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Historically, main-stream dentistry has viewed biocompatible and holistic dentistry as quackery. This is primarily due to lack of knowledge and options available. The lack of knowledge, has allowed many dental providers of biocompatible/ holistic dentistry to deviate far from scientific, evidence-based dentistry, which has made them outcasts to main-stream dentistry.

Today, medical/dental research is far more advanced. With more knowledge and options, a more balanced approach is possible. Biocompatible dentistry, really means to provide dentistry compatible with life and health. Dentists who patch teeth and ignore the side effects to the tissues and body, are ignoring health and biocompatibility. It is has become more evident that as biologic and osmotic beings, in an increasingly toxic world, being more knowledgeable and judicious is a must. Decreasing the use of materials and techniques, which may have undesirable side effects, has become increasingly important. Additionally, dentistry now has many options for techniques and materials, which was not the case in the recent past.

Chronic inflammation and chronic state of oxidative stress, are main contributors to aging and disease (1, 2). Oral chronic inflammation is caused by infection. The body’s autoimmune response are also a major contributor to a plethora of chronic inflammatory diseases and conditions (3, 4). Infections occur when the bacterial plaque, tartar on teeth and gums trigger and inflammatory response. Infection and inflammation creates pockets, the gums pull away from the teeth, also known as periodontal disease or gum disease. Infections and Periodontal disease can also be worsened by dental procedures which leave materials below the gum line (subgingival), thus acting like irritants and bacterial traps, similar to tartar. Bacteria colonizes tartar or foreign dental materials and the body’s autoimmune system responds with inflammation, resulting in chronic periodontal disease.

Dental Materials:

All medical and dental procedures have side effects, and all dental materials can also have toxic effects, it is unavoidable. Thus, an attempt to minimize side effects is very important. Allergies to dental materials can cause chronic inflammation (5), this can be much worse if the material is placed subgingival, in constant contact with the gingiva. Many restorative dental procedures (crowns, fillings, etc.) are placed with subgingival margins and contribute to chronic periodontal inflammation, which threatens teeth, but more importantly, overall health. Oral chronic inflammation and chronic periodontal disease are major contributors to several serious diseases and medical conditions such as heart disease, arterial disease, diabetes, strokes, rheumatoid arthritis, birth complications, and cancer (6, 7).

There are a number of dental materials which have more propensity to be hyper-allergenic, like Nickel, or some acrylics. Although, patients can be allergic to any material. If the patient has a history of severe allergies, it may be a good idea to test patients for allergic hypersensitivity for dental materials.

Choosing materials with less toxicity is more desirable. For example, it is well established in scientific literature that the components of composite resins, Bisphenol A (commonly used in dentistry) are cytotoxic in large quantities.  One can minimize the patient’s exposure to this, by using Bisphenol A free materials (which are available) and using them correctly. This can have a positive effect to the oxidative stress in the body. Of course, a healthy diet and healthy living are of greater importance.

Other controversial materials and their management, like amalgam with mercury and fluoride, should be discussed with patients. Extensive worldwide studies have deemed them safe (8). An open discussion between dentist and patient is important however, it is ultimately the patient’s preferences and their own research should be acknowledged and respected.

 

Root Canals:

There is concern that active bacteria is often found on asymptomatic root canals treated teeth with periapical lesion, leading to the dreaded chronic immune response and inflammation. When a root canal procedure is needed, alternatives are often limited. No treatment leads to more pain and infection. Extraction often leads to a number of undesirable options, like missing teeth, all with negative consequences. The need to replace teeth and all its complications, including the implant option, which literature shows to have up to 50% occurrence of peri-implantitis or chronic inflammation. Thus, all options have risks and side effects. When needed, a well performed Root Canal may be the best option, but ultimately the patient must make the final informed decision.

In the other hand, a high percentage of unnecessary root canal treatments could be avoided by discontinuing the use of procedures which have a history of damaging the pulp, like full crown preparations, or aggressive decay removal on filling procedures. Also, unnecessary root canal therapy is used in traditional dentistry for prosthodontic reasons, where not enough tooth is available for mechanical retention, ferrule, RCT and post add retention. Using supra-gingival minimally-invasive dentistry to nullify the need for unnecessary root canals (9).

Making dentistry heathier and more biocompatible:

Modern medical research about overall health and wellness has opened the eyes of many and people are gradually becoming more and more interested in their own health and want to know what they can do to improve their well-being. As discussed above, improving overall health, means more than just eating the right foods and routinely exercising – it also depends on choosing healthy dental procedures, materials, and choosing a dentist that is knowledgeable about evidence based biocompatible techniques and materials that will minimize inflammation, oxidative stress and other negative side effects. Using biocompatible materials without supra-gingival techniques, will not alone be beneficial.

The Academy of Supra-gingival health Dentistry promotes Supra-gingival health & biocompatible dentistry, which means dentistry compatible with life and health. Although, every medical procedure has risks and some side effects, dentists should provide, (and patients should request) the options that are the least harmful to the body and cause the least amount of inflammation, in order to repair the damaged tooth, benefit from long-term health and prevent disease.

Ways dentists can make dentistry healthier and more biocompatible:

  1. Acknowledge that the importance of providing healthy, biocompatible dentistry, and literature evidence that many restorative procedures & materials contribute to chronic inflammation, oxidative stress, and major contributors to aging and disease.
  2. Keep restorative margins supra-gingival.
  3. Use material which are more biocompatible.
  4. If necessary do biocompatibility testing.
  5. Decrease use of RCT by performing supra-gingival-minimally invasive dentistry.
  6. Become more educated about dental materials like amalgam, fluoride & others. As well as being capable to educate patient who may have been misinformed by “non-evidence-based providers”.

 


Resources:

  1. Khansari N, Shakiba Y, Mahmoudi M. Chronic inflammation and oxidative stress as a major cause of age-related diseases and cancer. Recent Pat Inflamm Allergy Drug Discov. 2009 Jan;3(1):73-80.
  2. Cottone S, Lorito MC, Riccobene R, . Oxidative stress, inflammation and cardiovascular disease in chronic renal failure. J Nephrol. 2008 Mar-Apr;21(2):175-9.
  3. Scannapieco FA, Bush RB, Paju S. Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review. Ann Periodontol. 2003 Dec;8(1):38-53.
  4. Ali J, Pramod K, Tahir MA, Ansari SH. Autoimmune responses in periodontal diseases. Autoimmun Rev. 2011 May;10(7):426-31.
  5. Koch P, Bahmer FA. Oral lesions and symptoms related to metals used in dental restorations: a clinical, allergological, and histologic study. J Am Acad Dermatol. 1999 Sep;41(3 Pt 1):422-30.
  6. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005 Apr 21;352(16):1685-95.
  7. Ohshima H, Bartsch H. Chronic infections and inflammatory processes as cancer risk factors: possible role of nitric oxide in carcinogenesis. Mutat Res. 1994 Mar 1;305(2):253-64.
  8. Lund Håheim L, Dalen K, Eide R, Karlsson S, et al. Effect of Replacing Amalgam Fillings on the Suspicion of Adverse Health Effects from Amalgam [Internet].Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2006 Aug. Report from Norwegian Knowledge Centre for the Health Services (NOKC) No. 10-2006. NIPH Systematic Reviews: Executive Summaries.
  9. Ruiz JL. Health & Biocompatibility Using Supra-gingival Dentistry. Dentistry Today Nov 2018