The Thorndyke & Barnhart dictionary definition of holistic is, “concerned with all factors, physical, mental, emotional and spiritual that affect health, rather than treating isolated diseases and symptoms.” There are many dental problems that dentists are responsible for detecting and treating. Many are located solely within the mouth, and many are associated with other bodily conditions/illnesses. The health of the mouth can both affect and be affected by the health of the body - everything is connected.
In traditional, insurance-driven dental practices, the extent of a dental examination can range from a quick check-up with minimal x-rays, to a complete set of x-rays and gum pocket measurements. Following the examination, a list of recommended treatment procedures is presented to the patient. The main thrust is on finding the results of dental conditions, such as decay and gum disease, and then providing repair, teeth replacements and cleanings, with relatively little emphasis on the cause of the decay and gum disease. In most traditional dental practices, the initial new patient examination is done fairly quickly for several reasons:
• The examination process is mainly performed to find out what's wrong and to recommend treatment procedures, but often does not address the causes of the dental problems, which takes more time.
• Many people have fears and phobias about dentistry. After having made their initial appointment, some cancel to avoid this "day of reckoning." Consequently, dentists will double book short appointments in case of a “no-show.”
• Traditional dentistry is driven by the dental insurance industry which offers limited benefits for examination procedures and learning experiences. Thus, initial patient appointments may be abbreviated because they do not constitute a profit center. For economic reasons, dental assistants and hygienists may be assigned most of the examination procedures, with only a brief amount of time with the dentist. This diminishes the importance of the first visit in the mind of the patient, which makes it easier for them to cancel or “no-show.”
One of my early mentors said, "The health of the relationship between the dentist and patient is more important than the health of their mouth, because without the former, you'll never have the latter." Over time, I have discovered this to be quite true. In a holistic, wellness approach to dentistry, the primary focus of the new patient encounter is the development of a healthy and trusting relationship between the doctor/team and the patient. During this process, many assessments are performed to discover the cause of any unhealthy oral conditions from which a complete, written Review of Findings is developed for the following appointment, so more time is allotted. The oral examination takes place to not only discover the presence and cause of decay and gum disease, but many other evaluations are performed to assess the state of the entire oral system that include some, or all of the following procedures:
• Review and discussion of the patient’s complete medical and dental history.
• Oral cancer inspection: visual; palpation (manipulation of oral, facial and neck areas); Oral ID (fluorescence technology that detects both pre-cancer and cancer).
• Assessment of TMJ (temporomandibular jaw joint) function. Many people have a mismatch between their teeth and jaw joints that can result in teeth wear and symptoms, such as migraines, head and neck pain and vertigo.
• Measurement of teeth lengths to discover abnormal tooth wear patterns.
• Assessments for sleep apnea.
• Testing for dental materials allergies – especially important for people with a compromised immune system.
• pH testing (relative acidity/alkalinity of the body). Tooth decay, gum disease, cancer and other conditions thrive in an acidic bodily environment.
• Full periodontal (gum) pocket measurements and bleeding assessment.
• Bacterial plaque assessment using phase contrast microscope.
• Oral biofilm (plaque) bacterial samples taken from the tongue, throat and teeth. These are sent to a laboratory, which conducts a microbial analysis to identify any harmful bacteria that are causing gum disease and breath odor.
• If indicated, testing for blood glucose (A1C) C Reactive Protein (hsCRP) – especially important for patients with pre-diabetes or diabetes.
Recognizing the complex differences between each person and their unique dental needs, we want to allow enough quality time upfront to first get to know the new patient as well as provide all appropriate assessments. Through this holistic approach, the learning process is mutual: the doctor and team members are able to get to know the patient, and the patient gets to know the doctor and team in a manner that allows the best chance of gaining sustained health, not just a “quick fix.” This sets the stage for the development of individualized preventive and treatment planning to address the specifics of these differences. Mutually agreed and understood preventive and treatment regimens are then performed in a safe, trusting, and nurturing environment.
The word holistic connotes four aspects that affect health: physical, mental, emotional, and spiritual. The thrust of current dental and medical education has to do with treating the body, with much less regard for the person occupying it. Obviously, dental treatment is physical, but to solely address this health aspect without recognizing the other three may be testimony to the fact that 75% of the population has some fear of the dental experience. In a holistic, wellness-centered dental practice, adequate time is allotted towards an educational, relationship building process in which mutual trust can be developed, and negative emotions and mental stress having to do with past dental experiences are positively dealt with.
It is human nature to want to do your best for someone you care about. I've found through the years that the patients in my practice with the most optimum and enduring oral health are those with whom a mutual affinity was developed early on. A synergy of sorts ensued, starting with a co-learning process resulting in the development of shared responsibilities that are mutually enacted. This, I believe, encompasses the spiritual element of a true holistic dental practice.