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Beware of Dental Tunnel Vision

August, 2018

The "All-Aboard" Syndrome

I have been doing dentistry long enough that I now feel that I have acquired a certain amount of dental wisdom and I am obligated to speak out as to what I think is best for you, the patient.

Dentistry is essential to a person's well-being. One has to have an outstanding immune system to overcome potential problems in the mouth such as mercury fillings, root canals, cavitations and temporomandibular joint dysfunction. However, this does not mean that everything must be addressed in every patient. Everyone must be treated on an individual basis and doesn’t necessarily need everything done to the idea of perfection. The patient must be educated, and treatment must be in concert with their desire for health, aesthetics, and function.

Too often I see dentistry going through phases which I call the "All-Aboard Syndrome" dictated by insurance reimbursement, ways to increase productivity, and in all fairness, the desire of the dentist to do what they think is in the best interest for the patient. I too was not immune to this syndrome. After the army, when I entered private practice, I immersed myself for the next five years in the study of occlusion (the study of how the teeth and jaws come together) and full mouth rehabilitation. I was taught that everyone needs "an ideal occlusion" and consequently when I had my own mercury fillings removed, I had extensive gold restorations placed for the "perfect occlusion." Today, knowing better, I could have achieved the same result with conservative composite restorations, which would have required removing much less tooth structure. However, back then, many of us were getting "all aboard" with the concept of ideal occlusion which required extensive dentistry.

Another "All-Aboard" phase is that almost everyone needs full mouth deep scalings (removal of tartar and tissue below the gum line) at a fee of $1500-$2000. Many courses are offered to increase your income with this approach. I believe this has come about because there is excellent insurance reimbursement for this procedure. I can't tell you how many patients that I have seen who were advised to have this procedure and when I examined them, the microscopic slide of their plaque was excellent, and they had no periodontal pockets. All they needed was routine prophylaxis and some home care instructions!

Another "All- Aboard" phase that is growing now involves mercury fillings. Patients are becoming more aware of the dangers of mercury in the mouth, and when patients ask their dentist about removing them they are told, "Sure, I can do that!" Here, I see two problems: the dentist is completely ignorant on the subject and removes the mercury fillings without any precautions to protect the patient or the dentist has some "training" in the safe removal and believes that as long as oxygen is administered, and a rubber dam is used, all will be well. The problem is not knowing what one does not know. To safely remove mercury fillings, much more is involved. (see Amalgam Removal and Caution Regarding Mercury Removal).

"All-Aboard" for holistic dentistry. I find this very distressing. As a pioneer in this field, I feel that too many holistic dentists are trapped into tunnel vision. They think that by removing all metals in the mouth, extracting every root canal, and performing cavitational surgery in all four wisdom teeth areas or other areas of cavitations that almost every health problem can be solved. Root canals, cavitations, mercury fillings, and metals in the mouth are potential problems, but not all patients need all this treatment.

An example of "holistic-tunnel vision" came with a call to my office from a woman in pain from a root-canalled tooth that was failing after two surgeries. Even while on antibiotics the pain was persistent. She was told by a holistic dentist that he couldn't remove the root-canalled tooth until he removed all her mercury fillings. This is absurd – the woman was in pain and the tooth needed to be removed.

A relatively new "All- Aboard" phase is implants. Dentists are climbing on board at a rapid pace to learn how to place implants. The implant business is booming! Every missing tooth doesn't need to be replaced with an implant. For instance, very rarely does a person miss their second molars (the ones in front of the wisdom teeth), yet I see implants placed here all the time. Placing a titanium implant, which most common, is not necessarily best for the patient; ceramic implants are much more biocompatible. Most dentists are also clueless to the fact that they are placing the implant into an acupuncture meridian and this may cause health problems, or that the electrical currents generated with titanium may also be a problem. (see Dental Implants Are They Safe?) This does not mean that I am not against placing ceramic implants in the right patient under the right circumstances.

The most recent "All-Aboard" phase is Sleep Dentistry. Investigating sleep breathing problems is very important; many children and adults have this undiagnosed disorder. A decrease in oxygen while sleeping is associated with numerous health problems such as ADD/ADHD, diabetes, hypertension, chronic fatigue, cancer and much more. (see Sleep Breathing Disorders in Adults - Do You Suffer From a Lack of Oxygen and also Sleep Disordered Breathing -Uncovering Health Issues in Your Child. I have been studying this problem and attending courses almost every other month for the past year and a half. To assist in screening my patients for sleep breathing problems, I invested a significant amount of money to purchase a head CAT scan unit. As you can tell, I feel that this is a crucial area of concern. However, I am worried when I see advertisements for courses that tout "How to increase your practice $2,000,000 – insurance will cover this." When I hear this "All-Aboard" call, I get nervous. Almost all the hype is about making sleep appliances. Sleep appliances will work; however, you are then wed to an appliance forever. Rarely is anything taught about correcting the problem. There are permanent solutions in most cases.

Joining the "All-Aboard" crowd is Invisalign and courses for placing braces for only six months. These are great for straightening teeth and improving a smile. However, I worry about this because many of the patients that I have seen being treated in this manner haven't been made aware that they have a sleep-breathing problem or temporomandibular joint dysfunction. These patients would be better served by other types of treatment.

Please understand that I am not condemning dentists. For the most part, dentists go into dentistry to help people. However, the paradigm of dentistry being taught in dental schools and enforced by state dental boards and the American Dental Association is not compatible with a Whole-Body Dentistry paradigm. You only see what you know, and the powers that be have blindfolded most dentists.

With everything that I have discussed, I feel that it is essential that you, the consumer, be aware of the dangers of dental overkill. As I stated, dental health is core to good health; however, dental procedures can have a profound negative impact on the body when done excessively or improperly. Conversely, when dentistry is done in a whole-body manner, the positive effects on one’s health can be dramatic. 

No matter what aspect of dentistry that you are discussing, your entire being must be taken into account. I feel that a whole-body and conservative approach is the best course of treatment.

© 2018, Mark A. Breiner, DDS 

The information presented is for educational purposes only. Please consult a qualified dentist or health practitioner for diagnosis and treatment.