How Dentists Can Affect the Chronic Disease Epidemic in our Nation

It’s no secret that Americans are getting sicker, quicker, as evidenced by the alarming statistics of chronic disease reaching even into our youngest population. Today 48.9% of Americans are on at least one pharmaceutical drug, 23.1% on 3 or more and 11.9% on 5 or more.1 More alarming is that 1 in 5 children are classified as obese. According to the CDC’s report in 2015-2016, “the prevalence of obesity was 39.8% in adults and 18.5% in children age 2-19”, a huge increase from 30.5 and 13.9% in 1999.2

Dental caries rates in children, showed a steady decline from the 1970s until the mid 1990s when the trend started to significantly increase.”3 And overtaking caries as the most prevalent chronic disease in our youngest citizens, sleep disordered breathing symptoms are estimated to affect 9 out of 10 children.4 The lack of recognition and proper diagnosis of this epidemic is leading to skyrocketing numbers of prescriptions for ADHD and depression in our most vulnerable population.

What is going on and how can we as dentists help reverse these startling trends? According to the CDC in 2016 84.6% of children 2-17 visited a dentist in the previous year and 64.3% of adults did the same.5 We often see patients twice a year, 50% more than their physician if they only go for annual well visits. Therefore, we have the unique opportunity, and often more face time, to recognize signs of imbalances and help prevent overt disease before it manifests in disabling symptoms.

The Standard American Diet, aptly abbreviated SAD, exceeds the recommended intake levels of calories from saturated fats, added sugars, refined grains, sodium and adulterated fats.6 According to the quoted study, reducing sodium intake by 1200mg per day “could save up to $20 billion a year in medical costs.” Think of that staggering cost reduction by one simple change in our habits. We all know our medical system is in peril and is crippling the overall economy with no answers in sight. What if educating the population about these simple diet and lifestyle changes could impact the future of our healthcare system? Who can help educate the populace about these changes and have a positive impact on our future?

As dentists we are physicians of the masticatory system, as Pete Dawson states. He believes that no dentist can practice at the highest competency “without an understanding of how the teeth relate to the rest of the masticatory system, including the TMJs”.7 The key to successful treatment outcomes lies in proper diagnosis. Therefore, I propose a step further. We should be experts not only in diagnosis and treatment of problems in the teeth and gums, but we should also understand how the entire oral cavity and associated structures function and interact with the rest of the body for ultimate health. The mouth after all is the gateway to health. The gut begins in the mouth, and it has been well established in recent years how our gut health is the cornerstone of overall health. As Hippocrates stated in 400BC, “All disease begins in the gut.” We know that 80% of our serotonin is produced in the gut. Experts call the gut the second brain due to the immense network of nerves lining the entire GI tract called the enteric nervous system. In addition, 80% of our immune system lies below the gut lining, therefore it is crucial to keep the gut healthy and in balance.

The germ theory of disease was first proposed back in 1546 but for centuries competed with the miasma theory or early day homeopathy. Louis Pasteur and later Robert Koch are credited with expanding the study of bacteriology and the assumption that microorganisms cause disease. With the advent of vaccines and antibiotics, this theory has continued to persist as the way disease develops, despite the work of Royal Rife’s which showed that “microorganisms are pleomorphic, that they can change and often do”. A bacterium can mutate into a yeast or fungus and back again. Royal Rife saw this and even photographed it. He even saw a bacterium “poop” out viruses, as he described it.8 Other contemporaries of Pasteur including Bernard and Bechamp, who proclaimed that it is the environment in which germs live and not the germs themselves that create disease. To this day, this germ theory persists because the pharmaceutical industry is a multi billion dollar industry. Traditional and natural remedies can not be patented and therefore have been pushed to the wayside and practitioners labeled “quacks”. However, it is Eastern medicine and traditional homeopathy which understood even thousands of years ago that the body has the innate ability to heal itself if given the proper environment. To quote Hippocrates again, “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” With this in mind we can step back from labeling people with diseases and instead look at the processes occurring in each unique body to determine where the appropriate support is needed. Fortunately, functional medicine is becoming more widespread as many people spurn our disease care system and look for alternative means of wellness. Can dentists also adopt this functional view of health?

In dentistry we are trained to eradicate bacteria at all costs. We must remove all forms of germs with bactericidal mouthwashes and drugs, cut out the decay as soon as its evidenced on a radiograph, meanwhile ignoring the terrain or ecosystem of each individual patient. Is this effective? In many cases reducing the quantity of aggressive bacteria is crucial for helping a person heal, but why did that person develop such an imbalance of bacteria? We’ve all heard our patients state “ Its genetics” OR “Soft teeth run in the family.” It is no longer accepted by the scientific community to blame genes on every disease state. We know through the field of epigenetics that environment plays a much larger role in the development of disease and therefore as dentists we can have an impact by helping to recognize and correct the diet and lifestyle factors that allow the expression of faulty genes.

We are taught in dental school about the link between periodontal disease and cardiovascular disease risk as well as the association between gingival health and diabetes. That common link is inflammation. And as we know, inflammation is a major contributor to most chronic disease. Therefore, as dentists we are in the position to identify this inflammation and provide treatment and education to not only help heal the oral cavity but effect changes throughout the entire body.

If a patient presents with high blood pressure, cholesterol, and or arthritis this should inform us of underlying inflammation in the body. How does that manifest in the mouth? Could the condition of the oral cavity be contributing to the inflammation? There is much evidence of how heavy metals contribute to toxicity throughout the body. The World Health Organization in a 2005 Policy Paper wrote: “Adverse health effects from mercury exposure can be: tremors, impaired vision and hearing, paralysis, insomnia, emotional instability, developmental deficits during fetal development, and attention deficit and developmental delays during childhood. Recent studies suggest that mercury may have no threshold below which some adverse effects do not occur.”9 However it is extremely important to remember that individual response to mercury varies, and some of the factors known to potentially impact those exposed to mercury include their allergies, diet, gender, genetic predispositions to adverse reactions from mercury, the number of amalgam fillings in the mouth, and concurrent or previous exposures to other toxic chemicals such as lead (Pb).10 Could there be a link between a patient’s restorations and disease?

One problem we often face as dentists in trying to treat recalcitrant periodontal problems, is the issue of biofilms. We know that bacteria and fungi can hide within these fortresses and once the onslaught of drugs is removed, can multiply tenfold. Meanwhile, our intensive antibiotic protocols have successfully eradicated the healthy bacteria in the gut responsible for assimilating vitamins minerals and activating proper defense mechanisms in the rest of the body. We therefore greatly compromise the gut, the immune and nervous system. In addition, we enhance the compromised terrain which allows the microbes and toxins to propagate and wreak havoc on our systems. In April of 2019 an article published in Nature Magazine demonstrated that “putative periodontopathogens are present in health at low levels, but changes to the subgingival nutritional environment increase their competitiveness and drive deleterious changes to biofilm composition.”11 From this knowledge we must rethink the treatment of disease from eradication to instead enhancing the healthy bacteria by normalizing the environment in which healthy bacteria survive. There are several companies making oral probiotics like Evora Pro and Dr Gerry Curatola, has spent the last 20 years developing Revitin, a remineralizing toothpaste that’s main endeavor is to recreate the healthy environment that prevents major oral disease with crucial vitamins, minerals and prebiotics.

As clinicians we vow to do no harm. We must have a better understanding of how our treatments affect the overall body system. We must take a thorough history of patient’s medical background. Childhood illnesses and tendencies can be clues to the body’s susceptibility to certain disease states. We must ask about diet, exercise and sleep habits. We can no longer spout good oral hygiene and a fluoride regimen as the most effective ways to treat oral disease. Dr Steven Lin writes in his book The Dental Diet12 that it is our poor nutrition and especially lack of fat soluble vitamins and minerals like calcium that underlie most dental problems. After all, a cavity in a tooth is due to the imbalance of remineralization and demineralization that takes place daily. It is a lack of enamel hardening minerals NOT the lack of fluoride. Our food supply has had a steadying decline in necessary minerals over the last few decades.

In 2004, a team of researchers from The University of Texas published a study in the Journal of the American College of Nutrition. Their evaluation of nutritional data from the U.S. Department of Agriculture from both 1950 and 1999 for 43 different vegetables and fruits, found “reliable declines” in the amount of protein, calcium, phosphorus, iron, riboflavin (vitamin B2) and vitamin C over the past half century.13 The researchers believe this declining nutritional content is due to interest in improving traits like size, growth rate and pest resistance over the nutritional aspects. These practices have led to serious deficiencies in our soil and therefore in our bodies.

One major mineral that is responsible for over 800 enzymatic reactions in the body and is often cited as being deficient in poorly rotated, over fertilized and overused agricultural plots is magnesium. Magnesium deficiency affects a disproportionate number of us. One reason being depleted food sources, another being an increase in our food and water supply of fluoride and chlorine which bind up magnesium making it unusable and of course stress.14 As dentists, we know that magnesium along with calcium are the two major minerals in sound enamel. Without magnesium calcium cannot solidify and therefore cannot maintain mineralization and resist acid attacks. Our children suffer disproportionately with their typical diets of refined grains, added sugars and bad fats. How can they possibly build healthy mouths and bodies without the necessary raw materials?

Dr Weston Price, a dentist who traveled the world in the 1930s is often cited now for his incredible work in understanding that caries and malocclusions only occurred in populations where industrialized foods and lifestyles had been undertaken. In native populations eating their native diet, there was a complete absence of dental disease. However, once these populations were introduced to Western ways, they developed dental disease at the same rate as the rest of the population.15

Like our physician colleagues, we learn little if anything about nutrition in our doctorate curriculums. Many of us are not equipped to counsel our patients on nutrition, however we should be equipped to note inflammation, infection, swelling, malocclusions, narrowed airways, and dysfunctional occlusions. We should be educating ourselves about the root causes for these maladies and use our network of providers to direct our patients to the right practitioners to heal the underlying deficiencies and therefore prevent disease. We should recognize periodontal disease as an autoimmune attack, after all we know that this disease is a result of the body’s defense mechanism resorbing bone in response to endotoxins. Since all autoimmunity begins in the gut, if not equipped ourselves to treat gut issues, then we should be referring to health coaches and functional medicine doctors.

As experts of the mouth, we should be able to diagnose color changes in the oral mucosa, tongue and oropharynx. One way to familiarize ourselves with the connection of the mouth to the rest of the body is to understand the Chinese meridian system. The Chinese mapped out 12 different pathways of energy that connect the entire body using live dissection techniques. Dr Jerry Tennant, an opthamologist, studied cell biology and basic pH chemistry after becoming very ill with encephalitis and not finding any relief from allopathic medicine. We, like everything on Earth, are energetic beings. Our heart beats and brain waves can be measured today. Without the proper frequency and appropriate voltage of energy throughout our body, minerals cannot travel through cell membranes and our organs cannot communicate with each other. Dr Tennant believes every tooth acts as a circuit breaker for each of these 12 meridians. For example, an upper first molar lies on the breast meridian, so an infected #14 in a woman with a BRCA gene should be counseled about the connection. Dr Tennant has worked with multiple oncologists and has found that in over 90% of cancer patients there was an infected tooth along the same meridian of the cancer.16 Remove the infection and we remove one obstacle to ideal health.

Dentistry is the only medical profession that keeps necrotic tissue in the body by way of root canals. Infections or dead tissue anywhere else in the body is treated or cut out. Many holistic and biologic dentists adamantly oppose root canals. They can cite various studies which prove that 100% of root canaled teeth harbor some form of toxins even in apparently “healthy” looking root canals evidenced by radiographs. Dr Tennant believes that each root canal can decrease the energy in the circuit by 60%. Therefore, and especially in otherwise healthy individuals, not all root canals cause problems for the patient. It is when a patient becomes ill or lives with a chronic illness that we must look at the mouth and determine if there is anything that could be contributing to the illness and therefore remove the obstacle so the body can heal. I keep a laminated copy of the tooth meridian chart in every operatory and use it to educate my patients about how things may be related in the body and how we can uncover the root of their issues.

What about the tongue? Chinese and Ayurvedic medicine also link illnesses to the status of the tongue. We are trained as dentists to look for oral cancer, but what about discoloration of the tongue, fissures, teeth marks, size? Deep fissures in the tongue often represent digestive weakness, many cracks signify dehydration. Teeth marks also indicate digestive problems due to a swollen tongue. The dental community often sites teeth marks as a sign of apnea.

Airway has become a hugely hot topic in dental circles today. We know that apnea can cause or is caused by numerous health problems like acid reflux, stroke, heart attack etc. But what we are just learning is that the problem of small airways and malocclusions can be caught early and corrected in our children. As mentioned previously, 90% of children have at least one sign of disordered breathing. The alarming rates of ADD/ADHD and depression and anxiety are on the rise. Could it be connected to the lack of oxygen our children are getting while they sleep? Did you know that bedwetting could be a sign or poor oxygenation? Children paradoxically become hyperactive when tired, and it has been assumed for years that this behavior is psychological and must be dampened with medication. Imagine correcting a tongue tie, tongue thrust, improper swallowing and narrowed airways while a child is growing? A side effect: properly proportioned jaws that allow the natural straight eruption of teeth. I don’t know about you but I see insufficient jaws in almost every child I treat. What is the cause for this? Epigenetically our nutritionally poor diet and habits are contributing to this trend. Our children are soothed with pacifiers and bottles way too long. Our children’s first foods are soft and now come in handy squeeze pouches, both which prevent the proper development of strong jaws and proper lip support. If we can recognize these signs of improper development we can intervene early on in a person’s life and have a dramatic effect on the health long term. There are several companies like Myobrace, Healthy Start and Vivos which understand the implications of these problems and can assist dentists to intervene and treat.

But what about adults? The CPAP machine is still the gold standard for sleep apnea, but many dentists argue that dental devices can be as good if not better in some cases of apnea. The main issue lies in the narrow arches, retruded mandible and often swollen tongue. By trying to either force air down the airway or pull the mandible forward, we are still not addressing the issue of the box itself. Are there ways to increase the arches in adults? Yes, and if we truly want to get at the root cause for apnea we need to be looking to expand the arches, train our patients to breathe through their noses and strengthen the airway itself through voice exercises. One simple tool is to use microfiber tape while you sleep. This encourages nasal breathing which we know is crucial to produce the nitric oxide necessary to dilate our blood vessels so oxygen can be properly escorted throughout the body. Nitric oxide, a crucial molecule for cardiovascular health, is produced during nasal breathing with the help of oral bacteria. So if we eradicate oral flora with harsh mouthwashes and antibiotics are we negatively affecting our patient’s cardiovascular health?

I was writing my first draft of this article on an airplane and as we prepared to land I felt a tap on my shoulder from a woman behind me. She said “ I couldn’t help reading your paper.” How she could see between a 2 inch gap in an airplane seat is beyond me, but she went on to tell me that she had always had a very healthy mouth and recently she was diagnosed with periodontal disease. She was so confused and upset and went on to mention that she was also recently diagnosed with diabetes. No one had made the connection for her until she read my paper. She profusely thanked me for enlightening her of the whole body connection and hoped that I would publish my article so I could help many more like her. SO I ask all of you reading, if I can help one woman educate herself about her own health journey from squinting to read a rough draft of a plea to dentists in size 11 font and dramatically alter her life, what can you do? 

Oral Health welcomes this original article.

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  16. Tennant Jerry MD MD(H), Psc.D. 2013. Healing is Voltage.

Dr. Rachaele Carver graduated from UCONN School of Dental Medicine in 2003 with her DMD followed by a General Practice Residency in Milwaukee, WI. Following three years of private practice in Boston MA, she opened her own practice in 2009 in the Berkshires of Massachusetts. In 2016, she received her health coaching certificate from the Institute for Integrative Nutrition and became a board-certified Naturopathic and Biologic Dentist from the American College of Integrative Medicine and Dentistry in January 2020. She lectures nationally to educate practitioners and laypeople alike to understand the root cause of disease and how to reclaim vibrant health. Check out her new Podcast, “The Root of the Matter,” on all streaming platforms.

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