On September 24, 2020, the Food and Drug Administration (FDA) issued a Patient Safety Communication recommending against the use of dental amalgam in pregnant and nursing women, women planning to become pregnant, children especially those under six years of age, people with preexisting neurological disease, with impaired kidney function, and with known heightened sensitivity or allergy to mercury or other components of dental amalgam. This validates a concern I learned many years ago, that dental is a major determinant of health, aging and disease from unknown causes.
I am an integrative Internal Medicine physician who finds many patients with unexplained chronic illnesses can be helped by screening for dental problems and making needed referrals to biological dentists. Physicians should learn to consider dental as an integral part of health and disease, add dental information into patient records, and screen for the dental determinants of health.
Teeth and dental problems are rarely included in a medical doctor’s diagnostic assessment. This is a tragic consequence of the split between the medical and dental professions. For those who have seen many doctors for their condition with an unsuccessful diagnosis, the mouth may be a missing link to chronic illness. Veterinarians know how important dental is to their patients; doubling the life span of horses with regular deworming and proper dental care and nutritional support.
Why is the oral cavity important? Teeth are integrally connected to the body: through blood supply, lymph, jawbone, gum tissue, and electrical pathways. An infection, a metal or material toxicity reaction, an electrical imbalance, and/or a mechanical problem will manifest in other organs, glands, joints and the like. In addition, teeth and jaws are integrally connected to the system of cranial nerves, and nerve conduction pathways that run throughout the body.
In my years of practice, first as the medical director of a Midwest HMO, now as an integrative physician, and with 25 years in the US Army Reserve Medical Corps, I have learned systemic impacts of oral health are some of the greatest overlooked factors in chronic diseases like heart disease, arthritis, breast, lymph and reproductive cancers. Perhaps uncommon among medical doctors, my new patient evaluation may include a panoramic dental x-ray. Based on this information, patient history, physical examination, other tests, and the status of their health, I often refer patients to a biological dentist or oral surgeon for needed dental work.
What is a biological dentist? I first met Doug Cook, DDS, of Suring, WI decades ago, when I attended a seminar and challenged everything he said. I came around to his way of thinking about the inherent links between dental problems and health impacts. I attended many conferences of the International Academy of Oral Medicine and Toxicology (IAOMT) and International Association of Biological Dentistry and Medicine (IABDM) to learn. IAOMT developed a protocol called the Safe Mercury Amalgam Removal Technique (SMART), which minimizes exposure to mercury vapor during the removal process. It is vital to work with a biological dentist for removing of amalgam fillings when medically indicated.
Recent advances in medical testing are now also available in dentistry. PCR testing, developed in 1983 for fingerprinting and genomic analysis, is increasingly used in detecting bacteria, viruses and other pathogens in a wide range of diseases, including Lyme and COVID-19. PCR tests can be ordered for extracted root canal teeth, tissue and jawbone specimens from DNA ConneXions. To test patient biocompatibility with medical implants, MELISA® is a CLIA-certified blood test which measures hypersensitivity to multiple metals from a single sample. There are similar tests for biocompatibility with dental materials, available from BioComp Labs.
Why is this important? Mercury toxicity is fairly common among the people with chronic diseases and unexplained illnesses that make up the majority of my patients. Many patients do not methylate well, and have bioaccumulated a toxic load over their lifetimes. Root canals are also fairly common, as those without strong immune systems are more susceptible to dental decay and its sequelae. The history of dental restorations means that patients have a wide variety of materials in their mouths: dental amalgam, gold, composite, porcelain, ceramic, and glass ionomer fillings and crowns, bridges and abutments, dentures, titanium or zirconia implants, etc. Some are well tolerated, while others elicit allergic, toxicity, and/or immune system reactions.
Dental and oral infections can play a significant role in Lyme-like autoimmune reactions, as I have found repeatedly in my patients. For an explanation with graphic illustrations, see the slide presentation, “The Little Things that Matter: Oral Bacteriophages,” by Bonnie Feldman, DDS, MBA. Root canal infections have been implicated in autoimmune and neurological diseases; a 2018 study in Dentistry found patients with systemic health problems were up to three times as likely to have infected root canals as those in the healthy group: 17.2% vs. 5.9%, respectively. Oral infections are implicated in brain pathology and may be a causative agent in Alzheimer’s; see studies from 2015, 2016, 2017, and 2019. Oral infections and periodontitis in heart disease are reviewed in this 2015 paper.
Is it any wonder that we cannot help many of our chronically ill patients when we overlook so many of these factors? Dental may be the biggest rotting elephant that is not even in the room when you do your clinical evaluation. It is time to pay attention to the dental determinants of MAD health.
What can we, as clinicians, do to help? Ask our patients to open mouth wide and take a look, ask them questions about dental work and any symptoms, and record basic data from a visual inspection. I went so far as to buy a used panoramic x-ray machine for my office, which shows fillings, root canals, implants, and visual evidence of dental and jaw infections! Learn about biological dentistry, the SMART protocol, and dentists in your area who use these techniques, to whom you might refer patients when medically indicated. We need to tear down and build integrated medical and dental (MAD) referral teams to better serve our patients, and improve individual and community health.