What is Holistic Dentistry? - Dr. Michael Ruscio, DC

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What is Holistic Dentistry?

The Inside Scoop on Mercury Fillings, Fluoride, and the Oral Microbiome.

Key Takeaways:

  • Holistic dentists see oral health as part of the whole body system and focus on how it affects the rest of the body and vice versa.
  • Holistic dentists often use alternative methods to treat oral health, such as dietary changes, ozone therapy for early cavity treatment, and limited fluoride use.
  • Holistic dentists practice safe removal of mercury (silver) fillings to reduce exposure to mercury vapor and particles. 
  • Improving oral health involves improving the oral microbiome through tools like diet and probiotics. 
  • A holistic dentist assesses and treats your oral airway to help prevent tooth crowding and invasive orthodontic procedures, and improve sleep and cognition.

Many people seek out a holistic dentist in hopes that their chronic health symptoms can be alleviated with mercury filling removal. And while the debate is still out on whether these fillings are harmful to your health (don’t worry, we took a deep dive into this topic), holistic dentistry actually offers many more benefits than just safe removal of silver amalgams. 

Holistic dentistry (also known as biological or natural dentistry) views your oral health as an integral part of your overall well-being and understands the connection between your mouth and the rest of your body. Holistic dental care often includes therapies that conventional dentistry does not, such as nutritional recommendations, fluoride re-education, ozone therapy for cavities, and proper breathing and swallowing techniques. 

If you are looking to learn more about what holistic dentistry has to offer, and what the research says about the controversial topics of mercury fillings and fluoride, then this article is for you. 

What is Holistic Dentistry?

Holistic dentists, much like doctors of functional medicine, see oral health as a part of your overall health. They look at how the oral microbiome — the normal microorganisms that inhabit your mouth — affects not only your teeth and gums, but also your gut, skin, and many other body systems. They seek to use dentistry methods that are low in toxic load in order to keep the whole body healthy, and they look at how the gut microbiome, oral airway, diet, and sleep affect the health of your teeth [1].   

Holistic dentistry often uses dental treatments that you will not find at a traditional dentist, such as ozone therapy (which we’ll cover later) to treat early cavities, more biocompatible dental implants that may cause less inflammation in the body, and safe removal of silver mercury fillings to decrease the risk of toxic mercury exposure to the body and brain. 

They still provide typical oral hygiene education such as flossing and tooth brushing, as well as routine teeth cleaning, fillings, crowns, root canal therapy, and other dental procedures. However, they offer additional options that focus on whole-body healing before recommending more invasive procedures like a root canal.  

Ideally, any dentist that falls on the holistic/natural/biological dentistry spectrum tries to find the most effective, least invasive, least toxic, whole-body safe treatments for dental concerns and disease prevention.

What’s the Difference Between Holistic Dentistry and Traditional Dentistry?

For the most part, holistic dentists and conventional dentists treat the same conditions. They both provide general oral care including teeth cleaning, x-rays, fillings, crowns, and root canals when needed. 

Holistic dentists have the same dental schooling as traditional dentists, but often with additional training in the oral microbiome, safe mercury filling removal, oral myofascial therapy (treatment of the muscles and bones of the face and mouth) homeopathy, and/or acupuncture.

Another notable difference is that holistic dentists don’t just look at the mouth, they ask about your diet, sleep, and exercise to see how those may be having an effect on your dental health [2]. They may offer nutritional advice if they feel that your oral and/or gut microbiome is poor and contributing to recurring cavities or inflammation of the gums.

Holistic dentistry assesses the movement and structure of the jaw, fascia, and muscles of the face and neck, shape of the palette, and breathing. These factors can change the shape and function of the face, growth of the teeth, breathing, and swallowing. They can then perform or recommend certain exercises to help restore normal function to these processes.

Traditional dentists typically reserve this type of treatment for oral myofunctional therapists and will provide you with a referral, if needed.

There are some additional treatment areas where these two types of dentists differ, including their stance on root canals, mercury filling removals, and the use of fluoride. We will get into those next, but first, let’s see why you may want to seek out holistic dentistry. 

4 Reasons You May Want a Holistic Dentist

So, when might you want a holistic dentist? Here are four reasons why you might want to look for a holistic or biological dentist.

  1. If you are having recurring cavities, gum disease, or other dental problems that are not improving with traditional methods.
  2. You are considering having your mercury fillings removed.
  3. You are seeking an oral airway health assessment, possibly due to trouble breathing and/or sleeping or if your child has been told they need orthodontics.
  4. You know that the health of your mouth is affected by the health of the rest of your body, and vice versa, and want dietary and lifestyle advice.

Now let’s take a closer look at the treatments holistic dentists can provide so you know if seeing a holistic dentist is right for you. 

Most Common Holistic Dentistry Treatments

Each holistic/bioavailable dentist will have their own approach to whole-body dental care. 

Some of the alternative dentistry protocols they may follow in a visit are [2]:

  • Taking a comprehensive medical history of your whole-body health
  • Assessing your nutrition and discussing the connections between the oral and gut microbiomes
  • Assessing the muscles and fascia of the face and neck and checking your oral airway health
  • Recommending ozone therapy for early cavities rather than choosing fillings as a first step
  • Using digital X-rays instead of (or in conjunction with) film to decrease radiation exposure
  • Using energetic treatments like acupuncture, muscle testing, or homeopathy 
  • Offering IV (intravenous) nutritional therapy when needed

Research is lacking on the efficacy of some of these treatment options, especially as they directly pertain to their role in dentistry. Some of the above treatments may actually come with a higher risk than conventional dentistry. Digital x-rays may deliver more radiation than film X-rays, and ozone therapy may be less effective than standard treatments at disinfecting the mouth [3, 4, 5].

Regardless, holistic dentistry’s approach to using less-toxic materials and treating the entire body is beneficial for your health. Many of the above therapies like nutrition, a healthy microbiome, and acupuncture are known to provide significant benefits for overall health, which likely extends to oral health.

Mercury Fillings

First, let’s talk about the removal of mercury fillings, as that is usually the reason why most people look for a holistic dentist in the first place. Mercury is a highly toxic metal — remember those old glass thermometers containing silver mercury, and how dangerous it was if you broke one? This is the same concern that many have when it comes to mercury in your mouth.

Silver amalgams (metal fillings) are a mixture of mercury, copper, silver, and tin. However, “silver” is a bit misleading, as they are actually 50% mercury, by weight [6]. Very few dentists — holistic or conventional — use full silver fillings anymore. In fact, governments around the world are now following the Minamata Convention on Mercury to reduce the occurrence of amalgam fillings and limit the body’s mercury exposure [7].  

Silver amalgams are highly controversial, and the research on their health effects is mixed. Some claim that there is no health risk associated with mercury fillings, as they consider them to be stable and unable to leech mercury into the body. However, many countries have restricted the use of mercury fillings in dentistry due to the health risks posed to certain populations, and to dental professionals when working with mercury amalgam powders. 

In the United States, the Food and Drug Association (FDA) has acknowledged the health risks of mercury fillings and recommends against their use in the following populations [8]:

  • Pregnant women and women trying to conceive
  • Nursing women
  • Children, particularly those under six years of age
  • Those with pre-existing neurological conditions
  • Those with impaired kidney function
  • People with known allergies to tin, mercury, silver, and copper

These recommendations are due to potential mercury exposure when getting the filling (from particles in the air) and from possible exposure over time once the filling is in the mouth. 

The International Academy of Oral Medicine and Toxicology (IAOMT) has compiled a comprehensive review on the alarm surrounding mercury amalgams. However, there is a concern for bias regarding their stance on this topic, as they are notoriously opposed to mercury fillings. Regardless, their findings are still worth noting, as they reveal that mercury fillings may not be as stable as previously thought, and they discuss some serious concerns with the potential health risks. Below are some of their more noteworthy findings [9]: 

  • High mercury levels have been found in people who have amalgam fillings.
  • Mercury is excreted in the breast milk of some mothers with these fillings, and levels of mercury have also been found in cord blood, kidney, and brains of infants. 
  • Mercury may play a role in Alzheimer’s disease, and many recommend testing mercury levels in people with cognitive decline. 
  • Mercury levels in the urine of children were found to increase over time and may contribute to kidney damage at high levels [10]. 
  • Exposure to mercury might contribute to anxiety, chronic fatigue syndrome, multiple sclerosis, allergies, and more, but few studies have directly looked at mercury amalgams as the source of exposure. 

Many people who have mercury fillings and also have conditions such as Hashimoto’s, allergies, asthma, skin rashes, chronic fatigue, and anxiety report feeling better after proper mercury filling removal. One small study found that people with a variety of different symptoms and mercury fillings did have mercury in their urine and those levels decreased once the fillings were safely removed [11].

So what does all of this mean, and how it is applicable to you? Considering the consistencies in the FDA’s and the IAOMT’s stance on silver amalgams, if you are seeking out a filling, it’s probably safe to opt for composite (metal-free) fillings. 

But things get a little more complicated if you already have a silver amalgam and are considering removal. The research is still unclear as to whether mercury fillings are stable in the body and if they pose a health risk. Additionally, the process of removing these fillings can increase the risk of toxic exposure to mercury. 

Therefore, the removal of mercury fillings is probably not the best first place to start if you are looking to heal a chronic illness or persistent health symptoms. Instead, try focusing on your gut health first. However, if you’ve been tested for mercury, your level came back high, and you are considering silver amalgam removal, let’s take a look at how it can be safely done. 

Safe Mercury Filling Removal

As previously mentioned, drilling into the tooth and filling during the removal process releases mercury particles and vapor into the air, which is a considerable health risk. Without proper protection, mercury can be absorbed through the mouth and gums of the patient, as well as be inhaled by the patient and dental staff. For this reason, many holistic dentists enforce strict protocols during amalgam removals.

Holistic dentists are often trained in safe mercury amalgam filling removal to ensure that no mercury gets into the body upon removal of the fillings. The most widely used protocol is the Safe Mercury Amalgam Removal Technique (SMART) which includes steps that reduce mercury vapor and particulates so as to keep the patient and dental staff safe. These guidelines include measures like a face and neck barrier for the patient and masks and shields for dental staff. An oral vacuum close to the face can reduce any mercury vapors getting into the air, as can proper ventilation and filtration of the procedure room. 

Overall, the decision of whether or not to have your fillings removed to improve your general wellness is a choice you should make with your dentist. If you aren’t sure what your mercury levels are (or they are undetectable) and you have no health concerns, it’s important to weigh the risk of possible exposure while having them removed. 

If your levels are undetectable or unknown and you do have persistent health symptoms, it’s probably best to start your healing process elsewhere — like your gut. This is not only a safer option, but poor digestive health is a well-known cause of many health concerns.

However, if you have elevated levels of mercury in your body and symptoms that you suspect are related to potential exposure (such as symptoms that began right after getting a filling) it may be time to consult a holistic dentist. If you do decide to have them removed, be sure to work with a dentist who follows safety protocols.

Now that we’ve dissected the mercury filling debate, let’s move on to the second most common topic that people question about dental health: fluoride for cavity prevention.

Do We Need Fluoride?

In the United States, fluoride is a naturally-occurring mineral that’s added to our water, toothpaste, and is put on our teeth at the dentist as an additional treatment. This preoccupation with fluoride is due to its teeth-strengthening effects and role in tooth decay prevention [12]. However, there is disagreement as to whether or not we even need all of that additional fluoride and, since fluoride is actually toxic at higher doses. The answer to whether we need fluoride requires some explanation, so let’s get into it.

Many holistic dentists feel that all of this added fluoride is unnecessary, and in fact, 98% of European countries do not drink fluoridated water. Adding fluoride to water is not generally considered a necessity for dental health and is best avoided to prevent toxicity [13, 14]. Holistic dentistry warns against the overuse of fluoride because, in high doses, fluoride can damage teeth, is toxic to the nervous system, and may negatively affect the thyroid [15, 16]. Higher fluoride also increases the risk of enamel defects in developing teeth. These concerns are, in part, why the fluoride levels in the United States were decreased in 2015. 

However, research does support that fluoride-containing toothpaste is significantly better than fluoride-free toothpaste at preventing cavities [17]. 

As with many micronutrients, fluoride appears to be best used in moderation. It’s likely that low doses of fluoride in your toothpaste and at your annual dental check-ups are fine (just avoid swallowing it). But it’s probably good to steer clear of fluoride-containing water or invest in a good home water filtration system with a fluoride filter.

Perhaps the most important point of this fluoride debate is that fluoride use does not address the possible root causes of cavities such as a poor oral microbiome and a diet high in processed foods and sugars. 

An over-reliance on fluoride for cavity prevention distracts from the factors that are causing poor dental health in the first place. You can consider it a “band-aid” treatment that is treating (or, in this case, preventing) the symptoms of dental disease while ignoring the underlying cause. This is where holistic dentistry comes into the picture and can help you make the long-lasting changes that you need for better oral health.

While your teeth are certainly an important part of oral health, they aren’t the only structure that deserves attention. This is why holistic dentistry looks at other components, like your oral airway health.

The Importance of Oral Airway Health

Traditional orthodontics treats issues such as improper bite patterns (overbite or underbite), crowding of the teeth, jaw misalignment, and an abnormally arched upper palate. However, what is rarely mentioned in traditional orthodontics and dentistry, is that the largest contributor (and possible root cause) to all of these problems is poor oral airway health

Structures of the oral airway include the mouth, jaw, nasal passages, tongue, and throat. Its health is frequently assessed through your default breathing patterns. If you don’t naturally resort to nasal breathing, this is often caused by life-long issues with your sinuses (like allergies) and/or improper development of the structures of the mouth. This abnormal development can result from being bottle-fed, overuse of pacifiers, or prolonged thumb-sucking as a child [18].

Assessing your current oral airway health can be summed up in one question — are you a nose or mouth breather? Meaning, do you naturally breathe with your mouth open or shut?

Signs of Poor Oral Airway Health

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Many dental and health issues that we think are common can be signs of poor oral airway health, such as [18]:

  • Insomnia, poor quality sleep, and snoring
  • Improper bite (overbite or underbite) and crowded teeth
  • Narrow palate requiring an expander
  • Wisdom teeth misalignment leading to removal 
  • Temporomandibular joint (TMJ) pain and teeth grinding
  • Multiple cavities
  • Chronic headaches.

Humans are designed to breathe through their nose with their mouth closed and the tip of their tongue at the top of the mouth just behind the front teeth. Proper tongue placement creates a healthy arch of the palate and prevents overcrowding of the teeth. It also ensures correct jaw alignment and a well-developed facial structure. 

In fact, one sign of consistent mouth breathing is improper facial structure when viewed from a side profile. Mouth-breathing is associated with the chin being set farther back from the upper lip and nose. It also results in a more narrow and asymmetrical facial structure [18]. 

Let’s take a further look at why nasal breathing is so important [18]:

  • Your nasal passages purify the air before it gets to your lungs — mouth breathing does not purify the air. 
  • The nasal airway makes nitric oxide to kill airborne pathogens and reduce inflammation before sending the air to your lungs.
  • Nasal breathing ensures proper placement of the tongue which leads to well-developed and aligned teeth, preventing tooth crowding, impacted teeth (the main reason why most wisdom teeth are removed), overbite, and underbite.
  • The temporomandibular joint (TMJ) aligns correctly, thus avoiding TMJ pain.
  • Mouth breathing while sleeping decreases the amount of oxygen that gets to the brain and can impact cognition, anxiety, mood regulation, and sleep quality. 
  • Nasal breathing can help prevent cardiovascular and neurological diseases, like Alzheimer’s.

In short, proper oral airway health is an often ignored, but vital component of our overall health. 

Holistic Dentistry and Oral Airway Health

Traditional orthodontics often use braces to straighten teeth or fix an overbite, but the root cause (abnormal facial structure development due to improper breathing) is often missed. However, holistic dentistry helps fill this gap in oral airway health through myofunctional therapy exercises.

After performing a comprehensive oral airway exam and determining you are a good candidate, a holistic dentist will prescribe orofacial myofunctional therapy (a type of physical therapy) that focuses on many different aspects of facial and oral functioning. You may be given speech, swallowing, and breathing exercises and taught proper tongue placement.

Interestingly, while many orthodontists today do not check the oral airway or provide orofacial myofunctional therapy, the connection between nasal breathing and dental health was started by orthodontists in the 1960s [19]. They noticed that repatterning nasal breathing, proper swallowing, and better resting mouth postures improved orthodontic outcomes. 

Aside from holistic and biological dentists, orofacial myofunctional therapists (OMTs), airway-centric traditional dentists and orthodontists, some ear, nose, and throat doctors, oral surgeons, allergists, sleep doctors, speech-language pathologists, and functional medicine doctors may all be able to help with oral airway health [19]. 

When looking for the right practitioner ask them about myofascial therapy, how they assess for mouth breathing, and how they can help improve your default breathing pattern. 

The Oral Microbiome

At The Ruscio Institute for Functional Medicine we often talk about the gut microbiome and its impact on wellness. But did you know that you also have an oral microbiome? These tiny organisms are important for not just dental health, but whole-body health as well. 

This topic deserves a whole article of its own, which you can read here, but I wanted to provide a quick summary of the oral microbiome so you are prepared when a holistic dentist talks to you about improving your oral health with diet and possibly probiotics. 

The oral microbiome is a community of bacteria in your mouth that when in balance, helps prevent tooth decay and gum disease [20]. It’s connected to the gut microbiome through the digestive tract. A healthy oral-gut barrier helps keep mouth microbes from moving into the gut, and good oral hygiene prevents gut microbes from moving to the mouth [21, 22, 23].

An imbalanced oral microbiome can impact not only your dental and whole-body health. Oral dysbiosis can lead to the growth of toxin-producing bacteria that trigger an inflammatory response in the mouth and damage oral tissues. Even more, when the oral-gut barrier is impaired, oral microbes and their toxic metabolites can travel to the gut and cause body-wide inflammation [23, 21, 22].   

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Oral dysbiosis may contribute to [24, 21, 25]:

  • Tooth decay
  • Gingivitis (inflammation of the gums)
  • Oral and esophageal cancer
  • Colorectal and pancreatic cancer
  • Cystic fibrosis
  • Cardiovascular disease
  • Rheumatoid arthritis
  • Alzheimer’s disease
  • Diabetes 

Holistic Dentistry and The Oral Microbiome

A holistic dentist will often recommend dietary changes for oral health, as certain foods like sugar and soda can damage teeth and cause gum disease. But what you may not know is that an anti-inflammatory diet can actually improve the balance of bacteria in your mouth due to its gut-healing effects. 

Many holistic dentists will recommend a Paleo diet to help improve the oral microbiome. This elimination-based diet removes processed foods and sugar, which are known to negatively affect dental health. However, the underlying goal of this diet is to identify and eliminate the foods that often trigger an inflammatory response in the body and disrupt your oral microbiome.

Probiotics are an effective gut-healing therapy and have been shown to decrease the oral pathogens that cause cavities (dental caries), gingivitis, and periodontal disease [26]. Probiotics may also be helpful in combating bad breath, and improving gum disease [27, 28]. These effects are likely due to the tight relationship between the mouth and the digestive tract, known as the gut-mouth axis. 

For more information on how your digestive and oral health are related, we have an entire article dedicated to the oral microbiome and the gut-mouth axis.

Additional Holistic Dentistry Treatments

Mercury fillings and fluoride are arguably the biggest treatments that most people have questions about when considering a holistic dentist. However, holistic dentistry has quite a few other approaches to improve the health of not just your teeth, but your whole body. Let’s take a look at their stance on root canals, cavities, and X-rays. 

Root Canals and Dental Implants in Holistic Dentistry

Holistic dentists tend to be more conservative with the use of root canals and dental implants because they argue that they can increase the risk of infection in the mouth. 

When the pulp (connective tissue at the center of the tooth) of a tooth becomes inflamed or infected from tooth decay, a conventional dentist may perform a root canal to clean out the damaged tissue, disinfect the space, refill it, and seal the tooth [29].

Holistic and biological dentists believe that a root canal replacement (a tooth without vessels and nerves underneath) leaves the body with dead tissue that harbors bacteria and sets off the body’s immune system. This can potentially lead to neurological disease and cardiovascular disease [30]. 

There are several different alternatives that a holistic dentist may offer in place of a traditional root canal. They often will surgically clean out the area to avoid infection, and when using dental implants, holistic dentists seek to use biocompatible materials that exist in the body without causing local or systemic immune responses [2, 31]. 

Ozone Therapy for Cavities

Ozone therapy is when a gas or liquid oxidizer agent is used to disinfect the mouth and treat dental caries. The oxidation caused by ozone can kill bacteria that are involved in cavity formation and may be a useful alternative to the standard treatment — which is fillings [4]. This is most often used very early on in cavity development to avoid cavity progression, but most holistic dentists will use fillings if the decay is too deep in the tooth.

The largest body of research that we found on ozone therapy does show that it can kill harmful bacteria, but not enough to treat cavities or root canals [4, 5]. At the same time, many holistic dentists report that many people who have gotten ozone therapy did not have the advancement of tooth decay and were able to avoid fillings. 

This suggests that ozone may have a role in the prevention and progression of dental disease, but may be ineffective at treating significant, existing decay. It is best to talk to your dentist about when to use ozone therapy and for proper monitoring of the tooth. 

Digital X-Rays

To decrease the radiation caused by film X-rays (traditional imaging) some holistic dentists prefer the use of digital X-rays or a combination of the two. 

A digital X-ray produces digital images rather than images on photographic film. Digital X-rays may produce lower levels of radiation, but all X-rays produce ionizing radiation that can harm living tissue, especially with many repeat exposures [32]. In fact, one study found that some doctors take more images while using digital imaging when compared to film, leading to overall higher radiation exposure with digital x-ray [3]. 

While the overall risk of cancer from X-rays is low, with any kind of X-ray you want your dentist or radiologist to only take the number of X-rays you really need [3, 32]. Often, holistic dentists are open to a discussion about limiting your X-ray exposure.

The Benefits of Holistic Dentistry

A holistic dentist looks at your health as a whole, not just your dental health. Their holistic approach to treating dental health involves improving gut health, assessing and improving the oral airway, and using the least invasive dental procedures possible. This will also help support your overall wellness — especially if you have been dealing with chronic health problems.

While the topics of mercury filling and fluoride use remain fairly controversial, I hope we cleared up some of the confusion surrounding these debates and helped guide you in the best direction for you. Overall, holistic dentistry is a great option for those who are looking for a natural, alternative, and non-toxic way to treat their oral health.

If you are searching for the root cause of your chronic health conditions, you can become a patient at Ruscio Institute for Functional Medicine. We would be happy to help you get to the bottom of your symptoms, and discover if a holistic dentist might be a good addition to your healthcare team and healing journey. 

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

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