March 1, 2018
by Janice Goodman, DDS
What is functional dentistry and why is it worth talking about? I am curious if this is a movement or new direction in dentistry. Here are my thoughts.
Functional medicine and dentistry are using your detective skills and sleuthing out underlying root causes and abnormalities that have lead to a patient’s complaints or symptoms and about intercepting pathological physiology in order to prevent compensations that lead to pathology, pain or illness. It’s not a new concept, Dr. A. Fonder coined the term, “dental physicians” long ago.
Solving the most challenging cases in dentistry involves establishing an environment that will facilitate the patient’s conversion to a mature stable swallow, restorative nasal breathing, proper oral volume and jaw position, neutral bite, healthy cervicals and cranial bones” (Darick Nordstrom), as well as properly sequenced, balanced and functioning cranial nerves.
When investigating complaints, the functional dentists look at functional pathology and recognize compensations for it. They will investigate a problem by checking nerves, muscles, jaws, teeth – in that order. This is a departure from what we usually do, ruling out pain from odontogenic origin first. Of course, for acute problems, the majority of dental pain is from a cavity, cracked tooth or periodontal issue, but for chronic issues that are not easily diagnosed the functional dentists approach makes a lot of sense.
The connection between airway, breathing, sleep, bruxism and craniofacial pain is well established. You might see a more functional dentist if you want to stop bruxing – you have a habit that is pathological neurophysiology and you just can’t control it and it is leading to all kinds of problems. A flat plane night guard actually makes it worse, and you desperately want to understand the why of the problem. The functional side of dentists understands the scientifically valid information on bruxism and clenching and can help to investigate and establish why they are doing it and look for solutions.
The ADA, and many specialty fields are beginning to encourage this type of thinking, so we should all consider moving in this direction, too.
Recently the ACP Prosthodontists put out a position paper that all dentists should screen for OSA prior to fabricating a night guard for bruxism.
The ADA also just passed a resolution saying that dentists should now screen their patients for sleep disorders. Just opening the vertical dimension, without moving the jaw forward can actually close the airway and make the OSA/SDB worse.
The new position statement of the responsibilities of dentists treating sleep disorders from the AADSM may be viewed in full and is reprinted in this issue of Oral Health.
Several organizations have been established and are encouraging countries to make it law that all newborn babies be assessed for tongue and lip tie restrictions. Brazil was the first country to adapt such a law.
In Japan, dental hygienists have mandatory orofacial myofunctional studies as part of their program. In fact, the myofunctional therapy message is gaining a lot of interest and traction in dentistry.
Recent scientific discoveries make functional dentistry seem more significant. The knowledge that there is an intricate immune system in the brain was only discovered about a year ago. There is new research that bruxism and clenching are not always benign, we know that it leads to dental/TMD issues, and now there are several independent sources that possibly link it with neurodegenerative conditions.
P Gingivalis is being found in the brains of Alzheimer’s patients – should we understand the mechanism of how it got there and try to prevent it?
There is a lot of talk about “Functional Somatic Syndrome” where the whole nervous system appears sensitized and it includes bruxism. It also includes symptoms like disturbed, fragmented sleep, light headedness, orthostatic hypertension, stress in the parasympathetic and sympathetic nervous systems, cold hands and feet, and more.
Functional Medicine has recognized that it needs to work alongside the dental community. Here are a couple of examples: Considering the tongue is the architect of the mouth, helping the tongue to function correctly will help with palatal and arch development, nasal breathing, correct swallowing, building up molars to improve neck issues, alleviating clenching to affect Dopamine release via the HPA axis, and also, could modulate chronic and neurodegenerative conditions.
Functional dentistry does not imply alternative, natural, holistic or complimentary. It is not integrative medicine either – although the two can overlap. We are talking about evidence based medicine and dentistry and taking the time to not just treat pathology with repair, but to also look for the etiology of and suggest changes that will help optimize a patient’s health.
We are all functional dentists to some degree, just like we are all cosmetic dentists. All dentists try to do their finest artistic work but some dentists may be just a bit better trained or talented at it. It is in our code of ethics to help patients find solutions to their problems and improve their health and quality of life.
This issue of Oral Health is partly dedicated to sharing some of these functional ideas through mentorship. Oral Health does not necessarily endorse everything in these articles, but invites the reader to form opinions of their own and send in their comments. OH
About the Editor
Janice Goodman, DDS, is the General Dentistry member of the Oral Health editorial board. She recently completed a Masters of Science in Oral Medicine and Orofacial Pain at USC and practices in downtown Toronto.