; a website offers “one weird trick” to cure cancer. This disturbing trend goes for dentistry as well. Recently, a number of theories have been circulating on the internet (and elsewhere) that call into question some key dental treatments which, following years of research and clinical experience, are considered the current standards of care. Here we will challenge a few of the most common claims among “holistic dentistry” proponents.

Holistic Dentistry Claim 1: Root Canals Cause Disease

Dentists perform over 15 million root canal treatments each year in the US alone. These treatments are needed when a bacterial infection has made its way deep inside a tooth. Left untreated, harmful bacteria can eventually spread into the jawbone and beyond.

There are two basic treatment options for a tooth with infected pulp tissue: It can be extracted (removed) or it can have endodontic (root canal) treatment. While extraction may seem the simplest answer, getting a replacement tooth can be a time-consuming and costly option. Yet in most cases missing teeth need to be replaced, not only for the sake of appearance but also to preserve oral health and to keep other teeth from shifting.

A root canal procedure can actually save the infected tooth. The diseased tissue is removed, the inside of the tooth is disinfected, and the tooth is sealed to prevent re-infection. Despite its undeserved reputation, root canal therapy is generally no more uncomfortable than getting a filling and, in fact, eliminates pain.

So what’s the problem? Early in the 20th Century, dentist Weston Price promoted a theory that retaining a “dead” organ (the tooth) in the body led to a variety of illnesses. Variations of that same idea crop up today, often with the claim that root canals are linked to immune system problems, cancer and various systemic diseases. Is there any truth to these claims?

First, a root canal-treated tooth is not a dead organ as Price claimed—it is attached to the body by blood vessels, nerve tissue and collagen fibers through the periodontal ligament, and to this date there is no scientific evidence showing that root canals cause disease anywhere in the body. In 1951, responding to Price’s claims, the Journal of the American Dental Association devoted an entire issue to the subject. Their conclusion: There was no evidence to back up those claims. As to the cancer claims, a 2013 study published in a specialty Journal of the American Medical Association found that having a root canal does not increase cancer risk; in fact, people who had multiple endodontic treatments had a 45 percent lower incidence of oral cancer than people who had no or fewer root canals! While the study does not claim that root canal therapy prevents cancer (so I don’t recommend unnecessary root canal treatment as a preventive measure!), it’s clear that endodontic treatment is not a detriment to your health. It seems more “holistic” to save a tooth and keep you whole rather than extracting it.

Holistic Dentistry Claim 2: X-rays should be avoided at all costs

X-rays have been used in medicine and dentistry for over a century. A form of electromagnetic radiation, x-rays can penetrate human tissues, allowing us to see what’s beneath the surface. They have been used to diagnose ailments that can’t otherwise be seen. The concern is that the small amount of radiation involved could lead to cancer or other diseases. In this case, it’s perfectly reasonable to ask whether it is possible to minimize the risks.

Any dentist should only use x-rays only when needed to diagnose problems that can’t be seen with the eye. My opinion is that a full set of x-rays should be done every three years for most people. If you have frequent cavities, x-rays will be needed more often to protect you from more significant problems. Changing your diet and improving your oral hygiene can help reduce your risk of cavities and thus limit your x-ray exposure.

In everyday life, we all get a certain amount of radiation (measured in units called millisieverts, or mSv) from many sources. Cosmic rays from the sky, radon gas from the earth, smoke detectors and airport security scans—along with certain medical procedures—all add to our overall exposure, which may total about 3-5 mSv per year. Fortunately, the vast majority of us receive a dose that’s too low to do harm.

A typical x-ray at a dental checkup adds around .005 mSv to our total exposure; that’s about the same as we get from solar radiation in a normal day. A panoramic x-ray, in which a sensor rotates all the way around the head, can add twice as much. Certain specialized imaging systems, such as cone-beam CT scans, may deliver up to 1.07 mSv—a significantly larger amount.

It makes sense to limit exposure to radiation as much as possible. That’s why your dentist places a protective apron on your body when taking an x-ray. It’s also why the American Dental Association (ADA) recommends that x-rays should only be used when needed—not at every checkup. The decision whether to use an x-ray should always balance the medical benefit against the slight risks posed by radiation. If you have concerns, don’t hesitate to ask your medical professionals if an x-ray is necessary, and how they can minimize your exposure.

Holistic Dentistry Claim 3: Silver fillings are toxic

“Silver” (amalgam) fillings are actually an alloy (mixture) of metals that contains approximately 50% mercury, but do they put your health at risk? It’s true that elemental mercury (the shiny liquid metal) and many mercury compounds are toxic. Mercury contamination in the environment, including the air and water (and particularly in the tissues of certain fish), is a source of concern, especially for children and pregnant women. But this is not the case for silver fillings.

The mercury in dental amalgam combines with other elements to produce a benign compound. A similar process occurs when sodium and chlorine, two highly toxic elements, combine to produce table salt. Dental fillings containing mercury compounds have been in common use for over 150 years, and numerous studies have been unable to confirm a link between amalgam fillings and health problems—including a 2008 study showing that even a mouthful of “silver” fillings doesn’t release enough mercury to cause any harm. This hasn’t stopped some health care providers from blaming the mercury in fillings for a wide range of health problems—including cancer and nervous system disorders. Scientific evidence for these claims, however, is lacking.

The use of amalgam fillings is being gradually phased out in Europe with the goal of reducing environmental pollution in the manufacturing and waste disposal processes. And it’s true that good alternatives to amalgam, such as composite resin fillings, are now available. However, amalgam fillings remain the most durable, easiest to work with and lowest-cost filling material.

If you have a cavity, should you consider getting composite resin fillings instead of amalgam? Sure! They are prettier and can make a tooth stronger today by bonding the tooth surfaces together. But don’t rush to have all your old “silver” fillings replaced based on the unverified claims. There has never been any proof that amalgam fillings are harmful. What’s more, removing those fillings is likely to expose you to more mercury than leaving them in, as mercury vapor and tiny particles are released in the removal process.

Holistic Dentistry Claim 4: Fluoride Should be Avoided

Fluoride compounds are fairly abundant in the earth’s crust, and occur naturally in varying concentrations in fresh and salt water—even rain water. Fluoride is also added to many municipal water supplies and has been proven to reduce the incidence of tooth decay in those communities. In fact, the fluoridation of drinking water is recognized as one of the “Ten Great Public Health Achievements” by the US Centers for Disease Control and Prevention, and is endorsed by the ADA, the American Academy of Pediatrics and the World Health Organization. Fluoride is also an active ingredient in toothpastes and other dental products.

Despite this, a small number of vocal opponents continue to raise the issue of fluoride’s safety. Fluoride has been accused of causing cancer, Alzheimer’s disease, infertility, and many other illnesses. Is there any truth to these claims?

Like many other substances, fluoride is safe when taken in the proper amounts but potentially harmful if overused. A cosmetic condition called fluorosis, which may cause stains and irregularities on the surface of teeth, can occur when too much fluoride is ingested. This sometimes happens when kids swallow toothpaste instead of spitting it out. It also occurs in certain communities with high levels of natural fluoride in well water. (Those communities also have low levels of tooth decay; this was how it was first discovered that fluoride could prevent cavities.)

As far as serious diseases like cancer, there has never been any clear evidence that they can be caused by fluoride. For example, a 2018 study sponsored by a division of the National Institutes of Health found no link between fluoride exposure and adverse health effects. However, there is evidence pointing in another direction: Children who lived in Calgary, a Canadian city that stopped fluoridating its water in 2011, were found to have significantly more cavities than kids in Edmonton, a similar city with fluoridated water.

Don’t avoid fluoride if you want to prevent cavities, but it makes sense to keep your fluoride intake within the recommended limits. The optimal level of fluoride in water is believed to be 0.7 milligrams per liter. If your well or municipal water contains a much higher level, consider switching to bottled water to avoid the unsightly appearance of fluorosis. However, you should also test your bottle water, as some bottled water does have fluoride and some doesn’t. But don’t stop using fluoride toothpaste—brushing twice with fluoride toothpaste and flossing once daily have proven over and over again to be the best ways you can fight tooth decay at home.

Conclusion

All doctors and dentists should practice “holistically” by providing treatment that is best for the whole person—treatments supported by scientific evidence and a history of safety and effectiveness. Instead of making a decision based on what’s trending on social media, it’s wise to consult a trusted health care professional—such as your dentist—when you need advice.

Anything and everything can be harmful if used in excess. We are only as good as the knowledge we gain from evidence-based scientific findings.