“Listen to your patient, for they will tell you the diagnosis” Sir William Osler.
A patient comes into the dental office for a new patient exam.
She is late 50s, slightly over weight, looking a bit old and tired, tells you that she has increased blood pressure, suffers reflux, gets headaches, has an under-active thyroid, suffers anxiety and panic attacks, suffers depression. She takes medication for all these ailments. She also has irritable bowel syndrome, has had a bit of bowel resected. She has neck and back pain. She has restless legs. Did she mention that her ears sometimes feel a bit blocked ?
The dentist's eyes glaze over and he asks to look at her teeth.
She has all her teeth, mostly heavily filled with amalgam due to continual breakage and refilling,
chronic gingivitis, sticky plaque, some subgingival scale, 1 -3mm pocketing anteriorly and 2-4mm pocketing posteriorly, reasonably good bone, over-closed worn occlusion, reasonable guidance.
but she cant open fully and complains that she doesn’t like going to the dentist.
Who does? Then he remembers perhaps to look at the rest of the mouth.
Maybe the gums are a bit cyanotic, big tongue with white coating and scalloped edges. She gags easily but he persists and checks her throat – erythematous kind of lumpy tissue on rear wall of throat, mildly reddened uvula and border of soft palate.
He asks her about tonsils. She had her tonsils out many years ago because she had recurrent mild tonsilitis.
In fact, she says that often she feels that her sinuses are congested
and she has post nasal drip. She worries she might have bad breath. She admits that perhaps she snores and breathes through her mouth at night. She says she sleeps a lot but when questioned a bit he hears that her sleep is disturbed, sometimes she feels panicky, and gets up to the toilet a couple of times a night, often waking with a headache.
Most dentists are probably thinking she needs some xrays and hopefully some amalgams replaced and perhaps give the teeth a bit of a scale and clean, but this woman definitely fits into the “ morosely – ill,post- menopausal,complaining,neurotic female" stereotype. Anyway, if she can’t open her mouth properly and gags easily, any dentistry is going to be hard.
I think differently. The paradigm of dentistry is profoundly flawed if dentists have to drill and fill to make money.
Dentists are supposed to be doctors of dentistry ,and perhaps not just bachelors with a science degree, and as a profession, they are dedicated to being health providers for patients, focusing on the field of expertise which is “dentistry”.
At the American Academy of Cranio-Facial Pain conference, in Forth Worth Texas , July 2007, one of the top line speakers stated “that the dental profession must reclaim the face – our field of expertise is the maxilla and the mandible and their associated anatomy and functions.”
For too long, dentists have been tunnel-visioned about teeth and perhaps gums. Most general practitioner medical doctors usually have a blind spot with this area of human anatomy and health.
The end result is that many patients suffer unnecessarily, because we are listening only with one “dentist” ear and looking only with one “dentist” eye. I like to try to listen with two “doctor” ears and look with two ”dentist” eyes opened widely ( not wired shut or focussed through loupes).
I see that dentists are first-point or primary care health providers – the maxilla and the mandible and their associated anatomy and functions encompass and affect breathing, swallowing, eating, drinking, speaking, appearance, expression, head posture and to a large extent, self-esteem.
Dentists need to know about diet, and what is happening within their field of expertise when the patient is awake and asleep. Dentists have the most profound ability to help people get well and stay healthy.
Here is the diagnosis
The woman described above breathes poorly.
She breathes poorly because she is hypersensitive to some components of her diet that contain an amino acid called proline.
Her immune system reacts by engorging her throat with eosinophils and stimulating mucous production in her sinuses, and sensitizing her intestinal tract to these dietary proteins like gluten and nuts.
The cervical nerves that service the areas are chronic sensitized.
She opens her mouth at night to get air but her tongue partly obstructs.
She doesn’t oxygenate well so she doesn’t get into deep stage 4 sleep.
Her mouth gets dry so she clenches for more than half a minute while she swallows.
The long history of breakages and clenching has over-closed her occlusion and her condyles impinge onto retro-discal ligaments in her jawjoints ( TMJ s) when her teeth are together.
Her occlusion is slightly unbalanced with respect to her TMJs so she grinds a bit each time.
She doesn’t breathe at all while she is swallowing so she gasps and starts snoring again.
The gasp and diaphragm jerk is a reflex signal to the gastro-eosophageal sphincter to open and allow acidic
gases and fluids to burn her eosophagus and soft tissues of her throat.
This reduces smooth muscle tone and makes her snoring and breathing worse.
The forces from her occlusion and on her jawjoints (TMJs) drive her C1 and C2 vertebrae into a forward head posture
with tension on the support muscles of her neck, tension in her muscles of mastication, tension in her swallowing muscles, and tension on the ligaments and muscles that attach to her ossicles, eardrum and inner ear. She can’t open her mouth fully, she gags easily especially if her airway is threatened.
She panics if her brain feels that it won’t receive enough oxygen.
Low oxygenation and muscle tension disturb her sleep and set her up for a headache.
Disturbed sleep keeps her out of parasympathetic rest and recovery mode so her lymph system doesn’t work properly.
Her tissues and cells store water because they can’t clear waste fully. Her muscles won’t relax.
She sleeps in sympathetic alerted mode and she is always tired and sore, so her adrenal-pituitary axis trickles stressor hormones 24 hours a day.
Her saliva is poor and generally acidic.
Her blood pressure is driven up.
Her thyroid wears itself out trying to deal with compromised innervation from C2 in her neck, poor absorption
of nutrients, chronically stimulated metabolism, lack of enough water to flush acidic waste from postural activity, inflammation and medication metabolites. She can’t shift the extra weight no matter what she does and she struggles to do any exercise because she always feels tired.
That whole thing makes her feel depressed on top of the fact, that with no Stage 4 sleep, her serotonin production is low so she is clinically depressed whether she likes it or not.
So she eats a bit too much starchy sugary stuff or chocolate in an attempt to quell her “hunger” and feel good.
She knows it doesn’t help.
She doesn’t eat well anyway because mostly it gives her a pain in the gut.
The easily fermented carbohydrates breed germs that cause gingivitis and caries, and love her dry acidic mouth.
The low oxygen tension in her blood, her compromised immune system, her poor nutrient intake and metabolism make the scale under her gums a great place for anaerobes.
This puts her vascular system and heart at risk.
She is on the slippery slope of ill health and systemic sympathetic dystrophy.
Treatment is easy. If she loses all her teeth, she may actually be better off !
No seriously, she wants to keep her teeth,
so treatment is:-
Help her to breathe and to eat properly
1. Reduce her gastrointestinal inflammation with oral aloe vera juice available from any good pharmacy.
2. Supplement her meals with Biohawk DigestEasy proline neutralizing enzymes so the immune stimulating dietary proteins in cereals, nuts, dairy, eggs and meat are made digestible and nutritious.
This will also unblock her sinuses and nose by drying up her mucous.
Her immune system will calm down, she will be less agitated and will start to feel better.
3. Clean up her oral debris and any dental caries, and put her on a hygiene program.
4. Put her on an oxygenating Chlorine Dioxide mouth rinse in the morning
and an alkalizing CariFree* Treatment rinse mouth rinse at night.
5. Make her an airway enhancing TMJ supporting oral device to wear when asleep.
and make her a lower TMJ positioning orthotic to support her head and neck when she is awake.
6. Improve her nutrition with lots and lots and lots of water, vegetable juice, vegetables, salads, fruit,
and cereals; less meat and sugar ; more vitamins and minerals with extra magnesium and vitamin B complex.
7 Order a sleep study to show that she is oxygenating, not clenching and twitching her legs, and establish that she is now getting some Stage 4 sleep.
8 Improve her wellness by getting her to have a nice easy deep breathing 30 minute walk with her dog before dinner at night.
9 Establish a “getting ready for sleep" routine and wake up the same time every morning and do some
deep breathing stretching exercises like Yoga or Tai Chi.
10 Check her saliva and urine pH weekly, and when she feels better, can open up properly without gagging, and has established a healthy jawjoint centric relation position,
you are both ready to do some dentistry.
And you know what ?
- She will do whatever her dentist advises is good for her !
BioHawk Digest Easy is available from Dr Cliff J Hawkins BSc PhD DSc, past pro-Vice Chancellor University of Queensland Australia.
If you want some, then email cliff.hawkins@bigpond.com
The author of this article is Dr David Stephenson BDSc Hons who is a general dentist in Albany Creek, Brisbane, Australia.
This means he has to know enough about everything to give his patients good advice about how and where to obtain treatment from health providers who know what to do. He tries not to treat patients like fools.
He is a member of the ADA, the AACFP, and the North Brisbane provider for Home Sleep Studies Australia.
In his spare time, he does dentistry, paints, draws, plays Chopin, listens to Led Zepellin and The Beautiful Girls, and loves his wife, who works as his clinical coordinator beside him every day.
find him on a map at www.albanydental.com.au/contact-albany-dental-australia.php
contact him on drdavid@smiledentist.com.au
