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 to have their mercury fillings removed,  which they hope will get rid of their chronic symptoms. What they may not realize is that the jury is still out on whether mercury fillings are in fact harmful for most people. I’ll take a deep dive into this topic and explore other reasons why you might want to seek out a holistic dentist. 

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 treatments, such as nutritional recommendations, fluoride re-education, ozone therapy for cavities, and proper breathing and swallowing techniques, that conventional dentistry does not. 

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

What is Holistic Dentistry?

Holistic dentists, much like functional medicine practitioners, see oral health as a part of your overall health. They look at how the oral microbiota — the community of microorganisms that lives in your mouth — affects not only your teeth and gums, but also your gut, skin, and many other body systems. They choose dentistry treatments with a low toxic load to keep the whole body healthy, and they look at how the gut microbiome, oral airway, diet, and sleep affect your teeth and gums [1].   

Unlike traditional dentists, holistic dentists often use treatments  like ozone therapy (which we’ll cover later) to treat early cavities, biocompatible dental implants that may cause less inflammation, and safe removal of mercury fillings to limit mercury exposure in the body and brain. 

Holistic dentists still provide typical oral hygiene education for flossing and tooth brushing, and they routinely perform teeth cleaning, fillings, crowns, root canal therapy, and other common dental procedures. However, they offer additional options that focus on whole-body healing before recommending more invasive procedures like root canals.  

Ideally, any dentist that falls on the holistic/natural/biological dentistry spectrum tries to use the dental treatments that are the safest, most effective, least invasive, and least toxic, for the whole body when treating dental concerns and preventing disease.

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 education as traditional dentists, but they often have additional training about the oral microbiome, safe removal of mercury fillings, oral myofascial therapy (addressing the muscles and bones of the face and mouth), homeopathy, and acupuncture.

Another notable difference is that holistic dentists don’t just look at the mouth. They ask about your diet, sleep, and exercise to find out how your lifestyle may affect your dental health [2]. They may offer nutritional advice if they suspect that your oral or gut microbiome may be contributing to recurring cavities or inflammation of your gums.

Holistic dentists may also assess 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 your face, the way your teeth grow, and how you breathe and swallow. With a clear understanding of the structure and movement of your face,  the holistic dentist can perform or recommend certain exercises to help restore your face, throat, and jaw to healthy function.

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

Conventional and holistic dentists also tend to differ in opinion when it comes to root canals, removing mercury fillings, and using fluoride. I will get into those soon. First, let’s look at when and why you may want to seek out a holistic dentist. 

4 Reasons You May Want a Holistic Dentist

Not sure if or when you should consider going to a holistic dentist? Here are four reasons to consider finding one..

  1. You are having recurring cavities, gum disease, or other dental problems that are not improving with traditional methods.
  2. You are thinking of having your mercury fillings removed.
  3. You are seeking an oral airway health assessment because you’re having trouble breathing or sleeping, or because you’ve been told your child needs orthodontic treatments, like braces.
  4. You know that what goes on in your body affects the health of your mouth and vice versa, so you want dietary and lifestyle advice to protect yourself.

Now let’s look at the treatments holistic dentists can provide to help you decide whether seeing a holistic dentist is right for you.

Most Common Holistic Dentistry Treatments

Each holistic or 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 to get a sense for 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 X-rays to decrease radiation exposure
  • Using energetic treatments like acupuncture, muscle testing, or homeopathy 
  • Offering IV (intravenous) nutritional therapy when needed

Little research exists to confirm the efficacy of some of these treatment options, especially as they pertain to dentistry. Some of the above treatments may actually come with higher risks than their conventional counterparts. For example,digital X-rays may deliver more radiation than conventional film X-rays, and ozone therapy may be less effective at disinfecting the mouth than standard treatments [3, 4, 5].

That said, holistic dentistry’s approach to using less toxic materials and treating the entire body may be better for your health than conventional dentistry. Similarly, many holistic therapies, such as nutrition counseling to support healthy gut and mouth microbes, and acupuncture, can benefit your overall health.

Mercury Fillings

Let’s talk about removing mercury fillings, which is why most people look for a holistic dentist in the first place. Mercury is a highly toxic metal — remember those old glass thermometers containing mercury, and how dangerous it was if you broke one? That danger is why  many of us worry about having any amount of mercury in the mouth.

Mercury fillings, also known as silver amalgams, are metal fillings containing a mixture of mercury, copper, silver, and tin. Referring to them as “silver” is a bit misleading because they are actually 50% mercury, by weight [6]. To avoid confusion, I’ll call them metal amalgams from now on. 

Metal amalgams are highly controversial, and the research on their health effects is mixed. Some claim there is no health risk associated with mercury fillings because they appear stable and unable to leech mercury into the body. However, very few dentists — holistic or conventional — use full metal amalgams anymore.

Many countries have restricted or stopped using metal amalgams because they pose health risks to certain populations and to dental professionals working with metal amalgam powders. In fact, many governments around the world follow the Minamata Convention on Mercury to reduce the occurrence of metal amalgams and limit people’s exposure to mercury [7]. 

In the United States, the Food and Drug Administration (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 populations are at higher risk for mercury toxicity when they breathe in particles while having the metal amalgam put in and when particles possibly leach into the body once the amalgam is in place. 

The International Academy of Oral Medicine and Toxicology (IAOMT) has compiled a comprehensive review on the alarm surrounding metal amalgams [9]. However, the IAOMT is notoriously opposed to metal amalgams, which suggests the organization may be biased. Regardless, its findings are still worth noting. For example, metal amalgams may not be as stable as previously thought. Other serious concerns include:

  • People with metal amalgams can have high mercury levels.
  • Mothers with metal amalgams can have higher mercury in their cord blood and breast milk and their infants can have mercury in their kidneys and brains. 
  • Mercury may play a role in Alzheimer’s disease, and many recommend testing mercury levels in people with cognitive decline. 
  • In children with metal amalgams, mercury levels in the urine may increase over time and contribute to kidney damage.Exposure to mercury might contribute to anxiety, chronic fatigue syndrome, multiple sclerosis, allergies, and more, but few studies have directly looked at metal amalgams as the source of exposure. 

Many people with conditions such as Hashimoto’s, allergies, asthma, skin rashes, chronic fatigue, and anxiety have reported feeling better after having their metal amalgams properly removed. One small study found that people with metal amalgams and a variety of symptoms did have mercury in their urine, and the level decreased once the amalgams were safely removed [10].

So what does all of this mean, and how does it apply to you? Considering the consistencies in the FDA’s and the IAOMT’s opinions on metal amalgams, if you need a filling, it’s probably safest to opt for composite (metal-free) fillings. 

But if you already have a silver amalgam and are considering removal, things are a little more complicated. For starters, the research still can’t say for sure whether metal amalgams are stable in the body or pose health risks. Additionally, the process of removing them can increase your risk of toxic exposure to mercury. 

Therefore, having your metal amalgams removed is probably not the best place to start if you’re looking to heal your chronic illness or persistent symptoms. Instead, you may have better luck focusing on your gut health first. 

That said, if you’ve been tested for mercury, your level came back high, and you are considering having your metal amalgams removed, let’s look at how to get it  done safely.

Safe Mercury Filling Removal

When a dentist uses a drill to remove a metal amalgam, mercury particles and vapor rise into the air,  causing considerable risk. Without proper protection, the patient can take in mercury through the mouth, gums, and lungs. The dental staff can also breathe in mercury. To protect everyone involved, many holistic dentists enforce strict protocols during amalgam removals.

Holistic dentists often receive training to safely remove metal amalgams and ensure that little or no mercury reaches the body in the process. The most widely used protocol is the Safe Mercury Amalgam Removal Technique (SMART), which includes steps to reduce mercury vapor and particulates. The protocol includes measures like a face and neck barrier for the patient and masks and shields for dental staff. An oral vacuum close to the patient’s face, and proper ventilation and filtration of the procedure room, can reduce mercury vapors . 

Overall, deciding whether to have your metal amalgams removed to improve your health 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 issues, it’s important to weigh the risk of possible exposure while having your metal amalgams removed. 

If your mercury 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 problems.

Finally, if you have high levels of mercury and symptoms you suspect are related to exposure (for example, symptoms that began shortly after getting metal amalgams) it may be time to consult a holistic dentist. If you decide to have your metal amalgams removed, be sure to work with a dentist who follows safety protocols.

Now that we’ve dissected the metal amalgam 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 is typically added to drinking water and toothpaste, and dentists often apply it to our teeth during routine treatments. The ubiquity of fluoride comes from its ability to strengthen teeth  and prevent tooth decay [11]. However, many people think we get way too much  fluoride, which is toxic at higher doses. Whether we need or can live without fluoride requires some explanation, so let’s get into it.

Many holistic dentists believe that added fluoride is unnecessary and possibly detrimental to human health. In fact, 98% of European countries do not allow fluoridated water, citing research showing that it is not necessary for general dental health and can lead to fluoride toxicity [12, 13]. Holistic dentistry warns against overusing fluoride because, in high doses, it can damage teeth, injure the nervous system, and negatively affect the thyroid [14, 15]. Higher fluoride also increases the risk of enamel defects in developing teeth. These concerns are partly why the United States reduced additive fluoride levels in 2015. 

Nonetheless, a meta-analysis of 96 randomized controlled trials found   that fluoride-containing toothpaste is significantly better than fluoride-free toothpaste at preventing cavities [16]. 

As with many micronutrients, fluoride appears to be best when used in moderation. Therefore, low doses of fluoride in your toothpaste and at your annual dental check-ups are probably fine — just avoid swallowing it. But it’s probably good to steer clear of fluoridated water if you can, or invest in a good water filtration system with a fluoride filter.

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

Over-relying on fluoride for cavity prevention distracts us from looking into what is causing poor dental health in the first place. Fluoride is like a Band-Aid  that treats only the symptoms of dental disease, but it does nothing for the underlying cause. This is where holistic dentistry may help you change some fundamentals to  address and improve your  oral and general health.

Although your teeth are certainly integral to your oral health, they don’t deserve all the attention. Holistic dentists also focus on other components, like your oral airway.

The Importance of Oral Airway Health

Traditional orthodontics treats issues such as improper bite patterns (overbite or underbite), crowded teeth, misaligned jawbones, and abnormal arches of the upper palate. Although it’s rarely mentioned in traditional orthodontics and dentistry, the largest contributor to (and possible root cause of) all these problems is poor oral airway health

Structures of the oral airway include the mouth, jaw, nasal passages, tongue, and throat. A holistic dentist can assess your oral airway health  by looking at your default breathing patterns. For example, if you tend to breathe through your mouth rather than your nose, you may have long-standing sinus issues. Mouth breathing could also point to poorly formed mouth structures from being bottle-fed, using pacifiers too much, or prolonged thumbsucking as a child [17].

A holistic dentist can basically assess your current oral airway health by answering one question — do you naturally breathe with your mouth open or shut?

Signs of Poor Oral Airway Health

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Poor oral airway health may show up as common dental and health issues , including [17]:

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

Humans are designed to breathe through the nose with the mouth closed and the tip of the tongue at the top of the mouth just behind the front teeth. Proper tongue placement creates a healthy palate arch, prevents teeth from overcrowding, and 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 the side. 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 [17]. 

In contrast, nasal breathing ensures a number of important functions. When you breathe through your nose instead of your mouth [17]:

  • Your nasal passages filter the air before it gets to your lungs — this does not happen during mouth breathing. 
  • The nasal airway produces nitric oxide to kill airborne pathogens and reduce inflammation before sending air to your lungs.
  • Your tongue is in the right place, which leads to well-developed, aligned teeth and prevents tooth crowding, impacted teeth (the main reason for removing wisdom teeth ), overbite, and underbite.
  • Your temporomandibular joint (TMJ) aligns correctly, thus preventing TMJ pain.
  • During sleep, your brain gets more oxygen, which supports healthy cognition, positive moods, and good sleep quality. 
  • You reduce your risk of cardiovascular disease and neurological diseases, like Alzheimer’s.

As you can see, proper oral airway health is an often ignored but vital component of overall health. 

Holistic Dentistry and Oral Airway Health

Traditional orthodontics typically uses braces to straighten teeth or fix an overbite. Unfortunately,  this approach often overlooks the major root cause of crooked teeth and misaligned jawbones: improper breathing resulting in dysfunctional facial structure. The good news is that holistic dentists can improve oral airway health with myofunctional therapy.

After performing a comprehensive oral airway exam and determining you are a good candidate, a holistic dentist may prescribe orofacial myofunctional therapy,a type of physical therapy for many aspects of facial and oral function. You may learn exercises to improve your speech, swallowing, breathing, and tongue placement.

Interestingly, although today’s orthodontists don’t typically assess the oral airway or provide orofacial myofunctional therapy, the field of orthodontics first made the connection between nasal breathing and dental health in the 1960s [18]. They noticed that repatterning nasal breathing, proper swallowing, and better resting mouth postures improved orthodontic outcomes. 

Aside from holistic and biological dentists, the following types of practitioners may be able to help improve your oral airway health: orofacial myofunctional therapists (OMTs), traditional dentists and orthodontists who focus on the airway, EENT (eye, ear, nose, and throat) doctors, oral surgeons, allergists, sleep doctors, speech-language pathologists, and functional medicine practitioners [18]. 

When looking for the right practitioner, ask candidates about their experience with myofascial therapy, how they assess 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 you also have an oral microbiome? Read on to find out how the microscopic organisms in your mouth are important for your oral and overall health. 

This topic deserves an article of its own, which you can read here. But I’ll provide a quick summary of the oral microbiome so you are prepared when a holistic dentist tells you about improving your oral health with diet and possibly probiotics. 

The oral microbiome is the community of bacteria and yeasts that live in your mouth. When the community is fairly balanced, it helps prevent tooth decay and gum disease [19]. The oral microbiome connects to the gut microbiome through the digestive tract. A healthy barrier between the mouth and gut helps keep mouth microbes from moving into the gut, and good oral hygiene prevents gut microbes from moving to the mouth [20, 21, 22].

An imbalanced oral microbiome can impact your dental and whole-body health. In the mouth, dysbiosis (when there are more “bad bugs” than “good bugs”) can encourage toxin-producing bacteria to multiply, which can trigger an inflammatory response that damages the tissues. But the inflammation doesn’t just stay in the mouth.  It can spread to the oral-gut barrier, allowing oral microbes and their toxic metabolites to reach the gut and the rest of the body [20, 21, 22].

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Oral dysbiosis can be far reaching, potentially contributing to [20, 23, 24]:

  • 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 typically recommend dietary changes for oral health. For example, she or he will probably suggest limiting or avoiding obvious things like sugar and soda, which can damage your teeth and cause gum disease. But your holistic dentist may also recommend an anti-inflammatory diet, which can both heal your gut and improve the balance of bacteria in your mouth. 

Many holistic dentists will recommend a Paleo diet to help improve the oral microbiome. The Paleo diet automatically rules out processed foods and sugars, which we know can negatively affect dental health. It also gets rid of foods that tend to cause inflammation in the gut, increasing the likelihood of disrupting the healthy function of your mouth and the rest of your body. .

Probiotics are an effective gut-healing therapy that can also decrease the oral pathogens that cause cavities (aka dental caries), gingivitis, and periodontal disease [25]. Probiotics may also help combat bad breath and  gum disease [26, 27]. These effects likely result from the tight relationship between the mouth and the digestive tract. 

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

Additional Holistic Dentistry Treatments

Arguably, most people who seek holistic dentists probably have concerns about metal amalgams and fluoride. But holistic dentistry offers other treatments for oral health, too. For example, let’s take a look at how they might treat root canals, cavities, and X-rays. 

Root Canals and Dental Implants in Holistic Dentistry

Holistic dentists tend to be more conservative than conventional dentists when it comes to root canals and dental implants. Holistic dentists may err on the side of avoiding these procedures, citing concerns that they may increase the risk of infection in the mouth. 

First, let’s look at root canals. When the pulp, or connective tissue at the center of the 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 [28].

Holistic and biological dentists believe that a root canal replacement (a tooth without vessels and nerves underneath) leaves the mouth with dead tissue that harbors bacteria and sets off the body’s immune system. This can potentially lead to neurological disease and cardiovascular disease [29]. 

A holistic dentist may offer several alternatives to 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 inflammation [2, 30]. 

Ozone Therapy for Cavities

Ozone therapy is when a gas or liquid oxidizer agent is used to disinfect the mouth and treat dental caries. Ozone creates oxidation that can kill cavity-related bacteria , and it may be a useful alternative to standard fillings [4]. Ozone therapy is usually used early in cavity development as a way of preventing cavity progression, but most holistic dentists will use fillings if the decay is too deep in the tooth.

According to a large body of research on ozone therapy, the procedure can kill harmful bacteria, but not enough to treat cavities or root canals [4, 5]. At the same time, holistic dentists report that many people who have gotten ozone therapy  avoided further tooth decay and the need for fillings. 

This suggests that ozone may have a role in preventing dental disease and its progression, but ozone may be ineffective at treating significant decay. It is best to talk to your dentist about if and when to use ozone therapy and how to properly monitor a treated tooth. 

Digital X-Rays

To reduce the radiation caused by film X-rays (traditional imaging), some holistic dentists prefer to use 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 than film X-rays, but all X-rays produce ionizing radiation that can harm living tissue, especially with many exposures [31]. In fact, one study found that some doctors took more images while using digital imaging than when using film. As a result, their patients received more radiation than they would have with film X-rays [3]. 

In general, the risk of cancer from X-rays is low. However, any kind of X-ray, you want your dentist or radiologist to be conservative and take only necessary images [3, 31]. A good holistic or conventional dentist should be  willing to discuss ways to limit your X-ray exposure.

The Benefits of Holistic Dentistry

A holistic dentist looks not only at your dental health, but also at your health as a whole. The holistic approach to treating dental health involves improving your gut health, assessing and improving your oral airway, and using the least invasive dental procedures and tools possible. These measures should also support your overall health, which may be especially important if you have chronic health problems.

Although the topics of metal amalgams and fluoride use remain fairly controversial, I hope I’ve cleared up some of the confusion surrounding the debate and helped guide you to making the best decision for your health. Overall, holistic dentistry is a great option for those who are looking for a natural, alternative, and non-toxic way to treat their oral and general health.

If you could use some help in your search for the root cause of your chronic symptoms, we’re here for you at Ruscio Institute for Functional Health. We would be happy to help you get to the bottom of your symptoms and find out whether a holistic dentist might be a good addition to your healthcare team.

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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