This course was published in the April 2023 issue and expires April 2026. The authors have no commercial conflicts of interest to disclose. This 2 credit hour self-study activity is electronically mediated.
AGD Subject Code: 130
After reading this course, the participant should be able to:
- Define holistic dentistry.
- Discuss the full meaning of oral health.
- Identify the differences between holistic and traditional approaches to treating common oral diseases.
Holistic dentistry is an alternative method to traditional dentistry. Often referred to as alternative dentistry, biological dentistry, or biocompatible dentistry, holistic dentistry involves investigating the root cause of a symptom and/or disease.1,2
Holistic vs Traditional Dentistry
Holistic and traditional dentistry both address the health of the oral cavity.3 Holistic dentistry’s core ideologies include eliminating toxins from the body through removal of old dental materials, considering nutrition as key to prevention and reversal of degenerative dental diseases, preventing and treating dental malocclusion, and preventing and treating periodontal diseases at their biological basis.4
There is no separate educational program for holistic dentists; both holistic and traditional dental providers must earn either a Doctor of Dental Surgery or Doctor of Dental Medicine degree. While the American Dental Association (ADA) has classified several areas of dentistry as official specialties, such as pediatrics and periodontics, holistic dentistry is not one of them.
Holistic dentists may receive certifications that meet scientific criteria for safety and effectiveness in a specific educational program or organization, including those offered by the American Naturopathic Medical Certification, International Academy of Biological Dentistry and Medicine, and International Academy of Oral Medicine and Toxicology.2,5 The Holistic Dental Association also offers avenues for patients to find providers who offer a natural approach to dental treatment.6
Holistic practitioners incorporate traditional methods with whole body health to determine the root cause of oral health problems rather than focus solely on symptoms,2 whereas traditional dentistry focuses on the prevention, diagnosis, and treatment of oral diseases.
Holistic dental practices never use amalgam dental materials or fluoride in any form. Instead, they focus on dental materials that are biocompatible with the patient as well as fluoride alternatives to reduce caries risk.
To provide safe and effective treatments, holistic clinicians offer specific diagnostic testing and perform toxicology tests, mainly to determine the level of mercury in the body.3 According to a study by Shani et al,7 mercury can enter the bloodstream through saliva and is toxic to many of the body’s organs. This same study identified bisphenol-A as an additive used in dental composites that induces toxicity and should be avoided. These tests are performed by blood serum, hair analysis, and biocompatibility tests. A study by Vazquez-Tibau and Grube8 suggests biocompatibility testing is necessary to determine which dental materials are least reactive to the individual patient and which dental materials to avoid.
In order for the clinician to consider the whole health of the patient, he or she completes an intake patient interview, which consists of a comprehensive health history and an in-depth assessment of the patient’s nutrition.2,9 Holistic practitioners cannot diagnose medical conditions, so they collaborate with functional or integrative physicians to improve the patient’s whole health.2
Conflict often exists between holistic and traditional dental providers. Traditional clinicians claim holistic dentistry lacks a scientific basis for treatment. Conversely, holistic dentistry points out how traditional methods tend to treat isolated symptoms without considering the whole body and the root causes of the symptoms.2
Definition of Oral Health
The United States Centers for Disease Control and Prevention (CDC) defines oral health as “the health of the teeth, gums, and the entire oral-facial system that allows us to smile, speak, and chew.”10 Dental caries and periodontal diseases are some of the most common oral diseases. According to the CDC, more than 80% of people experience dental caries by age 34.10 Dental caries is the damage or breakdown of tooth structure caused by acidogenic bacteria in plaque. Even though dental caries is a highly preventable disease, more than 90% of adults have experienced tooth decay.10,11 Additionally, one quarter of adults ages 20 to 64 have untreated caries.11
Periodontal diseases are infections of the gingiva and bone surrounding tooth structures resulting in red, inflamed, and bleeding gums and destruction of the alveolar bone.10 Approximately 47% of adults age 30 years and older have some form of periodontal disease and 70.1% of adults 65 years and older have periodontal diseases.12
Treating Dental Caries
Holistic and traditional practitioners differ in their methods to prevent and treat oral diseases. To treat dental caries, holistic clinicians would remove all caries from the tooth and then use a biocompatible dental material to restore it. Prior to treating the patient, a biocompatibility test would be performed to make sure the patient was not sensitive to any materials.
Holistic clinicians use a test to identify the different types and the quantity of cariogenic bacteria in the mouth as well as test the pH level of the oral cavity. A low oral pH (5.5 and below) is a significant risk factor contributing to acidogenic bacterial growth, causing dental caries.13
For the prevention and treatment of dental caries, holistic practitioners often recommend products to help manage tooth decay in a more natural way. These include xylitol, plant-based essential oils, pH-neutralizing minerals, and probiotics.
Xylitol binds with calcium ions, aiding in the remineralization of tooth enamel. A sugar alcohol, xylitol creates a polyol when fermented, which helps reduce plaque and gingival inflammation.13 Xylitol is added to a variety of oral health products such as chewing gum, lozenges, toothpastes, and mouthrinses.14 A study by Wu et al15 showed that chewing xylitol gum helped to reduce the risk of dental caries and periodontitis.
Organic mouthrinses containing ingredients to neutralize acid and balance pH, strengthen enamel, reduce bacteria, and support tooth health can also be used to prevent and manage caries.2,16 Oral sprays that help soothe and moisturize the mouth by acting as a pH neutralizer may be recommended by natural providers.
Probiotic supplements may have the potential to prevent oral infections, such as dental caries, gingivitis, and periodontal diseases.17 Probiotics neutralize the pH of the mouth, inhibit the growth of certain cariogenic bacteria, and can colonize on a tooth surface. This capacity is what makes probiotics beneficial;17 although, further studies are needed on the risk of developing caries when childhood probiotic supplements are introduced.18
In comparison, fluoride is a key component in the prevention, treatment, and remineralization of early carious lesions in traditional dentistry. Fluoride can be introduced as a systemic form through community water fluoridation or as an oral tablet supplement. It is also used topically in toothpastes, mouthrinses, varnishes, and gels.10
Many studies show that 5% sodium fluoride varnish and 1.23% acidulated phosphate fluoride gel prevent root caries. Additional research demonstrates that 38% silver diamine fluoride (SDF) prevents and arrests root caries.19 Additionally, the use of fluoride to prevent, control, and manage caries is part of the ADA guidelines in the nonsurgical treatment of dental caries.20
Holistic dentistry is opposed to all forms of fluoride due to the possibility of the compound building up over time, potentially causing health problems.21,22 Holistic dental providers suggest finding an alternative way to prevent caries. For instance, Zhang et al23 notes that the direct application of SDF to dental pulp causes pulp necrosis and stains carious lesions black.
Managing Periodontal Diseases
Holistic and traditional practitioners treat periodontal diseases similarly. A diagnosis is made through the evaluation of periodontal pocketing of 5 mm or greater, treating these areas with nonsurgical periodontal therapy (NSPT), and encouraging a 3-month periodontal maintenance recare schedule.24
NSPT consists of using ultrasonic instrumentation and hand scaling to eliminate calculus and bacterial biofilm in the pocketing around the teeth, creating a smooth root surface ideal for healing.25 Post-procedure instructions for NSPT treatment involves the patient maintaining a strict oral hygiene regimen at home that often includes the use of an antimicrobial mouthrinse. In this situation, a holistic clinician would recommend an organic mouthrinse twice daily for as long as the patient wanted to use it. In comparison, a traditional practitioner would recommend a chlorhexidine mouthrinse twice daily for the next 7 days to 10 days.
Chlorhexidine mouthrinse is not meant for long-term usage due to its side effects, such as staining of the teeth, altered taste, and increased calculus formation.25 Holistic dentistry does not use chlorhexidine because it is a chemical compound and therefore considered a toxin by such practitioners.33
Green tea and lemongrass oil mouthrinses are also used in holistic dentistry to control periodontal diseases. A study that compared the efficacy of daily rinsing with a green tea-mouthrinse to a chlorhexidine mouthrinse found the green tea rinse had antibacterial, antioxidant, anti-inflammatory, and antiviral properties that were effective against dental caries and periodontal diseases without any long-term side effects.26
A study by Akula et al27 that compared the effectiveness of lemongrass oil mouthrinse and chlorhexidine mouthrinse in children found the lemongrass oil mouthrinse was also effective in reducing plaque and gingivitis and served as a good herbal alternative to chlorhexidine mouthrinse. This study also discussed the side effects of chlorhexidine in long-term usage, including impact on vital tissues and mitochondrial activity, cytotoxic effects on periodontal ligaments, and inhibition of protein synthesis.
Both holistic and traditional practitioners will ask patients to return 6 weeks to 8 weeks after NSPT is performed to evaluate pocket depths and healing, and to determine whether additional scaling and root planing or referral to a specialist is needed. Both will request a 3-month recare schedule for periodontal patients in order to ensure a decrease in disease progression.24
Holistic and traditional clinicians are both concerned with managing their patients’ oral disease, although their in-office treatments are similar, the at-home care products they recommend contain significantly different active ingredients.
Holistic and traditional dentistry both have a standard of care for treating patients, although they differ in their methods. Holistic dentistry focuses on treating patients by evaluating the whole body as a unit (mind, body, and spirit) and looking for the root cause of infection or dental problems, whereas traditional dentistry focuses on preventing diseases of the oral cavity and treating the specific symptoms of the disease.2
Today, safe and effective natural remedies are used in holistic dentistry for the prevention and management of caries. The consideration of using biocompatible materials while treating patients is a guiding tenent of holistic dentistry.
Holistic treatment methods are becoming more prevalent and oral health professionals may want to consider adding these to their armamentarium of recommendations.4 While traditional methods are effective, offering patients more options to support oral health may improve compliance.
Natural methods may help some patients feel more at ease and may encourage certain populations to receive oral healthcare vs no care at all. As patient education is key, oral health professionals should understand the rationale for alternative treatments and self-care methods to better meet the needs of their patients.
- Dalai DR, Bhaskar DJ, Agali C, Punia H Holistics: a new approach in dentistry. International Journal. 2014;1(2):32.
- Pallardy C. Holistic dentistry: finding a balance. Available at: agd.org/constituent/news/2022/02/14/holistic-dentistry-finding-a-balance. Accessed March 16, 2023.
- Britannica. Dentistry. Available at: britannica.com/science/dentistry. Accessed March 16, 2023.
- WebMD. Oral Health Resource Center. Available at: webmd.com/oral-health/default.html. Accessed March 16, 2023.
- Natural Awakenings. A Level Above Holistic Dentistry: Biological Dental Care. Available at: healthylivingmichigan.com/2021/01/31/344481/a-level-above-holistic-dentistry-biological-dental-care. Accessed March 16, 2023.
- Holistic Dental Association. Available at: https://holisticdental.org/. Accessed Accessed March 16, 2023.
- Shahi S, Özcan M, Maleki Dizaj S, et al. A review on potential toxicity of dental material and screening their biocompatibility. Toxicol Mech Methods. 2019;29:368–377.
- Vazquez-Tibau A, Grube BD. Biocompatibility in dentistry: a mini review. Modern Research in Dentistry. 2021;6(4):640–643.
- Thakur N, Bagewadi A, Keluskar V. Holistic dentistry: Natural approaches to oral health. J Int Oral Health. 2011;3:9–13.
- United States Centers for Disease Control and Prevention. Oral Health. Available at: cdc.gov/oralhealth/index.html. Accessed March 16, 2023.
- United States Centers for Disease Control and Prevention. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism. Available at: cdc.gov/oralhealth/publications/OHSR-2019-index.html. Accessed March 16, 2023.
- United States Centers for Disease Control and Prevention. Periodontal disease. Available at: cdc.gov/oralhealth/conditions/periodontal-disease.html. Accessed March 16, 2023.
- Gasmi Benahmed A, Gasmi A, Arshad M, et al. Health benefits of xylitol. Appl Microbiol Biotechnol. 2020;104:7225–7237.
- AL Humaid J, Bamashmous M. Meta-analysis on the effectiveness of xylitol in caries prevention. J Int Soc Prev Community Dent. 2022;12:133–138.
- Wu YF, Salamanca E, Chen IW, et al. Xylitol-containing chewing gum reduces cariogenic and periodontopathic bacteria in dental plaque-microbiome investigation. Front Nutr. 2022;9:882636.
- Papadopoulou C, Karamani I, Gkourtsogianni S, et al. A systematic review on the effectiveness of organic unprocessed products in controlling gingivitis in patients undergoing orthodontic treatment with fixed appliances. Clin Exp Dent Res. 2021;7:664–671.
- Fontana M. Enhancing fluoride: Clinical human studies of alternatives or boosters for caries management. Caries Res. 2016;50(Suppl 1):22–37.
- Sivamaruthi BS, Kesika P, Chaiyasut C. A review of the role of probiotic supplementation in dental caries. Probiotics Antimicrob Proteins. 2020;12:1300–1309.
- Chan AKY, Tamrakar M, Jiang CM, Tsang YC, Leung KCM, Chu CH. Clinical evidence for professionally applied fluoride therapy to prevent and arrest dental caries in older adults: A systematic review. J Dent. 2022;125:104273.
- Slayton RL, Urquhart O, Araujo MWB, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc. 2018;149:837–849.
- Dhar V, Bhatnagar M. Physiology and toxicity of fluoride. Indian J Dent Res. 2009;20:350–355.
- Zhao S, Guo J, Xue H, et al. Systematic impacts of fluoride exposure on the metabolomics of rats. Ecotoxicol Environ Saf. 2022;242:113888.
- Zheng FM, Yan IG, Duangthip D, et al. Silver diamine fluoride therapy for dental care. Jpn Dent Sci Rev. 2022;58:249–257.
- Bank House Dentistry News. Non-Surgical Periodontal Therapy. Available at: bankhousedentistry.co.uk. Accessed March 16, 2023.
- Md Tahir K, Ab Malek AH, Vaithilingam RD, et al. Impact of non-surgical periodontal therapy on serum Resistin and periodontal pathogen in periodontitis patients with obesity. BMC Oral Health. 2020;20:52.
- Mathur A, Gopalakrishnan D, Mehta V, Rizwan SA, Shetiya SH, Bagwe S. Efficacy of green tea-based mouthwashes on dental plaque and gingival inflammation: A systematic review and meta-analysis. Indian J Dent Res. 2018;29:225–232.
- Akula S, Nagarathna J, Srinath K. Anti-plaque and anti-gingivitis efficacy of 0.25% lemongrass oil and 0.2% chlorhexidine mouthwash in children. Front Dent. 2021;18:32.
From Dimensions of Dental Hygiene. April 2023; 21(4):32-35