Dental Implants: Part 1

As I write this, Bramer and I are sitting in the airport in Miami waiting for our return flight home after a very long, but fulfilling surgery and implant training program in Santo Domingo, Dominican Republic. You guys are my witnesses, that on this trip my husband agreed that we should spend months at a time in the Dominican doing humanitarian dentistry and soaking up the Dominican charm. My close friends know that I have a dream that once my girls are self-sufficient (stop laughing), I could volunteer in a dental clinic by day, and hit up some beachfront yoga by evening! We loved reuniting with the beautiful beaches of Punta Cana where we were blessed to have honeymooned 12 years ago. The island of Hispaniola has flown many flags, and the culture and history are rich, but like many previous colonies there is a distinct prosperous minority that coexists with an impoverished majority. I was drawn to this particular implant program because it beautifully combined advanced dental training with restorative dental treatment for the people of Santo Domingo.

Most people in America have a basic idea of what dental implants are. I am often asked about the “all new implant teeth in a day” commercials and billboards that seem to be everywhere these days.  Often times, these promises are great marketing, leaving out a lot of fine print.

Historically, different cultures have used common materials to “replace” missing teeth. For instance, 4,000 years ago the Chinese used bamboo pegs to replace missing teeth.     In addition, 2,300 and 3,000 year old French and the Egyptian skulls have been found with metal prosthetic teeth, which were intended to improve the individual’s post-death smile. There have also been historical attempts to reimplant another human’s teeth or animal teeth into a missing space in a person’s smile (unfortunately, these attempts fail due to infection and host rejection).

The mental image I hold of ancient implants is featured in a famous Implantology textbook that most dentists are familiar with. It is a photo of a skull with carved tooth-shaped shells in the lower jawbone that was excavated from Mayan ruins. This book notes that the implants appeared to be integrated into the bone, and that they showed signs of calculus formation. This most likely means these ancient implants were functional replacements for every day use, and not simply for post death vanity.  Luckily, implants have come a long way since bamboo pegs and seashells.

The father of modern dental implantology was an orthopedic surgeon, Dr. Per-Ingvar Branemark. In 1952, he unintentionally discovered the osteo-integrative (bone anchoring) properties of titanium, when he was unable to remove a titanium cylinder he had placed in a rabbit femur during a study on bone healing and regeneration.  In 1965, Dr. Branemark placed his first titanium dental implant. Since then, implant technology has gone from a “pet” project to the treatment standard for many patients with missing teeth.

In the next part of this Implant piece, I’ll explain some of the history and science behind Zirconia Implants- I know you are on the edge of your seat!

The heart of the discerning acquires knowledge, for the ears of the wise seek it out. Proverbs 18:15


A Matter of the Heart

It’s February- a month that conjures thoughts of love and the heart. It’s one of my favorites! I think this time of year is dear to me for two reasons: 1. The busy holidays are behind us and 2. In February of 2012 I experienced the indescribable love a mother feels for her first born.

In addition, through supporting my beloved husband, who has worked as a hospital administrator for the past 14 years, I have been involved in running for the heart, going red for women, wearing red at fundraisers, and listening to cardiologists talk about the importance of prevention as it relates to heart disease.  It is clear that Americans are passionate about the prevention and treatment of heart related chronic illness.

As a dentist I can tell you something I do not love… and that is periodontal disease. While we are conjuring images, you are probably imaging bleeding gums, bad breath, and that toothless relative that made “poor dental choices.” All of those conditions are possible in patients with periodontitis, but a far greater concern is that periodontal disease can have a significant impact on our overall health. It is well understood by dentists that the mouth is the gateway to our systemic condition. When it comes to the correlation between heart disease, inflammation, and periodontal disease we (conventional and holistic providers and dentists) concur that the wrong type of oral bacteria is detrimental to our overall health.

To clarify, the red bleeding gums you envisioned earlier is what dentist call gingivitis. Gingivitis is an inflammatory reaction to pathogenic bacteria taking over in the mouth. Bad breath is also caused by bacteria and the volatile compounds they produce. Tooth loss, mobility, deep gum pockets, and chronic gum inflammation are the hallmark traits of periodontal disease. Ok, so what’s the big deal about oral inflammation? Remember the gateway… Studies show overwhelming connections between periodontitis and heart disease. There are ongoing studies focused on defining the direct link, however, today there are two indisputable discoveries:

  • The same bacteria found in gum disease are also found in atherosclerotic vessels.
  • When people have moderate to severe gum disease their levels of C-reactive protein increase. CRP rises during whole body inflammation, and is used clinically to assess a person’s risk of heart attack.

So what can you do to decrease your risk of systemic health problems cause by detrimental oral bacteria?

  • Regular dental exams and professional cleanings by a dental hygienist. In our practice we take a plaque sample from each patient, and use a phase contrast microscope to identify their oral flora. Our team uses traditional cleaning methods, ozone, essential oils, and specific irrigation solutions to target each individual’s unique issues.
  • Good home care! I strongly recommend Oral irrigation in conjunction with brushing. If you ever had braces growing up, you remember that Waterpik that collected dust, because you were way to busy to fit that into your busy teenage schedule (eye roll). In a 1988 study it was determined that irrigation reduces gum bleeding, pocket depths, gingivitis, periodontal pathogens, and decreases a patient’s risk of bacteremia. Note that periodontal bacteria increase cytokine levels, and irrigating daily leads to a reduction in pro-inflammatory cytokines.

I get questions about oil pulling all the time. Oil pulling originated in India and is described in ancient Ayurveda texts. It is the rinsing and pulling of oils (usually coconut) for around 20 minutes and then spiting out the oil. So why coconut oil? It’s an edible oil and it is very rich in Lauric Acid. Lauric Acid is anti-inflammatory and anti-microbial. I generally tell patients that it is a good tool in conjunction with proper brushing and irrigating.

I will likely devote a future blog post to Nitric Oxide and Myofunctional Therapy, but if you are curious about those topics now check out this blog: (Mouth Breathing, Nitric Oxide and Your Health)

Due to the increasing number of professional articles released relating oral health and systemic health I’m sure that we will be able to dive in deeper in future blogs. One additional note, let’s be clear that our goal is a healthy microbiome not total bacteria annihilation!

I’ll close with this pearl of wisdom:

Above all else, guard your heart, for everything you do flows from it. Proverbs 4:23

I think we all agree that love makes life worth living, and I am in awe of this timeless advice. We must physically and spiritually guard our hearts, not just this month but everyday to live in optimal wellness.

Cheers! A Valentine’s toast to our hearts and our gums, and there’s nothing more attractive than a beautiful smile!

*References available upon request

Why Accidental?

I believe that spending the majority of my life in Texas gives me the authority to call it home. I was raised in by two extremely loving parents, and there was no question that my brother and I were their world! That being said when it came to healthcare and nutrition my parents never swayed from the recommendations of our well-intended, but very conventional medical doctors.

Growing up in Houston I loved the arts and I dreamed of working in a gallery in France. Rivaled only by my interest in Biology, because the miracle of life and the complexity of creation are areas that have always fascinated me.  I figured college was the perfect place to pursue both.  Fast forward a little bit and I am sitting in a college class where I am studying the cute guy next to me much more than the course material. We got married in 2006, and we still are easily distracted by each other today!

Before the wedding I was blessed beyond my imagination with acceptance into the University of Texas Health Science Center Dental Program in San Antonio. Blending the art of restorative dental work with the science of dentistry seemed to be a great way to pursue both of my passions. With my path set (or so I thought) I headed down to San Antonio to begin my dental education.

Prior to 2005, I had never heard of holistic dentistry much less met any type of alternative medicine practitioner. Let’s be real- I didn’t even know what hummus was! This is where things begin to get Accidentally Holistic. In the midst of wedding planning and preparing for dental school graduation, I was informed that my Mother had a kidney tumor. I was shocked! She seemed so healthy.  My mind swirled with whys. What caused this? What can she do to heal? All of the internet research and conversations with doctors left me frustrated and even more confused. The answer was surgical removal of her kidney. If the tumor was encapsulated she lived, if it was not she would eventually die of renal cell carcinoma. The beautiful part of the story is that she is a cancer survivor.

Believe it or not, two years later my Father was also diagnosed and treated for renal cell carcinoma. I remember thinking that surely this was some kind of twisted joke…what are the odds that spouses would be diagnosed with the exact same cancer in a 2 year spread. A fire was sparked- I was in pursuit of answers. Toxicity and cancer consumed my thoughts and my conversations, I would talk to anyone willing to listen. A dear mentor of mine (a dental anesthesiologist) led me to Dr. Stuart Nunnally and Dr. Lane Freeman in Marble Falls, Texas. He was wise enough to know that I would not thrive in a conventional dental environment, noting that the recent events in my life had presented me with a curiosity that would require a different approach to not only my practice, but my life as well.

The first observation I had in Marble Falls was a fascinating concentration of passionate dentists, doctors,  and patients.   This office was different than any other dental office I knew of, not only because of the procedures, but also because you could feel both love and perseverance once you crossed the threshold. The doctors and the patients were both fighting. Fighting for answers, fighting for wellness, and some were fighting for their lives.

The entire car ride home, all I kept thinking about was how many of the patients I interacted with throughout the day had such similar stories to that of my mother and my father. Looking back, it is clear that this simple day of observation, tied together so many of the loose threads in my life that had been dangling since I first became fascinated by biology, but at the same time captivated by art. I now see with clarity how art, science, health, and wellness can all converge.

I felt God gently lowering my walls against holistic dentistry, living in a small town, and making a turn in my career that I never had envisioned. Today I partner with dentists I love and respect, and honestly as cliche as it sounds I feel sometimes like I need to pinch myself.

*And we know that in all things God works for the good of those who love him, who have been called according to his purpose. Romans 8:28