Over the last few decades, a quiet revolution has been taking place in oral health care. The basis for this change has been a shift in thinking for both patients and practitioners. Both patients and practitioners are looking for more “natural” or “holistic” options for oral health care.
Holistic oral health care emphasizes the health and wellness of the entire person, not just the health of the oral cavity. This type of oral health care is prevention-based, instead of placing the emphasis on treatment of disease. Holistic oral health care supports the total health of the patient, the practitioner, and the environment alike. Other names for holistic oral health care include “alternative” oral health care and “biological” oral health care.
Holistic oral health care is not foreign to dental hygiene. The Human Needs Conceptual Model of Dental Hygiene defines the oral health of the patient as it relates to the patient’s total health, dental hygiene actions, and the environment.1 Additionally, the dental hygiene profession has been advocating the oral-systemic link for many years.
Patients sometimes question the inclusiveness and validity of their dental care. Dental hygienists often act as intermediaries between patients and practitioners, and regularly field questions related to potential toxicity of amalgam restorations, radiation exposure, and fluoride necessity.
Advances in oral health care and dental hygiene continue to support the holistic approach. Let’s consider a few examples and look at new ways to incorporate wellness-centered care into practice.
With an emphasis on disease prevention and health promotion, it’s important that patients are placed on individual-specific continuing care or periodontal maintenance appointments. Intervals may range from two to four months for periodontal maintenance, and four to nine months for continuing care. It’s important that oral self-care/oral hygiene instruction also be tailored to meet individual patient oral health care needs. patients that favor holistic care may reject traditional fluoridated toothpastes, so it’s vital that their oral biofilm removal is meticulous, they consume a non-cariogenic diet, and that other caries risk factors are identified. It’s important to counsel patients that request “all-natural” oral health care products that these products are not necessarily healthier, and that they also carry the potential for oral damage. For example, it’s important to instruct patients not to “make” their own tooth paste by combining baking soda, glycerine, and essential oils, as this can be very abrasive or traumatic to the oral cavity. Careful review of alternative oral health care products/options is necessary, in order to advise patients fully.
For patients that reject all sources of fluoride, due to toxicity concerns, information can be provided about adjunctive caries management strategies (especially for higher risk patients), such as xylitol, amorphous calcium phosphate, and baking soda rinses. Microbiological testing is a non-invasive and chemical-free way assist in the caries risk-level determination.2
Dental radiographs are invaluable to oral disease detection, yet many patients are rightfully concerned about radiation exposure. Today’s digital radiography offers better options than traditional radiography for reduced radiation exposure levels (50-90% less radiation than if E-speed film were to be used with traditional radiographic techniques). From a clinician’s perspective, digital radiography eliminates the need for toxic radiograph processing chemicals; this in turn is also better for the environment because these exhausted processing chemicals ultimately need to be disposed of.3
Caries detection can also be enhanced with the use of lasers. The Kavo DIAGNOdent® can assist in early detection of carious lesions, possibly reducing the size of the subsequent restorations and perhaps minimizing the need for local anesthesia and the potential need for endodontic therapy.4
Amalgam restorations are avoided in holistic practice due to mercury toxicity concerns. Composite resin restorative materials are diverse in chemical makeup, and although the risk of toxicity and allergic reaction may be lower than for mercury, it is still be present. No single restorative material is suitable for every patient in every situation; biocompatibility testing can help guide the practitioner to a dental material that is most compatible for the individual patient’s needs. All porcelain/ceramic restorations are one of the most bio-compatible materials, and can be used for inlays, onlays, veneers, crowns, bridges, and dental implants.
Most dental practitioners are well versed about the so-called “controversial” oral health care options (e.g. fluoride, amalgam, and dental radiographs) and have already formed their own opinion on each option. However, it’s through informed consent that the patient ultimately learns and then makes their own decision about their treatment care choice(s). Our role is to provide them with evidence-based information, that is free from bias, so they can choose their own course of informed-care on their path to true, total health.
Holistic oral health care also supports the health of the clinician. Ergonomic practice, with close attention paid to the physical and psychological health of the practitioner, creates a supportive environment that will help the patient reach their ideal health potential.
Strategies for an eco-friendly oral health care practice can be challenging, especially with traditional infection control practices. But, new innovative methods are abundant and ever-changing. The health care environment itself can apply similar holistic ambitions, such as the Canadian Green Building Council’s LEED® certification standards, by which the construction and/or modification of the built environment is managed to minimize identifiable negative impacts on the environment, through energy efficiency, water usage reductions or diversions, and sustainable practices.5 Traditional approaches that tend to be disposables-oriented may need to review the purchasing habits and consumption of supplies; the eco-minded reduce, reuse and recycle concepts are necessary to change previous patterns and practices. Waste can be reduced by switching to paperless documentation, minimizing packaging, using digital radiography, and selecting steam autoclaving instead of chemical disinfection. Reusables can replace disposables when it comes to evacuation tips, three-way syringes, client rinse cups, and sterilization bags. Recycling is the last resort, in instances where it isn’t possible/suitable to reduce or reuse; paper and metal can typically be recycled, perhaps with the aid of a specialized dental recycling company.6
Dental hygiene is a key care modality for total body health and the continued progression of holistic oral health care. A great portion of the dental hygiene practice is focused on total body health and well-being. In fact, with a few more progressive steps forward, we could be at the forefront of health promotion for our patients, environment, and the dental care field.
“Your Dental Bites” Survey
- Darby ML, Walsh MM. Dental Hygiene Theory and Practice. Third edition. St. Louis, MO: Saunders Elsevier; 2010.
- Iannucci JM, Howerton, LJ. Dental Radiography Principles and Techniques. Fourth edition. St. Louis, MO: Saunders Elsevier; 2012.
- KaVo. DIAGNOdent caries detection aid. Available at: http://www.kavousa.com/US/DIAGNOdent.aspx. Accessed Aug. 17, 2011.
- Green Education Services Web site. Available at: http://www.greenedu.com/leed-certification?_kk=4f727c03-cdad-4b62-a948-b54628129776&_kt=7823823286&gclid=CJup-5H12aoCFYjsKgodyyns7w. Accessed Aug. 18, 2011.
- Eco Dentistry Association. Why reduce waste. Available at: http://www.ecodentistry.org/?whyreducewaste. Accessed Aug. 18, 2011.