The topic of complementary health care may be new or unfamiliar to some. Therefore, the basic concepts of the philosophy and thought behind this kind of care will be introduced first. Knowledge of the basis of this philosophy helps one understand that holistic methods treat individuals and not populations (this is the basis behind the double blind study).
For example, two people with similar complaints, e.g., pain, can be treated very differently if we are looking at the manifestation of the condition in each one. Both people can be suffering from the same ailment while their symptoms may be very different. Why, then, are they all treated for their condition, as a general rule, with the same medication? Holistic methods try to personalize the treatment to the condition within the given individual.
Symptoms are the language the body uses to communicate with us as to what is wrong internally. On account of this, different symptoms would reflect a different disease state. Numerous complementary methods can be applied in the dental context, of which only a few will be discussed. Courses in these fields are generally taught by individuals whose professional work is geared to a particular treatment modality that is not dentistry.
Dentistry fits into what is termed a reductionist approach to health (see glossary), and complementary approaches often connect all aspects of the individual from a physical, mental and emotional perspective. This means that a properly trained practitioner should know the method in its full context even if it is applied only within the scope of dentistry. Such a practitioner would also know what general questions need to be answered in order to best apply the therapy.
While some courses can be found locally, others require travel, usually to the United States. Depending on the treatment approach, the course can be short; nevertheless, other courses require a number of meetings over a period of time. Some can be applied to clinical practice in short order, and other methods require time to acquire a basis of knowledge before they can be applied.
It must be emphasized that, at all times, a proper and complete history, testing (e.g., clinical exam, radiographs, taking a biopsy) and diagnosis are required before treatment can begin. Likewise, proper follow-up to monitor progress is essential.
Patient consent must be obtained prior to treatment, and the treatment plan must be thoroughly explained. The patient should understand that “this” approach will be followed as opposed to “that” approach, and that the patient can always change his or her mind and alter the treatment method (both from complementary to conventional and vice-versa).
If the patient is determined to follow a certain path and the dentist is not familiar or comfortable with the choices made, the dentist should tell the patient this and either refer the individual to a dentist versed in the method or to an alternative practitioner with whom the patient can work. Should neither of these options be viable, one can politely dismiss the patient because you, as the dentist, are not able to carry out the procedures requested.
PHILOSOPHY
The importance of studying the history of medicine is invaluable in that, upon reflection, the philosophical underpinnings of the time period come to light. Where do we go next? Philosophy is the starting point from which a therapy can be analyzed, for once that information is acquired one has the criteria against which one can judge. The question is not what can be done therapeutically but rather what should be done. A treatment may violate certain criteria; in such a case, perhaps the treatment should be reconsidered. The basis of medicine should be the art and science that aims at the promotion and recovery of health. There are five basic principles of classical medicine.
1. The role of medicine should be to prevent illness. This goal encourages the practitioner to induce people to live a lifestyle that will be conducive to good health.
2. Do no harm. People will become ill even if they are careful, and will require help in order to recover. Although the physician helps in this role, he or she must remember the therapy must do no harm.
3. Try to remove the basic cause of disease. This is not always possible as the cause may no longer exist.
4. The remedial or healing force of nature must always be taken into account. It is not the doctor or the treatment that heals, but rather the organism or the body. The physician’s role is to understand the nature of healing-what triggers it and what is an obstacle.
5. Holism. It must be kept in mind that one is treating the whole individual whose body and mind are in a constant interaction with a dynamic, changing environment.
The basis of knowledge must be observation. Only diligent, meticulous observation can provide the knowledge that is essential for the practice of medicine. It is easier to imagine that you know something than to admit that you do not know. Samuel Hahnemann, in his book The Organon of Medicine, writes in the first aphorism “The physician’s highest calling; his only calling, is to make sick people healthy–to heal, as it is termed. It is not to weave so-called systems from fancy ideas and hypotheses about the inner nature of the vital processes…. Nor does it consist of holding forth in unintelligible words or abstract and pompous expressions in an effort to appear learned so as to astonish the ignorant, while the world in sickness cries in vain for help.”2
Complementary dentistry/medicine (the term alternative or unconventional dentistry makes the modalities appear exclusive or elusive when, in fact, the patient benefits when we all work together) (1) does not try to explain the disease process and why it has come about but rather to stimulate the body to heal itself. Science may be able to explain what changes are taking place, but it will never be able to explain why those changes occur. This does not mean that we should neglect basic scientific research.
On the contrary, knowledge of physiologic and pathological processes makes us better practitioners if the information is used to make us better observers of disease processes and healing processes. As Goethe once said, “You see only what you know.” Knowledge is power–the power to observe phenomena that we were oblivious of beforehand.
The analogy has been made that what we need to give the body is the information it needs to heal itself. Then, once this has been transferred to the body, healing can start. One may ask: Why does the body not do this on its own? To a certain degree it does-through the processes of homeostasis-but when the ability of the body to adapt is overpowered, negative changes begin to get under way, and the body cannot easily recover its previous state on its own.
It is also important to understand that everyone is born with inherent strength and weaknesses, and, depending on an individual’s life history, the weaknesses may not be able to withstand the stresses placed on them. This will start a cascade process whereby health will be altered, with an eventual decline and subsequent disease. The changes that take place are reflected in our mental, emotional and physical make-up.
The analogy has been made that the disease process is like the trunk of a tree with branches signifying different changes in our health. The purpose of a holistic approach is to change the state of health by altering the disease process, which is represented by the trunk of the tree. When this is done, the branches slowly start to fall off (the seemingly unrelated symptoms all start to move toward health). This is not an overnight process and does require much effort on the part of the patient and therapist to ascertain the symptoms and their changes.
The other critical process in this pursuit is the recognition that there is a balance between the internal processes that run health on a moment-to-moment basis and a term called hygie
ne. Hygiene refers to how we take care of ourselves, our relationship with the significant people in our personal lives and in our workplace. Do we eat properly and get enough sleep? Without a balance in these aspects of our lives we cannot expect to find health, let alone recover health. Too often we neglect ourselves and expect a pill to fill in the gaps in our lifestyle responsibilities.
ACUPUNCTURE
Acupuncture has been around for thousands of years as an organized form of medicine and is used to treat numerous ailments. The majority of Western laboratory research has related to pain control and its relation to endorphin release, but the applications of acupuncture are much broader. Acupuncture relates disease manifestation to imbalances in the whole system. This would require an Eastern diagnosis as opposed to a Western medical diagnosis. By applying acupuncture to the requisite body points the system is balanced, thereby altering the disease process. This involves an understanding of the meridians or pathways through which energy flows in the body and the ways in which these meridians relate to health.
Listed here are some of the procedures for which acupuncture application is suitable: pain relief during fillings and extractions, gagging, anxiety before or during treatment, coughing, TMD, muscle soreness after long procedures, wisdom-tooth pain, periodontal disease, decay and chronic-pain syndromes.
The functional aspect for pain control seems to relate to endorphin release. Acupuncture treatment appears to raise the pain threshold, so, even though the patient can feel everything, the sensation is within a tolerable level. The problem that arises in individuals with a low pain threshold is that the acupuncture does not stimulate or alter the threshold sufficiently to control the pain and the patient still feels too much discomfort. One way of reducing the stimulus during drilling is by going more slowly, which stimulates less pain, or drilling for short bursts and then stopping for a few seconds to give the patient a break before continuing. It is important to note that not everyone is a candidate for the use of acupuncture in pain management.
Why would a patient prefer acupuncture instead of freezing for pain management? This choice may be due to the distain many people have for the sensation of freezing. In addition, some patients have environmental sensitivities or allergies or react negatively (they feel ill) after receiving local anesthetic. Acupuncture needles can be bought individually packaged, pre-sterilized and as single-use disposables; they are easily used by the the practitioner. (www.medserv.ca)
A beginner’s course in acupuncture would allow the dentist to utilize acupuncture on patients for basic procedures while additional knowledge would expand the possibilities for further applications. Acupuncture can be learned at various private acupuncture schools throughout Canada or through The Acupuncture Foundation of Canada (www.afcinstitute.com).
HOMEOPATHY
Homeopathy is another modality with a long history of efficacy in dentistry. Developed in 1796 by Samuel Hahnemann, its applications and benefits have been described in numerous journals over the past 200 years. Like acupuncture, homeopathy stimulates healing in the body through the body’s own natural instinctive healing abilities and has been found to be beneficial for both acute and chronic conditions. The principle behind homeopathy is “like cures like.” This refers to the process of finding the correct remedy whereby the prescriber must find something in nature (animal, vegetable or mineral) that can produce the same symptoms as the person is experiencing. When given this substance in a diluted form, the body is stimulated to heal the same condition that the patient is experiencing.
Examples of homeopathic applications include the following: post-extraction pain, pain after injection, abscess pain, pain after dental treatment, bleeding after extraction, periodontal abscess, pain from irreversible pulpitis, autoimmune conditions of the mouth, chronic ulcers, anxiety before and during treatment, wisdom-tooth eruption pain, teething difficulties during the primary dentition, and chronic pain syndromes.
Prescribing for common conditions (e.g, extraction, pain after injection) is often straightforward. However, if the desired results are not achieved, a more in-depth understanding of the remedies is indicated. For conditions such as periodontal abscess or irreversible pulpitis, further study is required on case taking, case analysis and materia medica (knowledge that pertains to the remedies themselves). Remedies are inexpensive and generally come as pellets that are dissolved in the mouth.
There are a number of private schools across Canada that offer the training and accreditation through which members of the public can become homeopaths. The Canadian Academy of Homeopathy (www.homeopathy.ca) is a DVD-based course open only to health-care practitioners who want to practice homeopathy. These courses involve two to three years of part-time study and involve homework and examinations.
Individuals who want to learn more about dentistry and homeopathy are invited to attend an annual meeting-the National Dental Seminar in Homeopathy (www.dentalhomeopathy.org). This is a 2 1/2 day seminar for beginners that reviews philosophy, case taking, remedies and prescribing. One may also participate in the proceedings of the advanced group, which emphasize more case analysis and prescribing in the dental setting.
The sessions are taught by dentists for application in a dental setting. For general homeopathic information, one should look into information provided by the National Centre for Homeopathy, an organization that promotes education to both homeopaths and the general public (www.homeopathic.org).
CRANIOSACRAL THERAPY
Craniosacral therapy was first described in early 1900 by Dr. William G. Sutherland,3 an osteopath who first ventured into this study with the intention of discrediting evidence that the cranial sutures have inherent motion. After a period of experimentation he presented his findings to the osteopathic profession in 1932, when he described the relationship between the sutures, their motion, and the reflection of their motion to health.
Sutherland also studied the ways in which the relationship between sutures could be altered, with the goal of improving function and therefore improving health. In the 100 years since its inception, the art and science of craniosacral therapy has grown tremendously, and many people have benefited from it.
The cranial bones are in a constant motion called the cranial rhythmic impulse. The challenge in learning to feel the constant movement of the bones lies in developing the tactile proficiency to sense the movement. It is not much of a challenge to detect the radial pulse in the wrist. However, to feel the temporal bones or the occiput move requires training by qualified teachers. The palpation of the bones is subtle but can be learned by anyone with practice. The sessions are very gentle and relaxing for the client and usually last 30-60 minutes.
During a treatment session the practitioner must palpate the bones and be able to detect where the restrictions are occurring. Then, with a very gentle technique, he or she must ease the restriction, or guide it apart, to allow the bones to once again move harmoniously among themselves. These changes can be felt by the trained practitioner.
Craniosacral therapy allows the nerves passing through or around these structures to function properly as pressure and impingements are removed. It also facilitates the muscles acquiring a proper tone, thereby releasing tension and knots, if present. The fascia is also released allowing
local and distal tissues to settle into a healthier position.
The application of craniosacral therapy allows the dentist, after extraction, to reestablish proper bony movement (torquing of the bones during levering with an elevator or with forceps can be traumatic to the sutures). Migraines, temporomandibular dysfunction, orthodontic treatment, and chronic pain syndromes can likewise be successfully treated with craniosacral therapy.
Within the field of craniosacral therapy a number of philosophies have evolved; therefore, different schools generally focus on their own approach. Two such schools are the Upledger Institute (www.upledger.com) and courses recognized by the Craniosacral Therapy Association of North America (CSA/NA) (www.craniosacraltherapy.org). The home page of CSTA/NA is an extensive resource as it offers sections on history, research references and training courses. Both offer programs in various cities across North America.
The Upledger Institute courses last 2-5 days, depending on the course, with the applicant signing up for new courses whenever he or she chooses to do so. The CSA/NA programs generally span 2-3 years, with set dates over the course of study. One should be leery of any course offering that states that mastery of craniosacral therapy can be attained in one weekend.
Individuals who want to learn about dentistry and craniosacral therapy can join the W.G. Sutherland Dental Group, which meets four times a year (www.dentalcranial.org). This group offers a 2 1/2 day seminar that involves a basic and an advanced course. The web site has more information about this group and the application of craniosacral therapy in the dental setting. These courses are taught by dentists for clinical application.
CONCLUSION
The therapies discussed above are not replacements for the majority of dental treatments but rather adjuncts to helping our patients acquire the dentistry they need or to treat the conditions from which they are suffering. Due to the time it takes to master these techniques, the study of any one of them might not be practical for some practitioners. Of course, one’s goal as a practitioner should be to help the patient regain health.
After studying these therapies, symptoms or conditions that were previously thought to be “normal” or “untreatable,” one will find that many of them can actually be treated and that the quality of our patients’ lives can be enhanced. We do not need to master a technique to benefit from it. A referral to an experienced practitioner can help us in the work we are trying to perform and, therefore, can help our patients as well. Basic courses in these complementary therapies would allow us to utilize the techniques for simple problems that would make certain treatments easier to perform or more comfortable for our patients.
Patients come to our offices bringing with them a varied philosophical base. Our job is to respect the health approach they present with as long as it does not make us feel that we are being neglectful or harmful. To better understand the holistic philosophy with which our patients may come, we need to read and study these philosophies. Our outlook on life may change also once we acquire this information. After we have been informed/educated, we will have a broader knowledge base along with a greater understanding and ability to treat the patient with respect.
It is not our job to convince the patient that our choices or recommendations are the only correct route if they clash with that individual’s life choices. By better understanding our patients’ choices we can work more effectively with them towards the goal of improving their oral and general health.
Glossary of terms:
Allopathic: Different from the disease, also means “other.”
Complementary dentistry: When techniques other than conventional dental practices can benefit the patient.
Holistic: Relates to therapy for a condition that takes into account the mental, emotional and physical make-up of a person.
Homeopathic: Similar (homeo) to the disease (pathology). A minute dose of a substance-animal, vegetable, or mineral in origin-can produce the same symptoms in a healthy individual as what the person is experiencing, to stimulate a healing process.
Homeopathy: The art and science of prophylaxis and therapeutics as developed by Samuel Hahnemann. Applies to the types of medicines given and not to the therapies, such as surgery or manipulation, because they are not medicinal.
Reductionist: Reducing the body to individual parts or focusing on one area to the neglect of the rest. (e.g., treating just the lesion or disease)
Remedy: A homeopathic term that describes either a pellet or a liquid taken to stimulate healing.
Dr. Gary Fortinsky is a general practitioner in full-time practice in Toronto, ON. He has had an interest in complementary practices for the past 14 years and is a graduate and fellow of the Canadian Academy of Homeopathy (FCAH) and, in addition, holds the CCH designation (Certified Classical Homeopath). As well, he is a graduate of the Institute of Creative Therapies as a craniosacral therapist.
REFERENCES
1. Fortinsky, Gary, “Complementary Dentistry: A More Comprehensive Term,” Journal of the Canadian Dental Association 2001; 67:254-5.
2. Hahnemann, Samuel, The Organon of Medicine, 6th ed., Blaine Washington. Cooper Publishing, 1982.
3. Sutherland, William G., Teachings in the Science of Osteopathy, Portland Oregon, Rudra Press, 1990.
