The Dramatic Benefits of Minimally Invasive Dentistry
February 24, 2013
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By Dr. Mercola
Dental health is an important part of your overall health. Unnecessary drilling and filling your teeth with toxic materials can have far-reaching, long-term health ramifications.
Fortunately, there are options, but it can be tricky finding a dentist that is fully familiar with alternative types of dentistry, such as minimally invasive dentistry and biomimetic dentistry –
the latter of which means 'mimicking nature,' and involves using tooth restorations and techniques that imitate natural teeth, both in appearance and function.
Both of these are covered in Carol Vander Stoep's book, Mouth Matters. Carol has been a dental hygienist for 25 years.
She chose a career in dental hygiene over dentistry because she valued prevention over repair, and her book can be a valuable resource for lay-persons and dentists alike. It discusses whole body health from a dental perspective, along with advanced forms of dental diagnosis and treatment that we should all be requesting from our dentists.
"When I wrote the first edition of Mouth Matters, it was all about how gum disease affects heart disease, diabetes, stroke risk – all of those degenerative diseases of the body. I wasn't all that interested in teeth."
Carol says, "What I started to realize, as the question of root canals and breaking down teeth started to surface, was that if a tooth does break down or catastrophically fail, you're facing the same issue about introducing germs back into the body.
As a result of having written the first edition, it was wonderful for me to be able to be introduced to some of the top dental researchers, clinicians, people who are really trying to start a revolution in dentistry and trying really hard to do it.
But we all know that revolutions don't start from the top-down; they have to start from the bottom-up. That's why I'm here today. Because really, we need to educate people as to what it is that we want in dentistry. We need to know the kind of care that we want."
Naturally, preceding technological developments in dental tools is the foundation of diet. If you get your diet right, which includes avoiding sugars, processed foods and grains, then you're creating an environment in your mouth that will be resistant to dental decay.
Fermented foods, such as fermented vegetables, can be tremendously beneficial for your oral health. I've had a significant problem with tartar buildup on my teeth, having to get a cleaning once a month. Once I added fermented vegetables to my diet, I've been able to extend it to every two months. So diet is really the foundation of healthy teeth and gums.
Modern Dentistry Really Isn't as Advanced as it Could Be
Modern dentistry is still fairly primitive in many ways. About half of American dentists still use amalgam, half of which is neurotoxic mercury –
not silver as the name "silver fillings" would imply.
But that's not the only problem. The act of drilling into a tooth is in and of itself very destructive to the tooth, especially when using a high speed drill. It can create tiny little cracks that lead to further deterioration of the tooth over time. Low-speed drilling is not as destructive to the tooth but is still far from optimal. The conventional strategy to "drill and fill," regardless of the restorative material used, is an impermanent solution. An estimated 70-80 percent of the work done by dentists is re-repairing previous dental work.
"It's important to really understand – and one thing that I didn't appreciate was – that teeth are one of the most complex structures in your body," Carol says. "It takes a full nine years for them to even form. It's a series of arches. If you would think about masonry, anytime you cut an opening in masonry in order to handle the compress of strengths, a mason has to build an arch to hold that strength. If you were to take the keystone out of that arch or to cut the leg out off of that arch, the whole arch would collapse; the whole structure would collapse.
What I think is so beautiful about a tooth – an adult molar – is that it is a series of arches. There are at least four to five arches built into the tooth. They're actually made of different layers.
You have an outer, very tough shell called enamel. That's only two percent organic, and it doesn't flex a lot. But the internal part of the tooth, the body of the tooth, is 55 percent organic. It's made of collagen and water. It's made to shake, rattle, and roll, as we put all these compressive strengths on it. Chewing is a very, very tough thing. We want these teeth to last a hundred years and stay in function, and they're designed to do that."
The concept of minimally invasive dentistry is still in its infancy, although Dr. Tim Rainey has been tirelessly lecturing on the subject, all over the world, for the last 25 years. He has also written about it in dental journals. He still has a dental practice in Refugio, Texas where the majority of his patients are underprivileged children on Medicaid.
"The beauty of this dentistry is that it doesn't require shots. It doesn't take a lot of time. It's not painful. In fact, since he introduced ozone into his practice, he has never had a child come in with an asymptomatic tooth (meaning a tooth in pain) that has ever needed a root canal or an extraction. He's never even needed to anesthetize them," Carol says.
The Importance of Early Diagnosis
Early diagnosis is essential if you want to avoid invasive restorations. Unfortunately, conventional dentistry still has a lot to learn in this respect. According to Carol, traditional means of diagnosis, using an explorer, and x-rays only have a 25 percent success rate in terms of accurate diagnosis. False positives and false negatives can occur and do so quite frequently. Carol explains:
"You can have a tooth to be completely stain-free... It cannot stick with an explorer. If we take an X-ray of the tooth, nothing shows up. It looks completely pristine. However, [decay] can be hiding up under those pits and grooves –
some rather significant decay. In fact, when the enamel is forming, a lot of times there are little folds, fractures, and not completely mineralized enamel. There are defects in the enamel that we can't catch for many, many years. You can't really diagnose or treat an unopened fissure. That's really the first most important thing – I think – that people need to know.
...The decay has to get pretty deep into the tooth before we can diagnose it. In fact, X-rays are very late-stage diagnosis. Decay has to be at least two millimeters into the second layer of tooth under the enamel before an X-ray can begin to catch it. Then you have to be much more invasive in treating it. You want to be able to catch diagnosis early."
Fluoride is commonly thought to be a primary prevention strategy against tooth decay, despite the fact that, like mercury fillings, it is a highly toxic substance, shown to lower IQ in children. According to Carol, fluoride also makes early diagnosis more difficult.
"When that outer shell is heavily infused with fluoride, it changes the way an X-ray goes through a tooth," she says. "I think it delays diagnosis, because we're not able to see that decay as easily."
There are Better Alternatives to Crowns
Eventually, after a tooth has been repaired a number of times, a crown typically becomes necessary. However, biomimetic dentistry offers excellent alternatives to crowns.
"There are principles of adhesive dentistry that dentists should know, but again, most of them don't know. There are six different ways to put [resin material] in to where it can recreate the tooth structure," Carol explains.
For example, the dentist can section the resins, layering the material in according to something called C-factor (which has to do with the shrinkage of the material), so that it's not creating too much pressure on the tooth in any direction. Another alternative is to use more expensive inlays or onlays. A CEREC® machine can cut the material into precise-fitting pieces that are then permanently adhered into the cavity. CEREC® material can also be used to replace an entire tooth, like a crown. However, CEREC® inlays and crowns are far better than other resin fillers and metal or porcelain crowns as they are permanent and will not need to be replaced with time.
The Benefits of Ozone in Dentistry
Now, most people get concerned when they hear ozone, equating it with ozone pollution. When ozone levels rise, we're likely to get sick. But this is due to the pollutants caught in the ozone –
ozone itself is actually nature's way of cleaning the air. Granted, ozone gas, by itself, should not be breathed as it's toxic to lung tissue in high concentrations. But when selectively applied, it can provide significant benefits in dentistry. In fact, according to Carol, ozone is the only way to predictably re-mineralize the tooth. The conventional thought is that this is the function of fluoride, but this is not true.
Another component of minimally invasive dentistry is the use of ozone. "I can't believe I didn't hear of ozone until about a year and a half ago,"
Carol says. "But it's wonderful."Fluoride actually has a powerfully detrimental effect, because while it can strengthen the tooth, that's not the most important factor in preventing decay. While making the enamel denser, it also makes it more brittle by destroying the surface crystal matrix that helps protect the tooth. It's a very similar process as osteoporosis drugs that make your bones denser but more brittle...
"We are using it close to the mouth, so there are precautions that you have to know," Carols says. "You have to take a course in it. You can't just start using it. But since we deal with microbes in the mouth, I can't imagine a better place for ozone. I use it all the time in gum disease.
...The beauty is, with ozone, you don't have to remove all the decayed material. You just remove the worst of it, then you hit it with ozone. If there are any dentists listening, they can take it down just to what we call the leathery layer. There's still plenty of structure there. The crystalline structure is still there, and it's still strong. It's just been infiltrated by bacteria and their end products.
In the old way, you would want to take all of that out. We don't want to do that. Leave that there. Hit it with ozone for a few minutes and change the chemistry of the tooth. Let it re-harden. If you don't fill it, it will take about two months to re-harden. If you fill it, it takes four months to re-harden. It's kind of a lovely concept, isn't it?
...Ozone is the only way to predictably re-mineralize the tooth –
it's a component of the process. Because what it's going to do [when applied in gas form], is diffuse into the tooth, through those little white spots into the tooth... First, it's going to kill all the microbes in the tooth. That's important... The end products of bacteria are acids. It changes the chemistry of the tooth from acid to neutral, so that now the tooth can re-mineralize the way it's supposed to.
A lot of people think that re-mineralization happens from the outside in, but most of that re-mineralization is actually going to be coming through the pulp. The pulp, of course, is that hollow internal structure of a tooth that is filled with blood vessels and nerves and is designed to give the tooth nutrients and keep it hydrated. The minerals are going to come in through the pulp, feed out this way, bring the minerals to that area, and harden it."
Everyday Dental Hygiene Tips
If you're like most people, you probably use toothpaste. But according to Carol, not only do you not need fluoridated toothpaste, you don't need any toothpaste at all. This is because plaque is removed through mechanical scrubbing, and the toothpaste might just give you a false sense of "clean."
"Many of these toothpastes have surfactants and things that keep the tongue from telling you when it's clean. If it still feels like a sweater's on your tooth, it is. Also, you can tell better if you're jiggling it under the gums. That's an important feedback for you to know," she says.
"I have people using the toothbrush as long as it takes to where the teeth feel nice and smooth. If they want to add those adjuncts, I have them use baking soda at night because that's when our saliva slows down, and we really want to raise that pH. It's going to have a longer effect."
Another interesting tip is to use ozonated oil. This is simply olive or jojoba oil through which ozone has been bubbled through (note it must be medical grade ozone). You can use it to brush your teeth with, or apply it to your gums with a toothpick. (One caveat is that it doesn't taste good.)
"My favorite tool might be the butler soft picks... It's just a little tool that I can dip in the ozonated oil and put in between my teeth. You can put it anywhere there's a plaque. It pretty much melts the plaque off," Carol says.
For more information, please read Carol's book, Mouth Matters. You may also want to recommend it to your dentist. After all, the only way dentistry will change is by patients asking for better alternatives. You can also find more information on her website, mouthmattersbook.com.
"You can say, 'this is the kind of dentistry I want,'" Carol says. "Then also, for those who don't have a dentist, I have developed a database. I thought that was really important to do, so that people can go to see who it is that's been trained in it, who are using it, who are doing biomimetic dentistry, and who are using ozone in their practices. Ideally, it's a marriage of all three."
Alternatives such as CEREC® inlays are taught at the University of Southern California under Pascal Magne and Dave Alleman, and dental applications for ozone therapy are taught by Mollica & Harris (for information see oxygenhealingtherapies.com).