"The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease." - Thomas A. Edison

Peter Varley BDSc, FDSRCS, DFHom(Dent.) and Stuart Ferraris BChD, DGDP, DDFHom.(profile)

We can all use complementary therapies in our practice, but like anything new, we need the time and energy to learn. This can add dimension to the postgraduate programmes we use to support our every day orthodox therapies.

Setting the Environment

To run a holistic practice it is necessary to create an environment conducive to the type of natural therapies that you intend to practise. It is necessary to consider:

• the preparation of the patient,
• the ambience of the practice
• the attitude of the team of which you are all contributing members.

Psychological Preparation of the Patient

Psychological preparation of the patient, before they see the health care professional, is important. Rossi[1] in his book ‘The Psychobiology of Mind-Body Healing’ discusses ‘the power of optimism’, ‘the belief in cure’ and ‘the placebo’. Research by Evans[2] shows a placebo response, averaging 55% of all the analgesics studied. These include Morphine, Codeine and Aspirin. The power of psychological healing must therefore be a very important part of all health programmes.

Practice Ambience

We need to adapt to the individual needs of each patient. Some areas of the practice have to cut a more average path eg decor and smell. Other areas to consider are the literature generated by the practice, telephone personality of the staff and treatment on arrival at the practice. The ‘feel good’ factor can contribute to the initiation of healing. Paintings, flowers, soft music and personal photographs are useful. They lend a homely atmosphere. Austerity that can be associated with the clinical setting is softened.

Colour

Colour can be a useful influence on healing. Hunt R. The Seven Keys to Colour Healing[3].

Violet can be therapeutic for nervous and mental disorders

Blue is useful for teething.

Yellow is associated with cures for skin troubles. With the rising number of allergies associated with latex gloves, perhaps we should have yellow light shining on us over the hand basin.

White is definitely associated with sterility and the clinical environment.

While blue is useful, it needs careful thought, for it can be considered a little cold. Blue uniforms, for example, are often quite acceptable and smart. Blue decor, paradoxically, needs to be well chosen, if it is to avoid the cool emotional message and effect.

Aromatherapy

Aromatherapy uses the smells of natural herbs and flowers as therapeutic agents to treat differing pathologies. These agents are reduced to essential oils and applied to the skin as massage techniques or simply inhaled.

Smell is one of the most easily remembered senses. The smell of the dental office, especially for the patient, is very characteristic. The historical use of oil of cloves takes much of the blame for this. Oils such as lavender are useful in the reception and the surgery because of their calming properties. A cotton wool roll with a subtle fragrance of lavender placed below the patient’s nose,

Lemon oil, with its refreshing properties, may be used in the staff area to keep the team alert! The immune system gains stimulation from oils such as tea-tree, cinnamon and thyme. Aromatherapy oils can be used directly as ‘disinfectants’, for treatment of ulcers, lacerations or in root canals and cavities. Some of the conditions treated with aromatherapy oils are listed below:

Music

If the wrong type of music is playing it can increase the patients irritability and anxiety. There should be a consensus between the team and the patients. Popular classical music of a relaxing nature is the usual choice.

Patient can be encouraged to bring their own music. This can be played through earphones while they are being treated. The privacy of their own world of music can often be as relaxing to the patient as IV sedation.

Laughter

‘A merry heart doeth good like medicine; but a broken spirit drieth the bones.’ King Solomon, Proverbs 17:22

Robert Holden[4] who established the first NHS Laughter Clinic in Great Britain, feels that laughter ‘is the best medicine’ as it has an ‘internal massage’ effect. Dr Robert Willix5 who explains that happiness strengthens the immune system, while stress, depression and unhappiness weaken it. Stress generates a flash flood of free radicals.

Laugh with your team, laugh with your patients and most of all laugh with yourself.

The Team

A positive staff attitude is essential in running any practice. The team morale and motivation need to be supportive of the practice philosophy. Education is all important.

Involve all staff with good in-house communication through combined courses, shared literature and meetings. It is rewarding to see how enthusiastically the staff enjoy the opportunity to be part of holistic health.

Understanding each other’s individual needs is fundamental to team morale and enables rapport to develop between the team and the patients. Ron Hubbard6 describes the balance needed between affinity, reality and communication, in order to achieve good understanding.

At the front desk staff have the opportunity to communicate the practice philosophy. The philosophy is then reinforced by the team in the clinical environment.

It is necessary to involve the staff in complementary therapies, in theory and practice. Staff should be encouraged to use complementary therapies at home. They should be given the opportunity to experience treatment from the complementary practitioners used by the practice.

It is often the caring way in which the rest of the team supports the patient, that makes the greatest impression. The nurse, who holds the patient’s hand or places a reassuring arm around the shoulder, wins hearts for the practice.

Other gestures that are appreciated are a warm towel placed around the patient’s neck and a light blanket draped over the patient. This is especially useful during long appointments, where the patient’s core temperature may drop more easily than that of the working team.

A consistent theme of dress suggests a team concept to both the patient and the practice. The colour and nature of dress should communicate a comfortable balance between clinical efficiency and a relaxed happy atmosphere.

The Patient

The patient seeking a complementary practitioner is usually well informed. These patients are not easily side-lined by ‘science’. However they are ready to accept an orthodox solution only if the practitioner can give an opinion based on an overview of both orthodox and natural medicine.

Common Tools used Holistically

Mounted study models are a more holistic than hand held models. They convey the message of the teeth functioning in relation to the joints. Using electronic apex locators during endodontics avoids the over-use of radiographic exposure. Appropriate filters should always be fitted to x-ray equipment. Fast x-rays and lead aprons should be used and all associated equipment kept at maximum efficiency and well maintained. Research indicates that automatic developing film results are consistently better[7] Computer assisted radiovisiography can further reduce radiographic exposure.

Computer Programmes

Computer programmes are available to help the holistic practice. They can be used to aid homoeopathic constitutional diagnosis and nutritional analysis.

Vegadent

Uses the concept of energy meridians linking the individual teeth to many other body systems.These relationships are worth bearing in mind when considering a diagnosis based on all the information gathered from your patient. The condition of each tooth, either from abnormal occlusal loading, high amalgam galvanism or an inadequate root treatment, could cause an interruption in the healthy flow of energy along in the patient. This could then be expressed as ‘dis-ease’ in a related organ, which is not associated with teeth in an orthodox sense.

Holistic Treatment

TMJ, Migraine and Other Head Pains

To practise a holistic approach a dentist should have a thorough knowlege of functional occlusion and its relationship to muscle and joint pain and general body balance

It is important to give the patient advice on exercise routines, nutrition, sleeping positions, relaxation and massage to assist with the healing. Reassurance is an invaluable tool. Each patient will need a programme tailored to their needs. A general exercise that is attainable by most is regular walking. This needs to be brisk to achieve good aerobic levels, which will mean at least 20-30 minutes 5 times per week.

Periodontal Treatment

Why do some patients present with very poor oral hygiene, but with little sign of corresponding periodontal disease?

Pasteur, accredited as the father of the microbial era, observed on his deathbed, ‘Bernard was right. The germ is nothing, the soil is everything.’ This fundamental consideration is embraced in the philosophy of holistic health, whereas it is given little credit in the orthodox circles where it originated. By supporting the health of the individual holistically, the immune system is our most effective challenge to diseases of all kinds, including infection.

The story behind the birth of the germ theory makes for interesting reading. In the 1870’s the silk industry in France was nearly destroyed by a disease that attacked the developing silkworm. Louis Pasteur was called upon to stop the disease that he discovered was caused by a protozoan. He demonstrated that the disease could be controlled by eliminating the microbe from the silkworm nurseries.

However, Pasteur also noticed that it was not just the presence of the germ but also the physiological state of the silkworm that determined the susceptibility to infection.

‘If I were to undertake new studies on the silkworm disease, I would concern myself with the ways of increasing their general vigour. I am convinced that it would be possible to discover techniques for giving worms a higher level of robustness and thereby rendering them resistant to infection’.

Pasteur was aware of the importance of what he called the ‘terrain’ - the environmental factors that determined susceptibility and resistance to disease.

The holistic dentist will consider the patients general health, ie. the patient’s ‘terrain’,. He will consider nutrition, do a dietary analysis or take the patient through the Basic Diet Experiment. He will consider stress. Not just occlussal stress, but emotional and biochemical stress.

He will also support the practice of optimum oral hygiene and high quality restorations.

Antibiotics

The question the holistic practitioner asks when faced with an infection associated challenge is, ‘Has the individual sufficient immune capability to clear the challenge naturally or is there a gentle support option that can be recommended?’ Such options could include a homoeopathic medicine or where appropriate, a topical treatment such as propolis liquid. Very often just reassurance is all that is needed.

Nutrition

Homo Sapiens was a hunter-gatherer until communities developed around settled agriculture some 10,000 years ago[8]. As settled communities we learnt both to control food production and to cook more food. In evolutionary terms our physiology is still best handling uncooked food, with a variety to supply adequate and complex nutritional needs.

Pottenger suggests that it is unhealthy to consume cooked animal protein. In his animal study, the group of cats on the raw protein diet thrived over a 5 year period, while those on cooked protein became sick and developed diseases similar to those seen in human beings, including periodontal disease and loss of teeth.

The holistic dentist is concerned with a diet that will enhance normal dental arch development. Evidence suggests that the hunter-gatherer suffered generally fewer diseases and attained better average heights than agricultural communities, with the exception of the wealthy Western Nations[8].

Present day farming methods have impoverished the soil. Vitamin and mineral supplements have an important role to play therapeutically when the individual needs to nutritionally ‘catch up’. They are also useful as additives to modern impoverished foods.

Financial Aspects

“God cures and the doctors send the bill”- Mark Twain.

Fee Structure

Setting up a holistic practice can be expensive. Whichever system is used, the fee level will have to reflect the true cost of the service provided. The holistic practitioner should be prepared to increase fees rather than reduce time with the patient. It is important to be confident of the service provided. Patients pay for outcome and comfort. Team confidence is an essential element of both[9]. Changes must always be made to the ultimate benefit of the patient.

Time Management

The modern patient often rejects the impersonal way they are ‘time managed’ under orthodox dental care. Most complementary therapies, by their nature, need longer contact with the patient. This enhances their added value for the person seeking caring health attention.

To provide the time and to make the patients feel unhurried, requires discipline. To be financially successful we need to run an efficient practice that provides time for the patient. We need to charge sensibly for that time.

Medico-legal Aspects of the Complementary Therapies in Dentistry

When groups of practitioners come together and form societies with special interests in common, it is not unusual for them to form protocols that become the bench-mark for practice within that field.

The standard that is used in the United Kingdom is that of the Bolam Test[10] which is based on what a reasonable body of opinion would consider to be appropriate. It is therefore important to become members of recognised societies.

Conclusion

There are many useful therapies for the holistic dentist. Armed with the philosophy of natural medicine, practitioners can develop the therapies that complement their individual personalities and those of the patients they serve.

Education, application, observation and continual evaluation are the only ways to develop professionally. Armed with these tools we can make a meaningful contribution to the well-being of our patients, so that they feel happy and above all - healthy!

References

1. Rossi E L. The Psychobiology of Mind Body Healing. New York: W W Norton & Co, 1988.
2. Evans F. Expectancy, Therapeutic Instructions and the Placebo Response. In White L, Tursky B, Schwartz G (eds). Placebo: Theory, Research and Mechanism. pp 215-228. New York: Guilford Press, 1985.
3. Hunt R. The Seven Keys to Colour Healing. San Fransisco: Harper & Row, 1982.
4. Holden R. Laughter, the Best Medicine. London: Harper Collins, 1993.
5. Willix R D. You Can Feel Good All The Time. London: Fleet Street Publications, 1994.
6. Hubbard L R. The Components of Understanding. Los Angeles: Bridge Publications, 1994.
7. Rout P G J, Rogers S N, Chapman M, Rippin J W. A Comparison of manual and automatic processing in general dental practice. Br Dent J 1996; 181(3): 99-101.
8. Diamond J. The Rise and Fall of the Third Chimpanzee. Reading: Cox & Wyman, 1991.
9. Robbins A. Awaken the Giant Within. p 378. New York: Fireside, 1992.
10. Dental Protection Ltd. The Safety of Amalgam Restoration. Division of Medical Protection Society, 50 Hallam Street, London W1N 6DE.

Stuart Ferraris BChD, DGDP, DDFHom.

Stuart graduated in South Africa in 1976. He travelled extensively before settling in North Wales where he has developed a successful holistic dental practice using a broad range of Complementary Therapies.

He is a member of the British Homoeopathic Dental Association, the British Medical Acupuncture Society, the British Society for Medical and Dental Hypnosis, the Foundation of Biological Medicine, the Natural Medicine Society plus many other dentally related societies, including the American Equilibration Society and the Cranio Group.

In 1992 Stuart was awarded the Diploma in General Dental Practice from the Royal College of Surgeons. He has appeared on television, published many articles on dental and natural health topics and lectured both nationally and internationally on running a holistic dental practice.

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