Holistic Dentistry: Finding a Balance

  • by Carrie Pallardy
  • Feb 14, 2022
Holistic medicine has a long history dating back to Hippocrates, the Greek physician often referred to as the father of modern medicine, who, in 400 BCE, radically proposed that the causes of disease were natural rather than supernatural.1 At its core, holistic medicine is dedicated to treating patients as a whole. Western medicine, also referred to as traditional medicine, typically draws on medical technology to treat symptoms.2 

During the centuries between Hippocrates and the modern world, holistic medicine and Western medicine have often clashed as two separate ideologies. Critics of holistic practice often focus on a lack of scientific basis for treatment, while those who espouse the holistic approach point to traditional medicine’s tendency to treat symptoms in isolation without considering the whole body and the root causes of symptoms. 

Today, holistic medicine is a sprawling practice that encompasses treatments like acupuncture, chiropractic, nutritional counseling, supplementation, naturopathy and more. Some aspects of holistic medicine are backed by scientific evidence and some by anecdotal evidence, while some practices labeled holistic are born from pseudoscience. 

Yet, the fact remains that there is patient demand for holistic medicine, which can go by the name “alternative” or “integrative” medicine. Alternative medicine is already a fairly mainstream practice, with about 55% of people using at least one type of alternative medicine, according to a study conducted by personal finance site ValuePenguin.3 The same study found that 66% of people want their insurance to cover alternative medicine. Holistic approaches can be found in many medical fields, including dentistry. Despite the popularity of this approach, confusion still abounds. What does holistic dentistry look like today? How does it differ from conventional dentistry? Can dental providers strike a balance between the two approaches? 

Defining Holistic Dentistry 

Holistic dentistry is not a recognized specialty, which means its definition is up for interpretation by practitioners. At its most basic level, holistic dentistry is about looking at a patient’s overall health as it relates to their mouth and whole body. 

“To me, ‘holistic’ means looking at the whole person. We use the safest, most conservative measures with modern technology, techniques and evidence-based research to treat the oral cavity. Similar to functional medicine, we work with our patients and their healthcare team to try to find the root cause of disease rather than just treating symptoms,” said Bernice E. Teplitsky, DDS, FAGD, a holistic dentist practicing in Chicago and co-president of the Holistic Dental Association (HDA). 

Some dentists actively market their holistic approach, attracting patients who are interested in more natural methods and building a referral network with other holistic medical providers. Some holistic dentists are cash-pay only. 

Others adopt a hybrid approach, submitting claims to patients’ insurance companies for care that will be covered and accepting out-of-pocket payments for treatments not covered by insurance. 

Other dentists who use holistic methods go by entirely different names. For example, some practitioners might consider themselves biological dentists or natural dentists.4 Others may market an integrative approach. While the terms may differ, “holistic,” “biological,” “natural” and “integrative” dentists can all be under the same holistic umbrella. 

The term “holistic” might make it appear that holistic dentistry and traditional general dentistry have little in common, but that is not typically the case. Holistic dentists still provide standard care, like cleanings and restorations, but they tend to focus on minimally invasive treatment and may also avoid some of the materials accepted and regularly used in traditional dentistry. 

With holistic dentistry not being a recognized specialty, the exact approach each practice takes can vary significantly. “There are various ‘holistic/biological’ dentistry organizations that put on annual meetings,” said Teplitsky. “Each of them leaves you wanting to take a deeper dive into courses such as biomimetics, ozone, homeopathy, airway/obstructive sleep apnea and many others. Because there is so much to learn within dentistry, everyone’s knowledge and practices vary.” 

Learning About Holistic Dentistry 

Accredited dental schools do not offer specialized holistic education. Holistic dentists practicing today have undergone the same training as traditional general dentists. After completing dental school and residencies, some dentists discover the holistic approach. 

Pursuing holistic dentistry was personal for Carlo Litano, DMD, a holistic dentist practicing in Pinellas Park, Florida. After he completed dental school, he looked at his mother’s radiographs and found her case to be so complex that he didn’t feel comfortable treating her. He sought mentorship and found that holistic dentistry was the right fit for him. 

For Teplitsky, it was a matter of curiosity. During her residency, she was performing a periodontal surgery, and she was struck by how invasive the procedure was. She started digging to find alternative treatment options in dentistry. Through her research, she learned about professional organizations like the HDA and the International Academy of Oral Medicine and Toxicology (IAOMT). The International Academy of Biological Dentistry and Medicine and the American Academy for Oral Systemic Health also offer ways to learn about holistic dentistry. All these organizations sponsor meetings for dentists interested in learning about holistic medicine. Teplitsky also takes time to shadow other dental offices that use holistic techniques. 

Nilima Patel, DDS, MAGD, and Madhukar K. Patel, DDS, MAGD, a married couple based in Temple City, California, integrate a holistic approach into their practice. They were first intrigued by holistic dentistry when a patient brought it to their attention. Since then, they have taken online courses and connected with medical professionals in other specialties to develop their approach. 

“Furthering your education is a tremendous commitment. It will require you to invest in the latest technology, such as advanced lasers, 3D technology, 5D scanners and so on. Learning is invigorating. Helping patients live healthier lives is the goal,” said Kelly Halverson, DDS, FAGD, a biological dentist located in Richardson, Texas. 

Approach to Patient Care 

While holistic dentists come from the same training background as traditional general dentists, their postgraduate learning and experience leads to a different way of treating patients. “The three big things that we’re going to look at in holistic dentistry are structure, nutrition and toxicity,” said Litano. 

The examination process at a holistic dental practice is likely longer and more thorough than the typical patient exam at a general dentist’s office. “Dentists are the doctors not only for the teeth but also for the surrounding structures in the head and neck area,” said Nilima Patel. After talking with patients and going through their health history (a process they call the patient interview), she and her husband conduct an examination of patients’ teeth, lips, and tongues, as well as eyes, jaws, faces and necks. The Patels also speak to their patients about nutrition and how what they eat could be affecting their mouths and their overall health. 

Holistic dentists cannot diagnose medical conditions beyond their scope of practice, but they can refer their patients and work with other medical professionals. Collaboration is one facet of holistic dentistry. “You work with a lot of medical doctors and allied healthcare providers to try to help the patient take responsibility for their overall health,” said Daniel K. Marinic, DDS, FAGD, a holistic dentist practicing in Sedona, Arizona. 

For example, Halverson incorporates airway evaluation into her practice. In addition to a patient’s symptoms, she examines the patient’s anatomy to determine whether any issues are impacting their ability to breath. “At our practice, we have the capability to send a patient home with a sleep study, and we work with local physicians and other healthcare providers to address any issues,” she said. “Ideally, we hope to catch growth patterns and breathing issues in our youngest patients so they are not affected as adults. Sometimes our patients just need some coaching to correct poor sleep habits.” 

If patients come to Marinic’s practice requesting that their mercury fillings be removed, he asks if they have visited a physician for heavy metal testing before making any treatment decisions. Heavy metal testing can determine if patients have high levels of mercury in their body, indicating heavy metal toxicity. 

Holistic dentistry is meant to be more comprehensive. Its practitioners try to dig deeper to understand why patients are coming to their chairs. “Why are we seeing this patient every six months for this problem?” said Madhukar Patel. 

This more comprehensive method is often missing in general dentistry, according to Marinic. “[General dentists] get so busy doing procedure after procedure and jumping from room to room that sometimes they don’t have a lot of time to try to really understand why the patient’s there in the first place,” he said. 

Holistic dentists spend a lot of time talking to their patients before performing any dental work. But they still need to use radiographs for diagnosis and perform procedures to address dental issues. When they do need to perform procedures, many opt for minimally invasive options. For example, Marinic and Teplitsky learned to use the Ögram SystemTM for tooth extraction, which is designed to minimize trauma to the surrounding bone and tissue.5 

Holistic dentists may also use platelet-rich fibrin (PRF) in surgical procedures to support the healing process. “Taking time to educate patients on the benefits of minimally invasive procedures over a lifetime helps them to understand treatment options and make an informed decision,” said Marinic. “The best treatment that a dentist can provide patients is educating them to take responsibility for their oral health and coaching them to make decisions that benefit them in the long term.” 

Root Canals and Amalgam 

Root canals and amalgam are two of the most contentious aspects of dentistry when it comes to a holistic versus traditional approach. Endodontics is a recognized dental specialty, and more than 15 million root canals are performed every year.6 Holistic dental providers typically try to avoid root canal treatments due to concerns about infection and toxicity of materials.7 The American Association of Endodontists considers the procedure safe and effective, which is widely thought to be the case in the dental industry.8 

Holistic dentists may disagree on the safety of root canals, but that does not mean all dentists who take a holistic approach will automatically remove root canal teeth or tell patients there is always an alternative. “Everything we do is research-based,” said Teplitsky. She discusses all treatment options with her patients and recommends the best one based on various factors. 

Marinic will examine root canal teeth to determine whether there are any problems. “We use 3D cone beam volumetric tomography or cone beam scans to look at the root canals and see if there are issues with the root canal,” he said. His practice does not perform any root canals. If a patient needs one, they are referred out to an endodontist who uses the GentleWave® Procedure to clean the root canal system. 

Holistic dentistry takes issue with dental amalgam, which contains mercury and other metals. A 2019 article in The Journal of the American Dental Association states that dental amalgam is safe and effective, but holistic dentistry opts for different kinds of materials.9 “There’s no need to have metal in your mouth when there are better alternatives, like zirconium and some really advanced ceramics,” said Litano. While dental amalgam is widely considered safe, certain groups of people may be susceptible to negative effects related to mercury exposure in dental amalgams.10 Holistic dentists opt to focus on biocompatibility when selecting which materials to use. “Holistic dentistry is traditional dentistry that uses biocompatible materials,” said Marinic. 

Materials like ceramic are among the restorative materials preferred in holistic dentistry, but some practitioners go a step further and perform blood serum testing to determine which material works best for the patient’s immune system.11 “We can do biocompatibility testing to see which material is best suited for specific patients, especially for those who are sensitive to all sorts of food, materials and chemicals,” said Teplitsky. 

Dental amalgam is still widely used in the United States, but the European Union (EU) is working on phasing it out. The EU has rules surrounding how amalgams may be used and how they may be removed.12 As of July 2018, the EU banned the use of dental amalgam in deciduous teeth and in the teeth of children under 15, pregnant women and breastfeeding women.13 

The Food and Drug Administration does not recommend the removal of dental amalgam unless deemed to be medically necessary. Mercury vapor released during the removal process does temporarily increase exposure.10 The IAOMT has developed the Safe Mercury Amalgam Removal Technique (SMART) to protect patients, providers and dental staff from exposure to mercury vapor. The protocol involves using amalgam separators, dental dams and other protective equipment.14 

Understanding the Controversy 

If a provider spends more time with a patient and tries to find the root cause of their dental problems to improve overall health and wellness, what’s the problem? 

Disagreement over the safety of root canals and amalgam can be a major point of contention between the holistic and traditional dentistry communities. Holistic dentists are unlikely to use dental amalgam in their own practice, but the way these practitioners address treatment of patients with existing amalgam fillings varies. “You’ll find dentists who say they practice holistic dentistry, and the first thing they do is take out all the mercury fillings and pull all the teeth with root canals,” said Marinic. “That’s what can give dentists who practice holistic dentistry a bad name.” 

Holistic dentistry does go beyond the scope of traditional dentistry. These providers might recommend lifestyle changes and discuss health and wellness outside of just the mouth. While this can add up to more comprehensive patient care, a certain line cannot be crossed. “There’s a very clear line in the sand that a dentist is a dentist and a physician is a physician,” said Marinic. “Where some holistic dentists get in trouble is when they start trying to cross over that line.” 

Holistic dentists may be able to recognize or suspect major health issues. For example, persistent bleeding and swollen gums may be related to diabetes, according to Madhukar Patel. But, it is not within a dentist’s purview to diagnose or treat a condition like that. They can only make the patient aware of the symptoms and refer them to a medical doctor. 

The nebulous meaning of the word “holistic” can present a number of challenges for dentists who have embraced this approach. While holistic dentistry does have potential pitfalls, so do other specialties and approaches in the healthcare field. 

Holistic Dentistry and Traditional Dentistry 

Holistic dentistry and traditional dentistry are two distinct approaches in the dental field, but the lines between the two do not necessarily have to be so stark. Dental providers can draw on evidence-based practice from both approaches. Holistic dentistry can be complementary to traditional dentistry. “There is a balance between holistic dentistry and conventional dentistry. I use all the solid principles from mentors like Dr. Pete Dawson, Dr. Frank Spears, Dr. Bill Robbins and so many others,” said Halverson. “In addition to this, I have implemented biological principles from mentors like Dr. Judson Wall and Dr. Phil Mollica. My job is to educate patients so they can choose the appropriate treatment that is right for them.” 

Carrie Pallardy is a freelance writer and editor based in Chicago. To comment on this article, email impact@agd.org.

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11. “A Practical Guide to Compatibility Testing for Dental Materials.” IAOMT, 26 Aug. 2021, iaomt.org/practical-guide-compatibility-testing-dental-materials. Accessed 2 Dec. 2021. 
12. “Dental Amalgam in the EU: Heading Towards a Phase Out?” Health Care Without Harm, noharm-europe.org/sites/default/files/documents-files/5269/HCWH_Europe_Mercury_Factsheet_Dec-2017_FINAL_WEB.pdf. Accessed 2 Dec. 2021. 
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