Tooth decay is a disease. It is caused by specific bacteria that live in our mouths, called Streptcoccus mutans. Strep mutans lives in microscopic colonies on the surface of the teeth, and is able to produce such concentrated acid as its waste product that it can dissolve the tooth enamel. In other words, these germs burn holes in teeth, and all they need is their favorite fuel – sugar!
Tooth + Bacteria + Sugar = Tooth Decay
Unfortunately, Strep mutans is a very common resident in people’s mouths, so most people have been susceptible to tooth decay. Those lucky people who never get cavities don’t have those germs in their mouths.
Why is my little kid getting cavities?
Even if you carefully control your child’s diet and snacks, some kids turn out to have Strep mutans in their mouths and get cavities. Where does it come from? It’s not genetic, but it does tend to run in families. Babies get their oral germs from the family around them. By age 2 or 3 their mouth bacteria closely resembles their mother’s and other family members. The best way to break this “chain of transmission” is for young adults to have their teeth in the healthiest condition before becoming parents. That way they have much less tooth decay bacteria to pass on to the next generation.
Tooth + Bacteria + Sugar = Tooth Decay
To keep the teeth intact, we can kill the germs, and we can reduce their food supply by reducing how much sugar we eat, and how often we eat it. The same applies to all the simple “fermentable” carbohydrates.
Brushing and flossing is important, but they’re not always enough to get at the microscopic colonies the germs live in. Most dentists recommend topical fluoride, in toothpaste, in mouthwash, and applied in the office, as a preventive measure. It can be useful as a prescription medicine, but it’s not the only thing that works. There are non-fluoride methods of controlling the Strep mutans germs, including topically applied iodine, baking soda/peroxide tooth paste to keep the mouth alkaline, and various ozone preparations. Ask your IAOMT dentist and hygienist.
Doesn’t fluoride in the water protect us?
Community water fluoridation is promoted by many health authorities as a way to reduce tooth decay in the general population. The IAOMT, along with many other health-conscious organizations, opposes this practice. The science on water fluoridation has proven that it is ineffective, expensive, and poses clear health hazards.
It all starts with tooth decay, damage caused to a tooth by bacterial action. A cavity is the hole left in the tooth after the dentist cleans out the decay. The dentist recommends the type of “restoration” based on how much healthy tooth is left, and how strong it is.
A filling is a “direct restoration.” It is a paste put directly in the cavity and hardened in place.
An inlay, onlay and crown are “indirect restorations.” Most of the time, they are made outside the dentist’s office, and require a second visit to be cemented into place. Many dentists today have computerized “cad-cam” machines in the office, which allow indirect restorations to be made in one appointment.
Crowns are used to fix a tooth when the tooth is too weak to hold a filling. It can be because there is a visible crack in the tooth, or if corners of the tooth have already broken away.
Sometimes a tooth is sensitive to bite on, with no obvious reason. That usually means there is a hidden crack, and a crown is used to strengthen the tooth and hold it together.
Teeth that have had root canal treatment are known to be weaker, and are usually finished with a crown for strength.
The need for a crown, and what type of crown, is a decision for your dentist to determine. As always, the dentist must discuss the treatment plan, and it must make sense to you.
The classic standard crown material in times past was cast gold. Gold crowns are very durable, proven for centuries. However, they look like gold, and not everyone likes that.
The standard tooth colored crown for many years has been the “porcelain-fused-to-metal” crown. Most of the time the metal part would be gold, but many other metals were used.
It is important to avoid “non-precious metals” for crowns. They tend to be toxic and allergenic.
In more recent years, dental technology has perfected ceramic and composite-ceramic materials for crowns. They are completely non-metallic, they are tooth colored and look very natural, and they tend to be very biocompatible. There are many brand names, but some of the categories are: zirconia, lithium disilicate, zirconia blended composite.
If you are chemically sensitive, an important consideration is to use materials that are tested safe for you. Another consideration: the dentist should use materials they are familiar with.
Root canal treatments are used to preserve teeth that would otherwise need to be extracted.
A tooth that is too painful, or is actually infected, can often be treated so that the pain and infection goes away. The inflamed or infected nerve tissue deep inside the tooth is cleaned out, and the whole root is filled.
Millions of root canal treatments are done every year, and most of them end up making the teeth comfortable. However, it may take several months for a treated tooth to fully settle down.
This is a difficult question. On the one hand, a root treated tooth is dead. There are many reasons to think that they hide bacteria in microscopic spaces – low grade infections that stay as long as the tooth is there. Some dentists feel that all root treated teeth are a health hazard. They say there is no reason to keep dead parts in your body, and they should be extracted.
On the other hand, extracting the tooth is the only alternative to having a root canal treatment. Keeping your own teeth is a great value. It can be a lot easier and less expensive to keep a tooth that is comfortable and functional – chewing and smiling – than to extract it and replace it. Millions of teeth get root canal treatments every year, because people choose to try keeping the teeth rather than losing them.
We don’t have a good test to find out if a root treated tooth is hurting your health. If you are concerned about whether your health is good enough for you to tolerate root canal treatments, you must have the discussion with your dentist and your medical doctor.
Sometimes filling replacement is done for routine maintenance. They get old and corroded, or they break, and should be replaced to keep doing their job.
The harder question is should they be replaced by choice, to eliminate mercury exposure? It is a personal decision that only you can make for yourself. If you have studied the issue, and you decide that you do not want mercury fillings in your mouth, it’s your right to ask your dentist to replace them. Some dentists will be reluctant to do this for you, while others will understand and accept your request.
Some people with health problems are told by their doctors that they have mercury toxicity, and are given a prescription to replace mercury fillings.
If you choose to have old mercury fillings replaced, don’t forget the basic precautions.
- Find a dentist familiar with mercury-safe procedures.
- Make sure the dentist will protect you from breathing and swallowing the debris that comes off when drilling out the old fillings.
- If you are chemically sensitive, the dentist can test the new fillings to make sure they’re safe for you.
- If you are pregnant, or think you might be, or nursing: we don’t recommend anything but urgent dentistry during pregnancy. There is some risk of raising your exposure to mercury by drilling out old fillings, even with all the recommended precautions. It’s safer to wait until after pregnancy and nursing to disturb the old fillings. It’s even better to remove them well before having babies, if you can.
In order to replace old fillings, a dentist has to drill them out, clean the cavity in the tooth, and put a new filling in. That means it’s just like regular dentistry, with all the same possible complications.
Most of the time, things go easily. Teeth are usually sensitive to cold and pressure for a few days, or even a few weeks after being worked on, and quickly settle down.
Occasionally, a tooth with a new filling will take a long time to settle down, or will not settle down completely. If this happens, go back and have the dentist check the bite, because the most common cause is a high spot on the new filling.
It doesn’t happen often, but there are times when things do go wrong, and we can’t always predict when it will happen. A tooth that is comfortable with its old filling can become painful after being worked on. Or a tooth is weaker than we realize, and can break when the old filling is replaced. Then the dentistry needed to care for the tooth becomes more complicated and expensive.
On rare occasions, nothing goes right after a tooth is worked on, and it eventually must be extracted.
Your dentist must discuss all the possible complications of any treatment plan with you.
“Serum compatibility testing” has proven to be very useful for figuring out which specific filling materials are best suited for each individual person. The more sensitive a person is, or the more unwell, the more important the testing is.
The tooth colored composite fillings and other non-metallic materials we use today have caused many fewer problems for dental patients than the older metallic materials of the past. People who are not particularly chemically sensitive may not need to be very concerned with compatibility testing for basic dentistry.
Discuss whether compatibility testing for dental materials is necessary for you with your dentist. It is a good question.
- A practical guide to compatibility testing for dental materials.
- Biocompatibility (online training course)
Dental composites are the white, tooth colored fillings that most dentists use today. Composites are made of microscopic glass particles suspended in a plastic resin.
People are rightly concerned about the possibility that plastics give off toxic materials, especially “endocrine disrupting” chemicals like BPA (bisphenol-A). Most composites have BPA as part of their plastic component. None of them have free BPA that leaches out easily, like those old polycarbonate water bottles. None of them have phthalates (PFOA, PFOS, C8) in the formula (the other big category people are worried about).
We have reviewed this issue extensively. IAOMT started research projects to investigate, and we were unable to detect either BPA leaching, or any estrogen-like activity from a selection of composites, when tested at body temperature, and the same pH as saliva. We will be doing more research in the future.
There were some papers in the 1990’s that implicated “dental sealants” in exposing kids to BPA. Those materials are obsolete, and not used anymore.
There is a practical issue we must keep in mind. With the technology available to us at this time in history, dental composites are the only convenient and durable material we have to make fillings that are acceptably biocompatible, even for most chemically sensitive patients.
There are alternatives. To avoid plastics completely one would have to make inlays of gold or ceramic, and cement them with inorganic cements. These are much less convenient, and a lot more expensive, but definitely within the capabilities of most dentists.
Which is the right dental material for you? It’s a matter for testing and discussion with your dentist.
Periodontal disease, or gum disease, is another bacterial process that damages the attachment between the teeth and gums, between the teeth and the jawbone. Eventually teeth get loose and may even fall out. It is very hard to know if it is developing in your mouth, because it usually does not cause pain. Gums that bleed when you brush is a sure sign, but if you know some of your teeth are loose, it is already quite advanced.
It takes professional attention from the dentist and hygienist to determine if you have gum disease and how bad it is. Many people with earlier stages of gum disease just need to have their teeth cleaned on a more regular schedule, and learn to clean their teeth better at home.
For more advanced stages of gum disease, the IAOMT recommends treatment with non-surgical, anti-infective methods. Your dentist will have to determine what is the best treatment plan for you, but it usually involves multiple visits and careful follow up. It also involves learning good home care habits.
If my gums are infected, what about the rest of me?
There is a lot of evidence that the germs that affect the gums affect the rest of the body as well. DNA from periodontal germs can be found in hardened arteries and other seemingly unrelated diseased tissue. Healing diseased gums can go a long way to reducing the effects of infection on the rest of the body, while addressing problem bacteria in the rest of the body, such as “intestinal dysbiosis,” can improve the way your gums heal.
What about nutrition?
Everything we do about gum disease requires good health and good nutrition to support the healing necessary to get over gum diseases. People who continue to struggle with gum disease despite good treatment and home care often have hidden nutritional deficiencies. Consultation with a nutritional doctor or therapist is very helpful.
Tobacco is the biggest health stress for people who have gum disease. To save your teeth, quit smoking!
Biocompatible Periodontal Therapy (technical article)
Biological Periodontics (online training course)
Nutrition in Dentistry (online training course)
The oral cavity is a sea of microorganisms normally living in balance with the entire human body. Under certain conditions pathogenic or “disease causing” micro-organisms can become dominant, creating what we call infection.
These germs live together in a protective environment called a biofilm. This biofilm shelters a mixed infection made up of bacteria, viruses, fungi and even parasites. The difficulty is that each of these “disease causing” types would need a different type of drug to eliminate it, and drugs have trouble getting through the biofilm.
What if we had an agent that could easily penetrate biofilms and kill all the different types of pathogens? And, in addition, promote healing in the surrounding tissue without toxic side effects? We do now with oxygen/ozone therapy for dentistry. Normal oxygen is O2, while ozone is O3, oxygen in a supercharged form. It is harmless to us, when used with care, but instantly deadly to all kinds of bacteria. Many biological dentist have taken up this method, treating all kinds of dental infections with better effectiveness than ever. This includes gum infections, root canal infections, and even deeply seated bone infections.
The jawbones are unique among the bones of the body because of the way they are connected to the germy environment of the mouth, through the teeth. They are more subject to infection and injury than any other bone.
So when there is an injury, such as a tooth extraction, the jawbones tend to have trouble healing all they way. A dead spot, or a hollow may sometimes form in the jawbone when there is incomplete healing, even though the overlying gum tissue looks fine. Most of the time they are painless and don’t seem to cause any trouble. Other times such an area of poorly healed bone may harbor low grade infection that can impact your overall health. It can cause jaw pain and facial pain, even trigeminal neuralgia.
The official term for this process is “jawbone osteonecrosis.” Not all dentists believe that this problem exists. It is difficult to diagnose – it doesn’t usually show clearly on x-rays. There aren’t many dentists who are prepared to treat cavitations either. Treatment requires removing dead bone and associated infection, and restoring good blood circulation and healthy bone in the area. Methods range from oxygen/ozone injection to surgery. This is a subject that definitely requires discussion with your dentist.
IAOMT Position Paper on Jawbone Osteonecrosis (technical article)
Hidden Pathogens in Root and Jawbone (online training course)