Holistic Oral Health Care: What are we offering our clients?

by Joanne Peazel McCavery, RDH, BSc


Over the last few decades, oral health care has been in the process of undergoing a quiet revolution. The foundation for this change has been a shift in thinking for both clients and practitioners. Our clients are presenting with ever-increasing concerns to be treated in a more “natural” or “holistic” modality, and many practitioners desire to function that way.

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 client, 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 practice. The Human Needs Conceptual Model of Dental Hygiene defines the oral health of the client as it relates to the client’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.

Clients may question the inclusiveness and validity of the dental hygiene care they receive. Dental hygienists 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 maybe look at some new ways to incorporate wellness-centered care into practice.

With an emphasis on disease prevention and health promotion, individuals must be placed on client-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. Oral self-care / oral hygiene instruction must also be tailored to meet client’s oral health needs. Clients that favour 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 be identified. It’s important to counsel clients that desire “all-natural” oral health care products that these products are not necessarily healthier, and that there is the potential for oral damage. For instance, clients must be instructed to not “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 is necessary in order to advise clients accordingly.

For clients that reject all sources of fluoride due to toxicity concerns, information can be provided to moderate and high risk clients about adjunctive caries management strategies, 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 and many clients verbalize concerns about exposure to radiation exposure. Most concerns about radiation can be alleviated with the use of digital radiography, which utilizes 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^® is one example of a technological device that can assist in earlier detection of carious lesions, thus reducing the size of the subsequent restoration and perhaps minimizing the need the local anesthesia and the potential incidence of 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 client in every situation; biocompatibility testing can help guide the practitioner towards a dental material for the healthiest restoration possible. All porcelain/ceramic restorations may be the most biocompatible material in some instances, and can be used for inlays, onlays, veneers, crowns, and bridges.

It’s significant to note that although the oral health care provider has already formed an opinion about “controversial” oral health care practices, such as fluoride, amalgam, and dental radiographs, it is via informed consent and the client’s autonomy that they ultimately make the decision about their treatment.  Our role is to provide them with evidence-based information that is free from bias, so they can choose their own course of action 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 is well-suited to facilitate the client achieving their maximum health potential.

Strategies for an eco-friendly oral health care practice may be challenging, especially with traditional infection control practices, but innovative methods are abundant and ever-changing. The health care environment itself can apply similar holistic ambitions like the Canada 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 strongly oriented towards total health and is making great strides with it’s progression towards holistic oral health care. Much of our practice is inherently total health oriented; a few minor or major changes, sometimes even in our mindset, can help us transition into the forefront towards the health promotion of the client, our self, and our environment.

References:

1.      Darby ML, Walsh MM. Dental Hygiene Theory and Practice. Third edition. St. Louis, MO: Saunders Elsevier; 2010.

2.      Ibid.

3.      Iannucci JM, Howerton, LJ. Dental Radiography Principles and Techniques. Fourth edition.  St. Louis, MO: Saunders Elsevier; 2012.

4.      KaVo. DIAGNOdent caries detection aid. Available at: http://www.kavousa.com/US/DIAGNOdent.aspx. Accessed Aug. 17, 2011.

5.      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.

6.      eco Dentistry Association.  Why reduce waste. Available at: http://www.ecodentistry.org/?whyreducewaste. Accessed Aug. 18, 2011.