why holistic?

A Different Approach - Proof! Magazine December 2003 Holistic Dentistry Special Report by Dr David Cowan. Revised and reprinted by kind permission of the editor of Proof!

Dentistry is an enigma. While there have been many interesting developments, particularly in the concept of holistic dentistry over the last 30 years, little appears to have changed in day-to-day practice. In spite of the known potential toxicity of mercury, for instance, amalgam probably still accounts for the majority of restorations placed, and gum disease is still at epidemic proportions.

The idea of holistic dentistry can probably be traced back to a 1985 conference held in Cambridge, UK, on the hazards of mercury in dentistry. At that time, Sam Ziff, PhD, had just written a book called The Toxic Time Bomb, which was a plea for more research into the "potential toxicity of mercury and dental amalgam" mercury being approximately 50 per cent of what makes up amalgam `silver' fillings. The conference brought into focus a contentious subject that had been simmering ever since amalgam was introduced into dentistry in 1819. At around the same time, Dr Jean Munro had demonstrated how toxins in our environment could contribute to `new' disease states which did not appear to respond to treatment by orthodox methods. Clearly, what goes on in the mouth can have implications for the health of the rest of the body.

Dentistry has the ability to deal with many symptoms that, at first sight, may appear to be unrelated to the mouth. A patient who, for instance, has chronic headache or migraine may really have a problem with his jaws. Someone who complains of having a `metallic' taste in the mouth may have leaking fillings or a reaction between saliva and metals. An altered taste sensation may be due to a `coated' tongue, which may be indicative of an ongoing gut problem. Tooth wear abrasion and erosion-may be due to acid regurgitation from the stomach or a chronic grinding/clenching habit. Unsightly and uneven dentition may impact upon a person's self-esteem. Food debris and plaque deposits contribute to gum disease.

All of the above are seen by dentists everyday.

So, how might holistic dentists approach these problems? Take the patient with the chronic headache. After taking a thorough history and excluding other causes, it would be prudent to investigate the possibility of temporomandibular joint TMJ dysfunction. [The temperomandibular joints are the areas where the jawbone meets the skull in front of the ears]. Not only are the TMJ's probably the most used joints in the body but, due to their complexity, they are also able to cause, or be associated with, many problems. Although this joint is believed to stop growing by about age 20, it is constantly adapting to physiological or functional changes in the surrounding tissues. Factors that can affect the joint include stress, ageing and an associated decline in muscle activity, loss of teeth and, of course, changes in occlusion (Ide Y et al., Anatomical Atlas of the Temperomandibular Joint, Tokyo: Quintessence, 2001).

Stress can be not only mechanical, but emotional as well. Nowadays, we are told to `grit our teeth and get on with it', so we develop the habit of grinding our teeth [bruxism], which causes tension in many of the chewing muscles, resulting in TMJ problems, headache, migraine, tinnitus, earache, pain in the cheek or temple areas and generalised skeletal pain. Long-standing TMJ dysfunction has been linked to depression and can restrict movement of the upper neck (J Am Osteopath Assoc, 1991; 86: 512-85).

How many people do we know who complain of a stiff neck and neck pain? An holistic dentist would check the action of these joints in relation to how the teeth meet during chewing and talking, and whether for instance the ears are in alignment,the size and position of the eyes and if there are any complex bridges crossing the midlines in either jaw. This last observation is important because all the bones of the skull move and if this movement is restricted even fractionally, it may cause physiological stress leading to headache and migraine, changes in body posture, and pelvis alignment.

A coated tongue would require careful examination of the patient's lifestyle-in particular, eating habits, water consumption and amount of exercise. The possibility of fungal overgrowth or parasitic infections would also be considered and, if necessary, the appropriate lab tests carried out. The presence of such pathogens can have a major impact on the immune system and health, so treatment planning would also need to take this into account.

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