A look at holistic dentistry in Western North Carolina

DOCTOR INSIDE: Dentist Mark Knollman puts patients in charge of their own dental needs. Photo by Cindy Kurst
DOCTOR INSIDE: Dentist Mark Knollman puts patients in charge of their own dental needs. Photo by Cindy Kurst

“Would you like a cup of nettle?” asks Janna Gower,  office manager and the wife of Dr. Phil Davis, a local dentist. She hands me a chilled infusion of nettle root meant to naturally energize without producing the edgy nervous energy and acidity of coffee. A yellow smiley face at the mailbox marks the driveway for Healthy Smiles, Davis’ general dentistry practice, less than a mile from the Western North Carolina Farmers Market on Brevard Road.

Inside the renovated farmhouse, surrounded by organic gardens and a variety of large oak, elm and maple trees that shade the house, the atmosphere is cozy and welcoming. The private patient rooms are spacious, with large windows that can be opened to let in fresh breezes during nice weather and the sound of birds in the trees. The kitchen, where staff members share lunch each day, is clean and bright. She pulls out a quart jar of dark tea from the refrigerator and pours me a cup. This is what one facet of local holistic dentistry is like upon first look.

Holistic dentists (also called biological or integrative dentists) offer all the services you would expect from any dentist. They have attended dental school, graduated with a doctor of dental medicine or a doctor of dental surgery degree and are licensed by the state Dental Board. However, at some point in these dentists’ experiences, they recognized systemic problems as distinct from “business as usual” practices of traditional dentistry — whether that be through doctor-patient interaction, type of treatment or the avoidance of certain invasive procedures.

Holistic dentistry holds that oral health is directly connected to overall health. There is a spectrum of different care strategies, ranging from a patientcentric ideal of care (from The Pankey Institute) to wearing a hazardous materials suit for silver-mercury amalgam filling removal. While traditional dentistry points to avoiding sugary snacks as well as brushing and flossing regularly, holistic dentists emphasize the importance of whole-foods nutrition and cavity prevention, while at the same time limiting the use of toxic chemicals and invasive dental procedures such as extractions and root canals. They embrace new technology in an effort to provide care for their patients that goes beyond the conventional wisdom of dentistry of the past 150 years. Because there is no single care philosophy for holistic dentistry, it is important to ask your dentist during your initial consultation about his or her particular postdoctoral specialties.

A consultation and a quote

Dr. Mark Knollman, also a local dentist, begins every new patient relationship with an private consultation and always points out a framed quote by Albert Schweitzer:  “Patients carry their own doctor inside. They come to us not knowing that truth. We are at our best when we give the physician who resides within each patient a chance to go to work.“

Knollman says this is his opportunity to put patients in charge, listening without interruption as they describe their dental needs “as they feel it” and medically making sense of their complaints. Sometimes the conversation spills over from toothaches into life circumstances, Knollman notes, and the choices, good or bad, that bring someone to the dentist office. “You would be astounded by the personal stories people have sat in that chair and shared with me,” he says.

In 1995, Knollman was the first dentist in Asheville to have a digital X-ray machine, which exposes patients to 80 percent less direct radiation than traditional dental radiography. That’s good for the patient, he says, but even better for staff members, who have daily exposure not only to the radiation but also the chemical development process. Digital X-rays have higher resolution, which leads to better diagnosis and treatment for patients, he explains.

Knollman says he’s “Hg [mercury] free,” which refers to dentists who don’t use silver-mercury amalgam fillings. In fact, he hasn’t used an amalgam filling in over 25 years, he notes. When given the choice, he says, his patients prefer tooth-colored resin fillings anyway. Knollman describes himself as a Pankey Institute dentist, providing patient-centered care, adding that the institute encourages continuing education for “bridging the gap between what is known and what is practiced.”

To this end, he has invested in a variety of state-of-the-art systems to serve his clients, such as the Cerec machine, which uses a 3-D image of a particular tooth to create restorative dental pieces from ceramic on-site, as well as a single-tooth anesthesia system that does not require numbing the entire jaw. “We’re always trying to tailor the treatment for the specific needs of our patients,” he says.

Mercury in the middle

Perhaps the most unifying banner of holistic dentistry is the rejection of silver-mercury amalgam fillings as a healthy restorative dental substance. The American Dental Association has stated publicly and repeatedly that elemental liquid mercury acts as a binding agent for the powdered alloy of mixed metals in the amalgam (including silver, tin and copper) and is contained within the matrix of the alloy. A typical silver-mercury amalgam filling is 50 percent liquid mercury by weight. The U.S. Food and Drug Administration has ruled that mercury is safe for use in dental amalgam fillings for adults and children over the age of 6. In spite of these assurances, however, there has been growing concern among some dental professionals that the mercury is not as “trapped” as these agencies say.

Dr. Matthew Young is a mercury-safe dentist in Hendersonville. That means he not only refrains from dental products containing mercury, but is also a trained and accredited member of the International Academy of Oral Medicine and Toxicology. This group of dentists specializes in safe engineering protocols for removal, remediation and disposal of mercury amalgam fillings.

Young cites the Occupational Safety and Health Administration’s regulation about toxic exposure in the workplace. Then he points out a monitor attached to a machine behind a glass door, explaining that the air in every room in the office is constantly monitored for any mercury exposure. That’s not only to protect patients, but also staff members from daily exposure — a real concern, since mercury is bioaccumulative (it continues to build up in the system and cannot be “flushed out” by the organs).

Young takes an aggressive stance against using mercury in fillings, noting that if there were any other industry where mercury was in regular use, a host of test results and air-quality reports would have to be sent daily to OSHA. His work in creating a mercury-safe dental office has been so successful that it was included in a full-length documentary,  Evidence of Harm, released in 2015, about the medical consequences of mercury exposure on three patients.

Mercury vaporizes at room temperature, Young explains, and with the additional friction from a drill, can produce up to 300 times the acceptable dosage of 10 micrograms per centimeter in the air from one patient’s filling. To protect himself and his staff from exposure, Young employs a range of air-quality technology systems and tests them to make sure they are working.

The most effective equipment he uses for air cleaning, he says, is an IQAir vent, operating at maximum efficiency, that runs contaminated air through a carbon filter during procedures so nothing but clean air is released. Submerging fillings in water and removing amalgams in large segments also help minimize the generation of mercury particulates and vapor, he adds. All attending staff members wear face guards, respirators and hazmat suits to limit their exposure, he continues, while the patient is draped from head to foot, and a latex-free dental dam is used to isolate the tooth being worked on. Finally, he says, there is a mercury amalgam separator for the entire office, which filters all wastewater before it returns to the public water system.

A study by the Environmental Protection Agency in 2003 estimated dental clinics discharge about 4.4 tons of mercury each year nationwide and are responsible for half of the mercury discharge into publicly owned wastewater systems. Buncombe County’s annual portion of that is about the size of a 3-inch Rubik’s cube. According to the Metropolitan Sewerage District of Buncombe County, dental mercury makes up “a significant portion” of the total mercury processed by the treatment facility annually.

While Young sees mercury-free dentistry becoming more widely incorporated into acceptable practice, as more patients become aware and new dentists enter the field, he says: “Out of 190,000 dentists in the U.S., there are only 800 of us in the IAOMT. Many of us in the group discovered they were mercury toxic and joined in order to learn how to be mercury-safe. Remember that there is a distinction between being mercury-free, not placing amalgams, versus being mercury-safe, as we are, with the precautions we take.

“We have approached many dental schools and educators about this and other subjects. However, due to increased liability and costs, they have not been amenable to change. Dentistry had a long history of being a noble profession, and the thought of exposing our patients and staff to toxins is a hard nut to crack. The concept that the mercury is trapped in the matrix of the amalgam is still perpetuated by the educators,” he says.

Healthy smile = healthy life

Back at Davis’ office, the brief tour has concluded. Sipping the cool, unsweetened, earthy-tasting nettle tea, we talk about his practice’s  care philosophy of helping the whole body be healthy from the inside out. Specifically, the husband-and-wife team tries to minimize the toxic burdens for patients as much as possible by using only biocompatible materials and advising patients on how to achieve “minimally invasive dentistry.” To provide holistic care, Davis advocates learning from and working with other physicians from a variety of  medical specialties, such as neurology, endocrinology, naturopathy,  herbalism and acupuncture.

Education is the key to a healthy and trusting relationship with patients, he notes, so the waiting room is full of books about different disciplines that address oral health outside of dentistry. Davis encourages patients to contact other physicians for individualized testing to determine personal sensitivities. Like other holistic dental professionals, he operates a mercury-free and fluoride-free office. He has been published as a critic of fluoridated public water systems and advocates fluoride as a topical dental treatment for remineralizing the outside of the teeth only.

Gower feels “there is too much emphasis on products and individual solutions produced by industry — looking for a magic wand for health — as opposed to real, natural foods and clean water.” All of the water in the office and dental chairs is reverse-osmosis filtered, she notes.

“Dentistry is not just from the outside, just brushing and flossing; you need to keep the teeth healthy through good nutrition,” says Davis, emphasizing preventive care that starts in infancy and lasts your whole life. “Nutrient-dense foods can minimize the need for dentistry and promote healing after treatment,” he adds.

Several factors contribute to making his practice especially health-promoting, he points out, including accepting and respecting people, being open to new ideas and methods, encouraging patients to actively participate in their personal health and understanding that the mouth is the “front door” to the whole body as a system: Take care of it, and it will take care of you.

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