Dentistry - The Biological Approach

Biological Dentistry - Dentistry for the New Era

The term “Biological Dentistry” (also called “Holistic Dentistry”) is being used for a whole new paradigm of dental care. Traditional dentistry has typically followed an outmoded, problem oriented model, focusing on individual problems with individual teeth. The whole body, and whole person, has often been overlooked. Evidence is growing that traditional dentistry, however well intentioned, may have been contributing to generations of health problems. What has been overlooked is attention to concerns about how various dental materials and techniques may affect overall health. Biological Dentistry, though not a certified or recognised “specialty,” aims at optimal health for the whole individual. Materials and techniques are therefore chosen that are compatible with health.

Many concerns have arisen in the last two decades about materials used in dentistry that may actually be toxic to the body, current scientific evidence now supports this position. The main offender is the traditional filling material, “silver” amalgam. When you look in your (or someone else’s) mouth and see silver or dark gray fillings, those are amalgam fillings. Amalgam is a mixture of mercury with silver, tin, sometimes copper and zinc. It is approximately 50% (or more) mercury and that is where the problem lies. Although there is clear and irrefutable evidence that some of this mercury does escape from this unstable compound, it is still widely used by over half the dentists in Australia and dental schools are continuing to train new dentists to use this material without any mention or consideration to the potential health hazards it poses.

Amalgam Fillings

It is well established, scientifically, that elemental mercury (mostly in the form of mercury vapour) is released in small amounts from amalgam fillings on an ongoing, daily basis. Chewing or heat increases the vapor release some ten-fold, and it remains at that higher level for an hour and a half or more. The exact amount of release is subject to some variation, but a panel of experts at the World Health Organization (WHO) has agreed that the single greatest source of exposure to mercury in humans is from amalgam fillings. It is greater than exposure from food (including fish), air, water and environmental sources combined. When we add to this the fact that mercury is an extremely toxic material, rated more toxic than the other heavy metals such as lead, cadmium, and arsenic, then there should be some serious cause for concern about the safety of this material in dentistry.

The uptake of this mercury into the body has been well documented. Careful animal studies have demonstrated that mercury does, in fact, accumulate in body tissues. This long term, low level exposure continues as long as the fillings are in the mouth. Mercury vapour may be inhaled, absorbing rapidly and almost completely into the bloodstream. Some may be incorporated into food while chewing and absorbed into the bloodstream through the digestive system. In light of this information you must wonder why the profession dentistry in the U.S, UK, Australia and other countries have not sought to restrict or limit its use. Rather, the Australian Dental Association (ADA), a professional trade organisation representing the majority (though definitely not all) of Australian dentists, still maintains that mercury amalgam is a safe and appropriate filling material.

One can hold the opinion that amalgam is safe but when opinion is at odds with scientific fact (see list below), then opinion should be revised.

  • Mercury is an extremely dangerous, poisonous substance
  • There is no “safe” level of mercury exposure to humans
  • Dental “silver” amalgam fillings contain 50% mercury
  • Mercury is released continuously from amalgam fillings, because this material is inherently and chemically unstable
  • In humans, mercury amalgam fillings produce a pharmacologically significant daily dose of poisonous mercury
  • Mercury fillings are the largest source of toxic mercury exposure in the general population
  • Toxic mercury released from mercury fillings collects in all adult human tissues, being highest in the kidney, liver and the brain
  • Dental mercury crosses the placenta and collects in the developing unborn; the newborn is exposed again through mother’s milk
  • Mercury from dental fillings reduces kidney function
  • Mercury from dental fillings alters the normal bacterial population in the intestinal tract, producing antibiotic resistant bacteria
  • Mercury from dental fillings has been implicated in nervous system disorders such as Alzheimer’s Disease

The above information is enough to cause those of us practicing “Biological” dentistry to reject amalgam as a filling material and these facts are enough to declare mercury amalgam to be an unsuitable material to use in dentistry. Outside of Australia, many other countries are officially agreeing. Several countries have severe restrictions or outright bans on the use of amalgam fillings.

The History of Amalgam Fillings

In the first half of the 1800’s, dentistry consisted mainly of restoring teeth with gold, for those who could afford it, and a lot of extractions for those who could not. In about 1860, two brothers came from Europe to the USA with a new material that’s not much different from what is still used today as dental amalgam. It revolutionised dentistry, in that teeth could be filled with a material that was relatively inexpensive and easy to use. This meant that many more people could afford to have fillings done (and teeth saved) than ever before.

Many of the dentists at the time, however, were very concerned about this material, believing that it was not a healthy and shouldn’t be used. Proponents of this new amalgam material fought a heavy battle. The dentists who were against this material that they believed to be inferior tried to get fellow dentists to sign an oath not to use it. In the end, economic pressures won out. A new society was formed of those dentists who decided to adopt mercury amalgams and this became what is now the American Dental Association. In the 1920’s, a German chemistry professor named Alfred Stock published research articles and scientific letters attacking the use of amalgam fillings on the basis of possible mercury toxic effects. Again, the dental profession’s opinion prevailed and the controversy faded to the background until the late 1970’s. A Colorado dentist and well known nutritional advisor, Dr. Hal Huggins, began to champion the anti-amalgam position after learning about amalgam’s mercury effects. Dr. Huggins was finding that his work with patients in balancing their body chemistry through nutrition was enhanced when he paid attention to their mercury load and removed their mercury fillings. His clinical success led him to conclude that the use of mercury amalgam fillings in dentistry has been causing health problems in many people.

Dr. Huggins’ ideas were slow to take hold. However new scientific research in the early ‘80’s began to give credibility to the idea that amalgam use might be risky. Studies were done using careful and sophisticated measurements with a highly sensitive mercury vapour analyser, and it was conclusively shown that mercury vapour does indeed come out of amalgam fillings in the mouth (a fact previously denied by the America Dental Assoc). This led the way for further scientific investigation. In 1984 and organization was formed called the International Academy of Oral Medicine and Toxicology (IAOMT). This academy is dedicated to spreading information in the scientific community on the research being done regarding issues of mercury, as well as other related topics in biological dentistry. Some of the leading current research has come about from IAOMT members or as a result of IAOMT support. If one has any doubt about whether mercury vapor escapes from amalgam fillings, simply watch the “Smoking Teeth” video on the IAOMT website (www.iaomt.org).

The dental profession, in spite of a huge accumulated body of valid, scientific, peer-reviewed research, still
maintains their position that amalgam is safe and appropriate. However biological dentistry, regard amalgam as an inferior, toxic, 19th century dental material that has no place whatsoever in 21st century dentistry. (It’s a bit like still using carrier pigeons to deliver a message when we have the internet!).

Alternatives to Amalgam Fillings 

The question of what to use instead of amalgam fillings is the challenge for the biological dentist. There are a variety of materials and techniques developed over the last several years that satisfy our requirements of providing long-lasting, comfortable, aesthetic and non-toxic restorations of teeth. There is no perfect material. The best is still to have undamaged, natural tooth structure. So, prevention is still the first goal in dentistry. However, when damage does occur and needs repair, there are enough good materials available that make mercury amalgam obsolete. Dentists who were committed to mercury-free dentistry in the 1980’s had to struggle with these newer materials in their emerging stages of development and refinement. Today, they
continue to be improved as a revolution in non-metal dental materials has developed. Most versatile of dental materials today are those in the broad category of ceramics. This includes “composite resin,” porcelains, and various in-betweens. They can be used anywhere that amalgam was used, with expectations of equivalent longevity and strength, or better. Their aesthetic properties, when used properly, can nicely mimic the beauty of natural teeth and become virtually invisible in the mouth. Much study has been done on the biocompatibility of these materials, and they come out quite favorably. All of these materials do take more time and skill and advanced training to master. Unfortunately, many of these materials and techniques are still not being taught widely in dental schools. They are also more expensive to the patient than the old amalgam fillings. However, when patients are given the real truth about the toxic potential of amalgam, few choose to stick with this inferior material just to save some money.

It is my recommendation that you never allow another amalgam filling to be placed in your mouth by any dentist. The decision to replace amalgam fillings that are already in the mouth needs to be considered more carefully. Many of our patients come to us because their doctor or health practitioner feels that they may have some health problems where heavy metal (including mercury) exposure or accumulation may be part of the problem. As an adjunct to their medical treatment, they recommend having their amalgam fillings carefully replaced with more biocompatible materials. Others come to us because they have read and learned enough
about the mercury issues that they have decided they don’t want this material in their mouths anymore, and request that we replace it. In my opinion, either of these is a wise and valid reason for replacing the old mercury amalgam. I don’t take the position that everyone in our practice should replace all of their amalgam fillings. It is a choice. I do, however, feel a responsibility to educate everyone on the mercury issues and let them know that a mercury-free mouth is always available in my practice. Biological dentists generally would agree that they wouldn’t want to allow this material to be in their own mouths, or in the mouths of their families or staff.

What is involved in amalgam replacement?

The first step is the decision to do it. This decision should be carefully considered. It may involve discussion with your doctor, or one that I can recommend. It may involve some form of testing for body levels of mercury by your doctor. It may just be a matter of learning and digesting the facts about mercury and amalgam. Once that decision is made, there are several factors that I feel are very important in proceeding with your decision. First, the treatment should be done by a dentist experienced with, and committed to, mercury safe dentistry because of the potential complexities involved. Deciding to replace your amalgams, and then deciding to run off to the nearest or cheapest dentist and talk them into doing it would not be wise.

The dental treatment needs to be done cautiously in order to protect the patient from exposure to additional mercury during the course of the dental procedures. This is a crucially important point, and one that is likely to be overlooked by most dentists who are not committed to mercury safe dentistry. And be aware that just because a dentist has stopped using amalgam in their practice, they are not necessarily “mercury safe.” A lot goes into protective protocols to insure procedures that are safe from unnecessary exposure to mercury for the patient, the doctor, and the dental staff.  Some of the protocols were developed by the IAOMT, and we
continually update our protective procedures here at Evolve Dental Healing.

The choice of replacement materials also needs to be carefully considered. We want materials that are strong, long lasting, comfortable, aesthetically pleasing, and biocompatible and I believe all these factors can be achieved with either dental composites or ceramic restorations.

Lastly, it needs to be understood that removing amalgams from the mouth is only part of becoming mercury-free. As long as amalgam fillings have been in a person’s mouth, that person has been continuously exposed to a low level of mercury, most of which has been accumulating in the body. It takes some help to get rid of this accumulated mercury. The body doesn’t do it very effectively by itself and this is why I recommend an amalgam removal diet and supplement protocol to assist with the elimination process and where appropriate, I will help steer you to health practitioners who are experienced in dealing with heavy metal detoxification and clearing. This is a very important step to make sure that everything is done according to current research and clinical understanding of how to reduce or eliminate mercury in the system and reduce its potential toxic damage.

Of course, most people wonder about the cost of replacing amalgams. This will vary widely according to the number and size of the fillings and what materials and techniques are needed to replace them .At your initial consultation we will always provide you with a written estimate of the cost of the treatment that you choose.

Amalgam and The Environment

It’s clear that mercury is toxic to humans. It is also a significant environmental contaminant, and there are millions of dollars spent on cleaning up toxic sites from industrial pollution of mercury. There is also a great deal of effort being made to control mercury emissions from industrial settings where mercury is used. But what has been overlooked in many areas, until fairly recently, is that dentistry is one industry that is spilling a significant amount of mercury into the environment. Studies have estimated that anywhere from 14% to 70-80% or more of the mercury contamination of wastewater entering the treatment plants is coming from dental offices!

How does this happen? Any time a mercury amalgam filling is placed or removed there is a significant amount of excess amalgam “sludge” that is vacuumed up by the chair side dental assistant. It doesn’t just disappear. That mercury-laden sludge goes down the drain and into the wastewater system. In most dental practices, this goes completely unchecked. Several European countries have had regulations for years that require dental offices to be equipped with special mercury-separator devices that filter out or trap mercury before the wastewater leaves the dental office. No such regulations exist here in Australia. We are currently upgrading our amalgam separator to bring it up to the highest standard possible as new models have currently come on to the market.

Biological Concerns In Dentistry

There are other issues that, once we are committed to Biological Dentistry, we can’t help but find ourselves involved with and two of them are that I would like to mention are fluoridation and root canal treatments. With these, as with many other issues, biological dentists find themselves in a “minority” position with respect to most of the dental profession.

Fluoride and fluoridation

The use of fluoride, and particularly fluoridation of drinking water, has been touted for the last several decades as a huge boon to dental health. Dental societies and public health agencies have vigorously promoted water fluoridation as one of the most beneficial public health policies ever. I think, however, that the wool has been pulled over the eyes of the public and the dental profession. A careful look at the relevant science shows that the toxic properties of fluoride have been seriously overlooked, while the “benefits” of fluoridation have been hugely overstated, to say the least.  For more of the background on this subject you can download a position paper from the IAOMT at www.iaomt.org. Another valuable website with a vast amount of information
is Fluoride Action Network, at www.fluoridealert.ofg. I strongly disagree with most of what is presented in the Dental Association’s publication, “Fluoride Facts” (2005), but you may want to look at that as an example of the more traditional viewpoint, www.ada.org. I do not provide “fluoride treatments” in our office, I do not support public water fluoridation, and I certainly do not prescribe fluoride supplements.

Root Canal Treatment

“Endodontic” or “root canal” treatment is another area of current controversy. The rationale for this treatment is to save teeth where the “nerve” or “pulp” of the tooth has become irreversibly damaged or infected and cannot recover. The only other option is to extract the tooth. Of course, dentists are always in favour of saving teeth, but a biological dentist is more concerned about saving the health of the patient. Root canal treatment clearly has saved millions of teeth from extraction and allowed them to function comfortably and aesthetically. However, the question has arisen: at what cost?

Again, this is a long and complex story so to keep it succinct teeth that have been treated with root canal treatment, even when the treatment looks and feels “successful” from all traditional criteria, still may harbour residual toxins that can enter the body via the porosity of the root structure. The original research calling attention to this was done by Dr. Weston Price in the1920’s or so. His work is summarized well in Dr. George Meinig’s book, Root Canal Coverup Exposed. Very little modern research has been applied to this question. The one outstanding exception is work done by Dr. Boyd Haley and Dr. Curt Pendergrass, which can be seen on the IAOMT website.

The questions that arise from this are: 1) should root canal treatments be done at all (the alternative being extraction of the tooth), and 2) are existing root canal treated teeth a health risk and should they be extracted? At the present time, I don’t feel these questions have a clear, black-and-white answer. The IAOMT has a standing committee on endodontic concerns, and they have also been wrestling with this issue. Currently, they still have no consensus on the simple, core question: root canals- yes or no? So with this in mind I always discuss this individually on a case by case basis with my patients.

Non-Surgical, “Biological” Periodontal Therapy

It is estimated that over three fourths of the adult population show some signs of periodontal (gum) disease. This may range from mild inflammation of the gums to advanced, destructive infection. Medicine is now recognising the correlation between periodontal disease and other health problems in particular heart disease. Periodontal infection is now conclusively linked as a high risk factor for some types of heart disease. It is also considered a risk factor for some forms of ulcers, arthritis, premature low birth weight babies, and more. The good news is that there have been advances in the understanding of the multiple causes of periodontal disease, and more effective ways of controlling it. It needs to be treated as an infectious process. Many traditional, surgical approaches of the past have been shown to be rather ineffective long term.

A variety of non-surgical approaches to therapy are now being used. They may include such things as laser treatment, irrigation under the gums with antibacterial products, supportive nutritional supplements, and others. Home care techniques may be very different from what most people have been used to. Treatment is aimed at creating a healing environment for the tissues to return to a more complete and stable state of health.

Many of the old ways just don’t work very well, including the almost universal recommendation to have your teeth “cleaned” every six month with the dental hygienist. An individualised assessment of what really is appropriate for each patient is very important to ensure that gum health issues are properly addressed.

In summary, this practice has moved away from the attitude that something works well simply because that’s the way it’s always be done as many techniques, materials and attitudes of dentistry of the past need to be reassessed in light of their effect on the individual as a whole person. As a biological dentist it is always my aim to address the whole person and not just the teeth and mouth and I will always strive to provide the best treatment, in the safest possible manner and to keep up to date and abreast on all that is going on in this field worldwide.

Additional Reading

The Poison in Your Teeth, by Dr. Tom McGuire. Available through Dr. McGuire’s Dental Wellness Institute at www.dentalwellness4u.com

Mercury Detoxification, by Dr. Tom McGuire (available on his website)

Various other articles, links and downloads available from the International Academy of Oral Medicine and Toxicology (IAOMT) at www.iaomt.org

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