From the Archives: FAQ on the Biological Dental Perspective

Originally posted in slightly different form November 9, 2011

Since 2004, Dr. Gary Verigin’s free newsletter Biosis has offered its readers comment and teaching by Dr. Verigin, health news, wellness tips and more – all within an integrative, biological dental frame. It’s name comes from the Greek word meaning “to live.” “Biosis” means “a mode of life,” which is both a process and an indivisible state of being. It is wholeness itself.

Below is a sample – part of Dr. Verigin’s article “A Biological Dentist’s Perspective on Living Systems,” which offers a good intro and overview to what a comprehensive biological approach to oral and physical health involves.

In Neural Focal Dentistry, Dr. Ernesto Adler quotes dialogue from a German TV show:

Interviewer: Is it possible to draw conclusions about the rest of the organism from the examination of the teeth?

Dental Professor: NO!

Interviewer: Is it possible that teeth in a pathological condition may cause or sustain illness and disorders in the organism?

Dental Professor: NO!

But as Adler’s text shows, those resounding nos speak loudly of the speaker’s ignorance or resistance (or both) to dental realities. In 339 pages, Adler brilliantly relates his clinical observations on the connections between dental foci, interference fields and nearly every other branch of medicine. He presents hundreds of well-documented cases, showing amazing cures of severe illnesses once interference fields of the head were removed. (What are foci? See the previous series “Understanding Dental Foci and the Disease Process”: Part 1, Part 2.)

I now want to share how we combine Adler’s paradigm with Reckeweg’s, which we explored last time. The more keenly our clients know these concepts, the more effectively we can work together to map out the most logical route of beneficial dental therapy. And perhaps the easiest way to see how this all comes together is through answers to some common questions about our work with biological clients.

What happens when someone contacts you because their health care provider recommended they see a biological dentist?

First, I think that their practitioner is someone who thinks outside the box! Many conventional physicians seem to think teeth are like fingernails — appendages that look nice, help us eat and may be chewed on when nervous. The globally thinking practitioner understands better. The teeth are living organs, and along with the surrounding structures, they can affect a person’s health.

So while most dentists know that diseased periodontal tissues are linked to conditions such as heart disease and diabetes, not all realize that the teeth can cause problems. They don’t accept that mercury amalgam fillings, root canal teeth, cavitations and implants pose any health risks. They don’t think biocompatibility testing is needed or useful. They seem to believe that whatever materials a manufacturer sells must be safe and will cause no problems so long as they’re properly crafted into properly fitted restorations.

How do toxins fit into the picture?

If you follow the daily news, you’re well aware of just how unhealthy our country is. If you’ve seen films like Food, Inc., you know how genetically modified foods and industrial farming practices are global efficiencies that trade profits for health. If you’ve read books like Selling Sickness, you know how corporate medicine is driven by markets, not health or human need. And how unhealthy is it making us? Consider these findings from the Institute for Safe Medication Practices:

According to the information gathered from data submitted to the U.S. Food and Drug Administration during the first quarter of 2008, there were 20,745 reported serious injuries associated with drug therapy, up 34% from the previous quarter, and up 38% from last year’s average. Even more eye-opening than the number of serious injuries is the number of reported deaths — 4,824 people were reported killed from pharmaceutical drugs in the first quarter of 2008, a 2.6 fold increase from the previous quarter. This figure represents the highest number of patient deaths ever reported in a single quarter as a result of drug therapy. It also accounts for more deaths than those due to homicide during the same period.

Meanwhile, our environment is increasingly contaminated. The subglacial volcano that erupted in Iceland last month [April 2010] coughed up a dust cloud that crept across the industrial powerhouses of Europe, casting a pall over an interwoven world. The microscopic particles were reported to be as hard as a knife blade. Not long after, the BP spill began gushing millions of gallons of oil into the Gulf of Mexico from its source deep below the sea. Whole ecosystems are threatened. If and when fishing ever resumes there, you can be sure the catch will be tainted for a long time after.

These kinds of polluting substances are what Reckeweg called homotoxins:

[In] our war with these homotoxins and that which is damaged by poisons, toxins, chemotherapeutics and others, the organism tries to repair itself. These reactions of self repair we call illness. These reactions are expressions of proper healing. In Phases 1-3, the humoral phase the detoxication and excretion of homotoxins occurs. In Phases 4-6, the cellular phase is where the organism has lingering diseases; the organism is damaged more or less by homotoxins and attempts to regulate these damages.

So one of the first things we do when a person asks us to look for dental obstacles is to get their complete health history. For one, it can help us identify potential sources of homotoxins, whether their origin is explicitly dental or external. But it can also cue us to the possibility of dental foci. Lingering, chronic diseases, degenerative diseases, recurrent illnesses, allergic reactions and unclear ailments such as chronic fatigue and fibromyalgia often suggest that foci may be a factor.

How do you determine whether dental conditions are a factor?

Obviously, a detailed oral exam is required. We chart the existing teeth, fillings and restorations, as well as the condition of the gums. I also look for any soft tissue conditions that could indicate trauma or potential cancer lesions.

Next, we evaluate the client’s occlusion, dental orthopedic alignment, vertical dimension and TM joint function, and palpate the muscles of the dental cranial complex, including the neck and shoulders. If multiple metals or a lot of metal restorations are present, oral battery testing is in order. This test measures the electrical current they emit, which at significant levels can contribute to a host of medical problems. We may also conduct pulp vitality testing, which measures the response of each tooth’s nerves to electrical stimulation. It’s important to note, though, that this doesn’t determine pulpal health. A tooth can be “vital” yet still have a chronically inflamed pulp that may be a focus.

A full mouth set of x-rays is also taken, but they give us just a two-dimensional understanding of the teeth. They may show potential foci, but foci can’t be diagnosed from them.

How can you diagnose foci?

Palpation (systematic touching) of the submandibular (below the jaw) lymph nodes is the first step. If any are sensitive or enlarged, we know that the lymphatic defense barrier is under siege. Antibodies are being formed to counter homotoxins in the jaws’ terrain.

Another set of points to be evaluated are those advocated by Dr. Adler in Neural Therapy Dentistry. These “Adler points” are located in front of the paravertebral (upper back) muscles on the transverse processes toward the top of the spine (C2-3). If they’re sensitive to pressure, foci are likely present. If the sensitivity is over C2, the focus is in the upper arch; if C3, the lower. Sinus points are located at the lower edge of the occipital bone (on the lower back of the skull). Tonsillar points are located on the upper edge of the trapezius muscle. People who have had their tonsils removed — or who have thyroid disorders — often experience pressure to the fourth cervical vertebra, which indicates pathological changes in the deep lymphatic glands.

If these tests are positive, we then turn to electrodermal acupuncture evaluation (EAV). This technology lets us locate foci and determine their type, intensity and distant effect. Bar none, it’s the most meaningful test for foci available. As with any diagnostic tool, of course, EAV is subject to an element of uncertainty. Thoroughness and precision in collecting the health history and conducting the various exams, then comparing results across the data, are the best means of minimizing uncertainty.

If toxins are the problem, what kinds escape a root canal tooth or cavitation jaw lesion and disrupt the biological terrain?

In Cancer: A Second Opinion, German physician Joseph Issels noted that 98% of the cancer patients he’d treated had at least two root canal teeth when he first examined them. Swedish neurologist Patrick Störtebecker reported that over 90% of his brain surgery cases reflected the presence of dental foci. Suffice it to say, potent toxins are at work here.

One of the main toxins emitted is mercaptan — the same stuff that natural gas companies add to their odorless product so that if there’s a gas leak, people can smell it. It’s so powerful that if you had two Olympic-sized pools and someone put just three drops of mercaptan in one of them, your nose would be able to tell the difference (Discover Magazine, May 2010). Root canal teeth and cavitations ooze this stuff — along with equally smelly thioethers — into a person’s system 24/7, 365 days a year, from the dead microbes they house.

So what does a person do with this knowledge, and how should they proceed with treatment?

First, it’s important to realize that even if foci are present, they may not necessarily be the root or sole source of illness. Other factors may be involved, including toxins from pesticide residues in foods, food additives and pharmaceutical drugs. Often in the case of long-standing, chronic illnesses, an interference field can prove to be but a co-factor — albeit one that plays a huge role in the development of the multi-causal illnesses charted on Reckeweg’s Table of Homotoxicosis.


Click here to view a full size PDF of this chart.

This is another reason why getting the big picture is so important.

Over the years, I’ve seen all kinds of clients come in. One totes two shopping bags full of supplements they’re taking. Another lists 84 different pharmaceutical drugs and 60 over-the-counter drugs they’ve used in the past decade. Yet both and others like them still walk around profoundly fatigued, in pain and experiencing all manner of symptoms. They think that if they just have their amalgams replaced, root canal teeth removed or cavitations cleaned out, they’ll be on the road to physical recovery.

After 45 years of practicing dentistry, I can tell you, this never happens.

The homotoxins they harbor in their biological terrain — the common sounding board for the accumulation of everything they’ve been exposed to in their lives — are numerous. This is why Reckeweg developed his paradigm. He needed to have a roadmap of which organ systems or tissues layers were involved with which symptoms or illnesses, and how those symptoms or illnesses progressed.

Those with a profound toxic load should never proceed with dental surgery without first triggering regressive vicaration — movement from right to left on Reckeweg’s chart above — via Antihomotoxic Therapy and dietary changes. Once the illness, symptoms or EAV data shift from the cellular phases to the humoral, surgery becomes an option. The idea is to enhance the client’s physiological functions before doing anything that might sap their strength or otherwise cause a setback. You prepare the body to heal.

Adler writes,

While it is impossible to see the moon during an eclipse, the beautiful moon is still there. It is not possible to see everything at once. Interference fields are sometimes imperceptible to our sense of sight and smell, but in spite of everything, they do exist as far as their effects are concerned! It is just that they are sometimes very difficult to find. Because of this, it is not easy to come up with the appropriate treatment for the illness corresponding to the hidden interference field.

But although it’s not easy, the benefits of finding and appropriately treating dental foci are immense, and if foci are suspected, the sooner the better. Individuals need to be carefully evaluated before functional illness becomes an inorganic syndrome and they are plagued with chronic, lingering diseases which may be irreversible.

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From the Archives: Just What Is Biological Dentistry Anyway?

Originally published December 10, 2012

Look at, say, a random 20 websites on “biological dentistry,” and no one could blame you for being unsure as to what the specialty is all about. The term gets used in a lot of different ways, not always accurately.

For instance, you may see it applied to a practice that doesn’t use mercury amalgam or other metals in their dental work. But that’s just mercury-free dentistry. If strict protocols are followed for handling mercury (such as those of the IAOMT), it’s also mercury-safe. And yes, if mercury toxicity is your concern, you definitely want a dentist who is both. Biological dentistry is, but this isn’t what defines it. There are plenty of non-biological mercury-free practices around. (You can read all about our own office’s amalgam removal protocols here.)

Similarly, you may see “biological dentistry” used to describe practices that rely on compatibility testing and insist on biocompatible dental materials. These things are commendable but also not definitive.

Much closer to biological practice are those that focus on “the oral-systemic link” – how oral conditions can reflect and contribute to disease and dysfunction throughout the body. Yet if it ends with root canals as a source of focal infection, say, or concern about pathogenic bacteria spreading through the body, that understanding is incomplete.

And this is often how it goes, with “biological” seemingly used as shorthand or a catch-all for many kinds of non-establishment practices, not the singular specialty it is. Unfortunately, this can wind up doing a disservice to patients. Too often we hear their stories about having their amalgams or root canal teeth removed without experiencing the healing they expected and that biological dentistry can provide.

As co-founder of the first US professional group devoted to biological dentistry, Dr. Verigin can speak authoritatively as to its nature. The seed was planted in 1985, when he and colleague Dr. Ed Arana both attended

a class featuring Reinhold Voll, MD. There, this German inventor of the diagnostic tool EAV (electroacupuncture according to Voll) spoke of a new field developing in Germany: biological dentistry. The practice was showing how illness can often be traced to oral-dental conditions, either as a cause or aggravating factor. It affirmed dentists as true medical specialists, not mere mechanics of teeth. German dentists were blending homeopathy, acupuncture and related remedies with standard clinical practice to help people support their bodies’ natural processes of self-healing.

This hit home with Drs. Arana and Verigin. Each had long been dissatisfied with the “one tooth dentistry” practiced by most American dentists—an approach that sees the teeth and oral tissues as isolated from the rest of the body. They knew it just didn’t correspond with human physiology. Alone, each had sought something better. Both wanted a more informed dentistry. They saw biological dentistry as fully accounting for the systemic nature of health and illness, and the body’s self-regulating ability. [emphasis added]

Thus, as they put it in their founding statement,

21st Century Medicine will be concerned with the depollution of the internal and external environments. It is time to correct our mistakes and become biologists of the mouth in addition to our technical expertise. Physicians and dentists must work together for the good of the whole person. The fragmentation caused by specialization must be rethought. An integrated and unified approach of mind, body and spirit in diagnosis and treatment must be instituted for all. [emphasis added]

Distilled, it comes to this: Biological dentistry focuses on the role of dental factors in the etiology of disease, situating and understanding it ONLY within the dynamic of physical, energetic and psychosomatic factors. It’s about the interrelationships.


That second part is crucial. Yet it often seems to get glossed as the effects of dental factors on the body get overemphasized. Concern becomes fixed on the physical body, not the dynamics nor the extracellular matrix – the biological terrain – that facilitates them.


Without this understanding, the isolated treatment of cavitations or root canals or whatever can have little lasting positive effect. It’s like pulling the plug from a flooding bathtub but failing to turn off the tap. You’ve not solved the basic problem. As Dr. Verigin writes,

If we are to get the maximum optimum results, it’s vital to identify all obstacles present and contributing to the disordered biological terrain. It’s not just the mercury but the whole body that holds it, in both its physical and energetic aspects. And so it’s imperative to defer any clinical dental procedures until the biochemical and bioelectric issues are fully understood. Likewise, the client needs to fully understand why their terrain is disordered and how to balance it – the whys, whats and how-tos before treatment begins.

The terrain serves the conscientious biological dentist as a guide for when and how to address any dental factors that may be compromising health elsewhere in the body. Without that guide, you can do no better than guess.

Even more

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From Microbes in the Mouth to Dysfunction in the Body: Focal Infection Theory

By Gary M. Verigin, DDS, CTN

Integrative, biological medicine insists that the relationship between oral and systemic health is so important, dentists have a responsibility for the general health of their patients. This connection has been understood for decades. So it makes you wonder: Why has it taken so long for medical science to accept it?

The first work to draw attention to the oral-systemic relationship was W.D. Miller’s Microorganisms of the Human Mouth: The Local and General Diseases Which Are Caused by Them, published in 1890. Soon after, William Hunter synthesized the concept that oral microbes and their toxins were somehow involved in a wide range of conditions not obviously caused by infection, such as arthritis and heart disease. In 1900, the Lancet published Hunter’s first article, “Oral Sepsis as a Cause of Disease.” About two decades later, the British Medical Journal published a major update of his research, “The Coming Age of Oral Sepsis.”

According to Martin Fischer, MD, author of Death and Dentistry, “1900 may be taken as the high point of the debate ” on what came to be known as focal infection theory. And one of the most important participants in that “debate” was Frank Billings, MD.

Frank Billings, MDIn 1898, Billings was named Chair of Medicine at Rush Medical College in Chicago. He was much too busy to write, but he was paid to teach. Regularly, he would lecture on his theory that pneumonia was caused by agents from the tonsils, sinus or oral cavity infecting the lungs via the bloodstream. By 1901, such clinical concepts began to show up in print.

Billings soon became Head of the Department of Medicine at the University of Chicago. (He also served as Dean of Faculty.) By 1904, he was studying how local infections cause disease at distant sites – the etiology of focal infection. His most important associates at the time were the brilliant professor of pathology Ludvig Hektoen and Hektoen’s pupil Edward Carl Rosenow. Rosenow’s animal studies in particular were key to Billings’ work.

One of Rosenow’s most important experiments focused on appendicitis, which was believed to be caused by mechanical factors, foreign body intrusions or direct infection. He isolated identical strains of streptococci from the walls of both chronic and acute appendices, then injected them intravenously into rabbits. More than two-thirds of the animals developed acute appendicitis – results which he repeated using diseased tissues from all parts of the body.

He next isolated strep from the bowl ulcer of a patient ill with “mucous colitis” and injected it into a rabbit. Within 72 hours, the animal developed a hemorrhagic, necrosing colitis. Similarly, Rosenow took microbial products he had harvested from an abscessed bicuspid in the same patient and implanted them into the pulp chamber of a dog’s tooth. Rosenow wrote, “X-ray photographs of what happened…manifested…abscesses which developed about the filled teeth of the dog in every respect like those in the original human victim.”

These findings were at the same time being independently confirmed in Ohio by the great dental researcher Weston Price, DDS. Price would eventually go on to publish one of the essential works on the subject of focal infections: the two-volume Dental Infections, Oral and Systemic and Dental Infections and the Degenerative Diseases.

By 1915, Billings and his research team had fully synthesized his Focal Infection Theory, which he first delivered through a series of lectures at Stanford University Medical School. The following year, his book Focal Infections was published.

As Billings put it, “Focal infection is most commonly situated in the head, but may be located in any organ or tissue.” In other words, though focal infections can arise anywhere, they’re most apt to do so in the mouth. A few decades later, Patrick Störtebecker, MD, PhD, would demonstrate that toxins produced by the microbes in a diseased dental pulpal complex and surrounding bone actually enter the cranial venous system, which transports them to the brain and spinal cord where they may cause any number of degenerative diseases. Later research showed that infections from other body tissues could likewise affect the brain, substantiating the work of Marineso and Dragonesco, and Oscar Batson.

According to Fischer, “Billings…changed completely the place for emphasis in clinical pathology. Those peripheral manifestations of disease were no longer to be regarded as expressions of vague systemic intoxications but the product of direct invasions by microbial life, producing in situ a local poisoning; and it had not arisen there or gotten there by simple extension but via living germs sown into the area by an infected blood stream.”

By the mid-1920s, dentists with this awareness were removing infected teeth hand over fist, right over left – with less than stellar results. And so the concept of focal infection fell into disrepute. But as Huber Newman wrote in the 1996 volume of the Journal of Dental Research, “By relegating this notion to the professional back burner, we compromise our role as oral physicians – physicians whose area of specialization is the mouth. The problem about the original discovery was the tenuous nature of the link between putative oral foci of infection and related disease. And that is the warning to us: that for the hypothesis not to fall into disrepute for a second time there must be no unsubstantiated attributions, no theories without evidence. Many original publications were anecdotal. Direct cause-and-effect evidence was lacking,”

It wasn’t long, however, before that would change…thanks to the brilliant work of the Austrian physician Alfred Pischinger and those who have followed in his footsteps.

Alfred PischingerPischinger was the first to seriously challenge Virchow’s Theory of Cellular Pathology. Building upon the groundbreaking work of Hans-Heinrich Reckeweg, the father of homotoxicology, Pischinger helped us understand the human body as a self-regulating system. The pivotal moment came in 1955, when he presented his early theories of the basic regulative system to the German Society of Focal Research. The response was monumental. Shortly after, Pischinger was offered a full professorship in histology (microscopic anatomy) and prestigious position heading a research team in Matrix Regulation at the University of Vienna. He accepted.

Pischinger and his research team went on to prove scientifically that it’s the basic regulative system that controls the fundamental functions of life – things like body temperature regulation, metabolism, pH, redox potential and resistivity of trace minerals. It maintains the functional properties of the parenchymal cells – those that organ tissue is made of – through an ordered metabolism. It is also the nutritional medium for all cells and protects their genetic structure.

The guiding factor is what’s known as the ground substance. In the words of German researcher Hartmut Heine, now considered the top scientist in this area, “Ground Substance [is what] pervades the extracellular space of the entire organism, reaches every cell and always reacts the same way. Where the extracellular space is reduced to minimal fissures in the brain mass, the Ground Substance forms the intracellular substance.”

In short, it is the stuff of the milieu, the biological terrain, and the health of the entire organism – the human body – depends upon its health. For it is also a non-specific sounding board for all the irritations and intoxications that our environment bombards us with: pathogens, chemicals and other physical influences. The sum of them can bring the whole system to exhaustion. It becomes blocked, rigid. Energy can no longer move freely along the body’s energetic meridians – the “passageways” of sorts among the body’s acupuncture points. This, in turn, adds to the blockages and exacerbates rigidity. The body is made more vulnerable to illness, dysfunction and disease.

It’s now understood that this energetic aspect is the most important in the etiology, or cause, of disease. And it points to why those early 20th century dentists described above, yanking out infected teeth in hopes of removing the source of distant infections, failed to get favorable results. They weren’t yet aware of this “missing link”

In short, if the milieu is plagued by blocked energy and rigidity, surgically removing diseased dental tissues comes to naught. And to understand why, we need only look to Pischinger’s more informed and refined definition of a focus. In his words, it is “a chronically changed tissue area in the Vegetative ground system. It comprises organic and/or inorganic material, material which can no longer be decomposed and which can only be eliminated via a necrosis or inflammation. Such a focus forms a process, which radiates a damaging remote effect, since the local defense barrier has been broken.”

That effect is not only biophysical but energetic.

structures in the biological terrain/matrix/milieuGround system and cell regulation involve all the functions cells carry out to maintain balance, or homeostasis. Of particular concern are their responses to extracellular signals such as hormones and neurotransmitters, as well as how they produce and intracellular response. The vast majority of illnesses involve faulty communications among cells via the biological terrain. One of the things homeopathics can do – and drugs can’t – is target the molecules involved with cell- and terrain-signaling with specific electromagnetic bio-resonances, or photons, which are the quanta (energy packets) of an electromagnetic field.

Focal disturbances contribute to signaling errors that ultimately show up as dysfunction in the body and lead to the onset or progression of an altered tissue state, illness or disease. Specific information such as pH, redox potential and resistivity levels collected through Biological Terrain Analysis can help dissect such errors via evaluation of the energy package of the acupuncture meridians.

Once the state of the terrain is understood, we can understand how to remove the blockages – a process called opening the channels of elimination. This must be done if the surgical removal of foci such as root canal teeth and cavitational osteonecrosis lesions is to be of any benefit.

Again, if the blockages aren’t removed, removal of the foci won’t do much good.

Regulation in life is characterized by reversibility. Consider the simple example of water: how it turns to ice and then back to water by virtue of temperature. Likewise, steam condenses to water when temperature drops. These are natural movements from state to state, driven by what’s happening in the environment.

In clinically healthy tissues, fluid states are reversible – just like with water. Dead tissue states are not. The tissues can neither take in nor give out metabolic products. Instead, diseased tissue from dental foci creates only byproducts of decomposition – substances such as mercapatan, thioethers and ornithine, which can easily block regulation. The proteopolyglycanes – high-polymer sugars found in the terrain that normally facilitate communication – can no longer allow accurate and helpful information to transit through the space in the terrain between the capillaries and the cellular structures.

Thus, each cell is left to its own devices and embarks on a series of life processes that are no longer coordinated with those of the other cells. The DNA and RNA within the nuclei are altered. The cells become sick.

According to Voll, a German physician, and his associates, dentists Kramer and Thomsen, “The characteristic features of a disturbance factor…are that it is under strain [or] of overriding importance, it keeps to the path of the meridian and puts everything under strain generally….[T]he characteristic features of a focus are that it is under strain [or] of lesser importance, puts an organ under strain between a pair of meridians and puts a strain on a particular organ.”

Thus, what we need to know is whether the source of illness is a disturbance factor or a focus. If the latter, simple removal may be enough. But if disturbance factors are at work, focal removal alone will not solve the problem. For without removal of the blockages, as well, there can be no reversibility. It’s like water turning to ice and being kept from turning back to water.

Consequently, writes Heine, “The capacity of the ground system [i.e. the terrain] for regulation is for this reason most important in the course of an illness. In all acute and chronic diseases and tumors it is possible to prove the existence of disturbances in the regulation mechanism and ultra-structural alterations in the ground substance [i.e. terrain].”

Biological medicine has its own dynamics, both cybernetic and energetic. Every cell can and does communicate with every other cell in the body – as if each has the phone, mobile and fax numbers of the others, as well as their e-mail addresses. When communications are interrupted, humoral, neuronal, hormonal and basic regulative systems are affected – well before morphological changes are seen in the parenchymal cells; well before illness and disease begin to manifest themselves as symptoms.

Recently, I devoured the new book by Martin Pall, PhD, professor of Biochemistry and Basic Medical Sciences at Washington State University. In Explaining Unexplained Illnesses, this world-renowned expert in biological regulatory mechanisms lays out his new theory about multisystem illnesses (e.g. chronic fatigue, fibromyalgia, multiple chemical sensitivities and PTSD). Pointedly, he writes, “The challenge to a scientist or thoughtful lay person trying to look at these insights is how to objectively assess their importance without ‘falling in love’ with the theory and thus destroying one’s objectivity. That is a major challenge and in the face of this challenge, I would simply say that you do the best you can….The need for good science here is far from academics. There are tens of millions of people whose lives are severely impacted by these diseases and they are depending on us, whether they know it or not, to do the right thing.”

This passage reminded me of another – one from Thomas Kuhn’s famous Structure of Scientific Revolutions: “New assumptions (paradigms/theories) require the reconstruction of prior assumptions and the reevaluation of prior facts. This is difficult and time consuming. It is strongly resisted by the established community. When a shift takes place, a scientist’s world is qualitatively transformed and quantitatively enriched by fundamental novelties of either fact or theory.”

And as Kuhn writes elsewhere, “What must the world be like in order that a man may know it?”

Originally published in Biosis 18 & 19 (September & November 2007)
For more articles like this one, visit Dr. V’s Biodental Library.

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Goodbye, Fluoridation?

We’re not exactly sure why a fluoride pump that broke three years ago has only now become news in Corpus Christi, but become news it has.

KRISTV headline

According to the city’s Water Quality Manager, “the city hopes to have a new system installed in about two years.” Until then, no added fluoride.

And if city officials read the new paper from the Cochrane Collaboration’s Oral Health Group, they just might want to keep things that way. It’s bottom line message, as trumpeted by Newsweek

Newsweek headline

Reviewing 155 studies on fluoridation, caries and fluorosis, the group found “very little contemporary evidence” for the effectiveness of fluoridation in preventing caries. As explained in the plain language summary of the review,

Data suggest that the introduction of water fluoridation resulted in a 35% reduction in decayed, missing or filled baby teeth and a 26% reduction in decayed, missing or filled permanent teeth. It also increased the percentage of children with no decay by 15%. Although these results indicate that water fluoridation is effective at reducing levels of tooth decay in children’s baby and permanent teeth, the applicability of the results to current lifestyles is unclear because the majority of the studies were conducted before fluoride toothpastes and the other preventative measures were widely used in many communities around the world.

There was insufficient information available to find out whether the introduction of a water fluoridation programme changed existing differences in tooth decay across socioeconomic groups.

There was insufficient information available to understand the effect of stopping water fluoridation programmes on tooth decay.

No studies met the review’s inclusion criteria that investigated the effectiveness of water fluoridation for preventing tooth decay in adults, rather than children. [emphasis added]

We imagine the good people of Corpus Christi have many other things they’d rather buy instead of a new fluoride pump.

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What Your Oral Health May Mean for the Rest of Your Health

A naturopathic view:

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Dr. Verigin’s Comment: The Ravages of Modern Medicine

Part 2 of a series in Biosis, our office’s quarterly newsletter

By Gary M. Verigin, DDS, CTN

The highest form of ignorance is when you reject
something you don’t know anything about.

– Wayne Dyer

We must learn to rethink medicine. We must learn never to discredit something, be it a hypothesis or just a remote hint, that some things are not always what they seem.

The Ravages of Modern Medicine

Last time, I talked a bit about cardiologist Dr. Sandeep Jauhar’s recent book Doctored: The Disillusionment of an American Physician. It’s a powerful read – perhaps most so in his telling of his own family’s experience of what passed today as modern American “health care.” That chapter begins with an epigraph from Voltaire:

The art of medicine, like that of war, is murderous and conjectural.

cover of Doctored by Sanddep JauharOne Sunday morning, Sandeep got a call from his older brother Rajiv, the eldest son in a traditional Indian family and also a cardiologist. In fact, the brothers even worked at the same hospital, Long Island Jewish Medical Center.

Rajiv told his brother that their father had been having episodes of numbness and tingling in his left arm, with similar but milder symptoms on the right. Rajiv was worried that the symptoms were transient ischemic attacks (TIAs), or mini-strokes, and said he was taking their father to the hospital for evaluation.

Sandeep was skeptical. The symptoms were bilateral, yet the nerves aren’t distributed in such a way that two-sided symptoms could manifest. When he had seen his father a few days earlier, his father hadn’t mentioned any symptoms. Sandeep had inkling, though, that his father might be having some job-related anxiety and stress, owing to his personality type.

Rajiv accused his brother of being too academic about it all. He insisted he was taking their father to the hospital “to let the experts figure out what was going on.”

The on-call neurologist likewise suspected a TIA, so she ordered a CT scan of the brain. The results were clinically normal. She then ordered an MRI of the head and brain stem, since early strokes don’t always show up on a CT scan. The results were normal. So she placed him on a blood thinner.

When Sandeep arrived, he found Rajiv and their mother at his dad’s bedside. His dad was being medicated by drip bag. Rajiv said that his blood pressure was high, so he’d already been given the drug lisinopril – a drug he’d declined to take before, despite his sons’ urging.

Sandeep knew his father had refused all the medications they’d suggested because he no longer trusted drugs to keep him well. And looking at the path that led to that conclusion, it’s really no surprise.

About 6 years earlier, Sandeep’s father began having acute headaches from time to time, probably triggered by job stress. After several months, the headaches became chronic. The father began taking over-the-counter pain killers such as aspirin, ibuprofen and Tylenol, but got no relief. His physician back home suggested prescription meds. An array of specialists ordered an array of drugs: Flexeril, Fiorinal, Imitrex, amitriptyline, Paxil and prednisone.

But here’s the kicker: None of his three internists, two neurologists, two rheumatologists, one anesthesiologist and one ophthalmologist had any opinion as to why he was having chronic headaches. At most, they suggested he was just getting old or that the pain was “all in his head.”

Totally disappointed and fed up with this situation, the father one day stopped all medications. Two weeks later, his headaches were gone.

Now, here he was, caught up in the medical system again. More tests were ordered. First came an echocardiogram to see if perhaps a blood clot had partially dislodged in his heart and came to rest in his brain. That not being the case, they next did an esophageal echo, whereby an ultrasound camera was passed down his throat to get a close-up view of his heart. The observations were deemed unremarkable. A carotid artery ultrasound transcranial Doppler, a lower extremity Doppler and a chest CT all came up normal, as well.

At this point, the father was symptom-free, with no speech or other neurological deficits. So the attending neurologist decided to discharge him. She sent him on his way with scripts for the lisinopril, aspirin, Lipitor and the blood thinner Aggrenox. He returned to his son Rajiv’s house to recuperate for a few days before he and his wife traveled back to their home in North Dakota.

By the third day, his symptoms had returned, worse than ever. He had virtually no sensation in his left arm.

So they whisked him off to the hospital again, where he was examined by yet another neurologist. He was given another CT scan of his head. Preparations were made for a repeat MRI.

It was then that a seasoned nurse who was personally attending to the father took Sandeep aside and said that she had observed that his father’s symptoms worsened whenever he would tilt his head as if to touch his chin to his sternum. Sandeep rushed in to where the neurologist was reviewing the CT scan results, feverishly looking for subtle abnormalities. He told her what the nurse had suggested. The neurologist had never directly examined his father, so she instructed the father to tilt his head down, chin to sternum.

Sure enough, the numbness returned, suggesting a pinched cervical nerve, a relatively benign condition. They prescribed a neck brace and discharged him.

The more Sandeep thought about this whole chain of events, the more disturbed he became. The $30,000 diagnostic workup and a great deal of worry could have been totally avoided had the doctors only examined his father properly.

Diagnosis at a Distance

CT scanLong ago, that nurse’s keen observation and the judicious laying on of hands were virtually the only diagnostic tools a doctor had. Yet even though physical examination alone should diagnose a pinched nerve with about 90% probability, the skills it takes are often treated as obsolete by the modern medical system. It’s as if there’s an almost irresistible urge to defer to MRIs and CT scans, nuclear imaging and other high tech diagnostics, so as to please the hospital administrators, board of directors and investors – and quell any fear of a lawsuit for “not doing enough.” Hospital administrators and department chairs often view patients as commodities, always concerned about how to increase procedural volume and raise the bottom line.

It’s diagnosis at a distance, doctor removed from patient by machines.

And what physicians like Dr. Jauhar have observed is that their colleagues’ skills seem to have atrophied.

Jauhar cites a study from Duke University Medical Center, in which resident physicians were asked to listen to three common heart murmurs programmed into a mannequin. About half of them could not identify two of the murmurs, despite testing in a quiet room with ample time, unlike in the usual hospital setting. About two thirds missed the third murmur. Retesting didn’t improve performance.

Another study he discusses involved more than 500 residents and medical students in 31 internal medicine and family practice residency programs on the east coast. The participants were tested on 12 heart sounds that had been recorded from a variety of patients. The residents were only able to correctly identify the sounds 20% of the time – only slightly better than the medical students.

Yet it wasn’t so long ago that physicians managed to evaluate heart health with little more but a stethoscope and EKG instrument.

The Healer Reduced

It seems clear that, on the whole, physicians today are very uncomfortable with uncertainty. They’re rather uneasy making educated guesses based on their observations, intuition and reasoning. They want numbers, “objective” measurements, before making a diagnosis.

In his 1999 book Time to Heal, Washington University physician and historian Kenneth Ludmerer described the deteriorating intellectual environment in teaching hospitals:

Most pernicious of all from the standpoint of education, house officers [i.e., interns and residents] to a considerable extent were reduced to work-up machines and disposition-arrangers: admitting patients and planning their discharge, one after another, with much less time than before to examine them, confer with attending physicians, teach medical students, attend conferences, read the literature, and reflect and wonder.

In short, most everything that has historically defined the physician’s work has been stripped away in the shift of the healing profession to a corporatized health care system. So it stands to reason that when a physician is faced with a patient with health issues that he or she can’t explain, it can look a little something like this:

comic from Fischer's Death and Dentistry

You Can Learn a Lot by Looking

Hall of Fame Yankee catcher Yogi Berra once said, “You can observe a lot by watching.” And you can also learn a lot by looking.

Every week, we get call after call from people wanting us to make some kind of assessment as to whether oral conditions may be making their medical issues worse. Sometimes it’s about mercury amalgam “silver” fillings or mixed metal crowns. Sometimes it’s fluoride; sometimes, root canal filled teeth or cavitations (ischemic bone disease). Sometimes it’s about implants.

Often, if we do find a medical-dental connection, the patient wants us to do something about it right away. And we want to provide relief as quickly as possible. But we also want to provide excellent care the right way.

People often think of physicians and dentists as either incredibly greedy or unselfishly devoted. As ever, the truth lies somewhere in the middle.

Sir Julian Le Grand – a public policy expert and one of the main architects of the current “choice and competition” model of health care – has characterized changing attitudes among public servants and citizens through the metaphors of knights, knaves, pawns and queens. This seems to apply to those of us in health care, as well.

Dentists and physicians are often a mix of all of these roles. Most entered their profession with an earnest desire to help people, not to follow corporate directives or maximize income. Now, when the average person hears of medical executives receiving millions of dollars in bonuses, the blatant profiteering sickens. The system seems set to promote knavery over knighthood.

Recently, the Institute of Medicine estimated that health care spending that fails to improve outcomes amounts to $750 billion every year. Most of that is due to excessive paperwork, administrative costs and unnecessary or inefficient delivery systems.

In a commentary in JAMA a while back, Drs. Allan Detsky and Donald Berwick noted how “inpatient care at teaching hospitals has become a relay race for…physicians and consultants, and the patients are the batons.” A 2009 study bears this out. Of more than 2800 inpatients, 75% could not name a single doctor assigned to their care. Among those who offered a name, 60% got it wrong.

Like medicine, dentistry, too, is going through a most tumultuous time. We must ask ourselves what we’re willing to accept – and what we’re willing to fight for. Figuring out your value system is critical.

Personally, I’ve tried to keep it simple: helping people in need, tending to them in their most vulnerable state and, empathizing with them, making myself a bit vulnerable, too. I try to clear my heart and mind and soul as to what really matters so that we can provide the best dental medicine to those who entrust us to their care.

Next time, we’ll focus on some case histories of our own patients who have experienced the ravages of medicine first hand – and the impact of the choices they made in the aftermath.

Originally published in Biosis 47
CT scan image by frankieleon, via Flickr

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The Tooth-Body Connection

One of the foundational concepts of biological dentistry is the awareness of relationships between the teeth, gums and other oral tissues and the rest of the body. On one level, this is just common sense: after all, your mouth is physically connected to the rest of you. Yet even today, many dentists continue to treat the mouth in isolation, as if what happens there has no impact on the rest of the body. Happily, though, many more are finally beginning appreciate the relationships between oral health and systemic health – for instance, the connections between heart disease and gum disease.

But there is a deeper relationship, as well, with the body’s meridian system. Generally speaking, meridians are the channels along which qi (chi) – psychophysical energy – flows through the body. Each runs through any number of body structures and organs. If there are blockages or disruptions in any given meridian, dysfunction can occur in any organ or structure located on that meridian. Thus, it’s not uncommon to find that, for instance, people with problems in their first premolar may have gastrointestinal problems, as well, since that tooth lies on the same meridian as the large intestine and stomach.

meridian tooth chartTo help our patients – and others – better visualize, explore and understand these relationships, we’ve just added an interactive meridian tooth chart to our website. With it, you can click on any tooth and see the corresponding organs, glands, joints, spinal cord segments and other relationships between the teeth and body. You can also select an organ or system and learn which teeth are associated with it.

Start exploring now!

Learn more about your body’s meridian system.

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