11/13 Lecture: Holistic Dental Health (Transcribed) P2

Just ask your dentist to read the labels on the packaging from the amalgam manufacturers. It scares you.  If you read that, it really scares you. It talks about toxicity, how it can affect your nervous system, your liver, your kidneys. In the state of California, for most of you that are from here, we now have a proposition where a dentist has to disclose to a patient, if they’re going to use amalgams, that there could be birth defects, especially for women of child-bearing age.  This is what I see in my office every day. People say, “But doc, I’ve had these amalgams in my mouth since I was 12.”Yeah, I know.  I know.

So, some of the problems with amalgams when they’re first placed in, the fresh amalgam, the fresh mercury, is very, very active. This is when I’m most concerned.  There’s a period that could be called a period of inactivity, relatively speaking.  I think it’s always a problem to have those things in your mouth.

Then, as the amalgams start getting older, the amalgams start oxidizing.  The margin starts opening up, and the amalgam has the tendency to swell up with time. Why does that happen? Just from a mechanical point-of-view, forget about the biocompatible point-of-view, they start actually creating cracks on the teeth. Again, I must do a few crowns a week from people that have had amalgams and have had cracks from the amalgam. So, even if you don’t feel that this is a problem with your health, on a biocompatible perspective, just from a physical perspective, it’s not a good material.

So, I think those are incredibly toxic restorations.  So, if any of you still have amalgams, I would take a look at it, see what they look like, talk to your health practitioners about them. Run some tests.  See how toxic you are with heavy metals. Those are a lot of things that could influence your health. Now, this is what I find under the amalgams.   That’s very typical.  You can see on this side what the amalgam has created. That’s after the amalgam has been removed.   It’s actually interacted with the tooth in a significant way.  You can see, on your right, the crack line, very, very clearly there between those two spaces. That’s very typical, and we see that often. This is not a seldom case.  This is something that we see all the time.

So, after we’ve restored the teeth, obviously much cleaner, much healthier,

and obviously, the opportunities for those teeth to be lost due to cracks diminishes tremendously. So, a lot of people that come to the office ask me, “Well, doc.  I get it.  I really shouldn’t have the amalgams in my mouth, but what do I do?  How do I take them out?” I often talk to them about how would you talk any toxic material out of a building. Asbestos was big, right, in the 60s?  In some buildings, they have special people that come and actually take the asbestos out.

So, there is a certain protocol as to how we can take the amalgams out of your mouth and how we can do it safely because that’s very, very important. To have your amalgams taken out in an unsafe way, it really subjects you to have a lot of that material reintroduced to your body and lodge in some of your fatty tissues like your liver, like your brain. So, a lot of people that have gone to the internet have read and have asked me, “Well, doc.  What kind of protocol do you use? Do you use Huggins Protocol?  Do you use the International Academy of Oral Medicine and Toxicology? Do you use,” I don’t know.  There’s probably seven, eight different varieties. All of those protocols are good, but here’s where you have to start thinking. Here’s where you have to start developing trust in your health professional. A lot of times, because we get so involved in our head and we forget to really feel or trust or really get guided by something other than just our thoughts or the internet, we tend to choose the person who has the best protocol, but, really, you don’t take the eye out of the eight ball. What does that mean? The most important thing about a protocol is the practitioner behind it.

How meticulous is this person about implementing the protocol? A lot of people say, “Well, Dr. Huggins says you should never do this on Tuesdays and Thursdays.” Well, maybe. I’m not disputing that, but it’s much more important that you have a practitioner that’s going to put a rubber dam and make sure it seals really well. So, again, the important thing is that you have somebody you can trust that will do a good job for you, that you know is meticulous, that you know has your health as their primary concern.

So, the basics really is that the rubber dam is the key to this all, and has anybody had a rubber dam placed on them? Right, and so a rubber dam is just a physical barrier, and in our office, we actually place the rubber dam and then put a seal around each tooth in addition to that. Then, we actually pour water on the rubber dam to make sure nothing is really coming through. Once you’ve done that, and this is something you can ask your dentist to do.  “Could you check?  Could you put some water there to see if anything is leaking? before the amalgam gets taken out.

Then, the second part is a lot of the powder, a lot of the gas that is being produced with the heat of the drill, you also want to be protected about inhaling it. So, that’s again what I’m talking about is you guys using common sense, understanding what’s going on. It’s less important that you read on the internet that somebody has such protocol and more that somebody’s actually using oxygen, protecting what you’re inhaling, and protecting what’s going behind.

You can read the rest. So, a lot of the really proper protocol is to segment the amalgam so you’re not grinding it whole and taking them out by pieces. Some people have equipment that allow them to do that. In our office, we additionally use some homeopathy and some natural ventilation,  nutritional guidance, and we do quadrant dentistry. So, we place the rubber dam, and we actually remove everything by quadrants so we don’t have to be revisiting the same area over and over.

So, one of the interesting things is, well, you’re going to take them out.  You made that decision, “I’m taking my amalgams out” or “My amalgam’s out”.  “What am I going to replace them with?” This is a very interesting part of the process because there are basically two major way to replace an amalgam restoration. One is with composites and the other one is with some kind of a casted piece, and I will explain. The composites are basically powder, glass, and plastic. That’s what a composite restoration is. Those white fillings that are put in your mouth is basically powder, glass, and plastic. Most often than not, and so far in my research, I have found that just about every composite has BPAs with the exception of one, and I’ll talk about that one.

Then, the other possibility is the only one that does not have BPAs is a mix of a composite, what we call glass ionomer cement. Glass ionomer cement is a very, very good material. The only problem with that material is that it has fluoride. Now, here I’m being honest with you.  I’m talking candidly with you about what the options are. We live in an imperfect world,and you have to make good decisions. You’re going to have to make a decision about whether you’re going to go with the composite. Are you going to go with a composite that has BPAs or a composite that has some fluoride? No other option’s in the market.   So, when you’re making your decisions, you have to really understand there’s no perfect world.  There’s no perfect solutions when you’re using a composite.

As much as I am totally against the use of fluoride, here’s no fluoride in my office, the effects that I’ve seen with BPAs are quite a bit more devastating I think than the very minute amount of fluoride that is one this material, and the fluoride stays active for a short time. Then, it stops being active.  What do we use?  Which one of the two do we use? Well, it depends on you, your situation.

It depends on your condition, or do you not want to use either?   Well, you have another option, which is inlays and onlays. The advantage of an inlay and an onlay is that it’s a baked porcelain, significantly more stable, no BPAs, no fluoride. The big problem with that?  Yeah, they’re quite a bit more expensive.

Now, when you have a large restoration, in my book, there’s no choice. You can’t put a large composite that you’re going to be grinding down all the time. So, basically, that’s why. Then, when it comes to your inlays and onlays, there are different kinds of porcelains that you can use.  There are indirect composites, which are baked composites. Then, you have pure ceramic restoration, which is called bruxor crown.  Then, you have some combination porcelain inlays and onlays. So, when it comes to the onlays and inlays, here are your different choices. You have porcelain.  This is onlays and inlays as well as for crowns when you have to have a crown. You can have a porcelain fused to metal.   The different metals that you have is non-precious.  You can see what the non-precious contains, which is something that I would definitely not recommend. Precious, which people think is all gold, and it’s all grey. It also has some additional metals mixed into it. Gold by itself is a bit too soft, and semi-precious.

Today, I hardly ever use metal in the mouth.  would say that would be a very rare case when I would be forced to use a metal, and in that case, I would probably use just a metal, just a pure titanium, but most of the time, we don’t need to do them. We have bilayer type of restoration, which either are aluminum or zirconia oxide with veneer porcelain on top, or we have pure zirconia bruxor crowns, which are just pure zirconia crowns, which is really the advent of dentistry. This is the newest type of crown.

Any of this perfect?  No, and this is where I’m asking you guys to really understand what’s going on so that you can make good choices. I would say that if I had to use something in my mouth, I would definitely use either an onlay or a crown made of pure zirconia. That’s probably the cleanest material that you can find at this point. So, because patients are now demanding different materials, better materials, more biocompatible materials, dentists are responding.   People respond to demand.  Demand and supply.  If people start demanding biocompatible materials, biocompatible materials will be going through the pipeline.

So, more and more dentists are abandoning the old guard Okay, any questions about this so far? Okay, we’ll move on then.  Yeah?  Mixing of amalgams, of metals in the mouth? You mean having one tooth with one and one with a different kind of metal? Yes, that’s really not a good idea because the saliva will conduct electricity between them. It’s called galvanism.  So, to have two types of different metals, to have metals, in general, is not a great idea in your mouth. Two kinds of different metals is even worse.  So, thanks for bringing that up. Yes?

Yes, all those materials can be applied except, of course, the composites are only for fillings but the crowns and bridges can all be done with metal, metal fused to porcelain,  and porcelain by itself or pure zirconia, which is the bruxor crown. That is the different.

Yes.  Actually, when we remove the amalgam, you have a choice of either using composite or any filling can be replaced with a porcelain piece instead of composite. So, that would be the optimal, but obviously you have to factor in the cost at some point.

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How To Restore A Chipped Tooth (Infographic)

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11/13 Lecture: Holistic Dental Health (Transcribed)

We’re going to get to the final portion of our workshop.  I know that Dr. Smith and Caroll talked a little about dental issues as regarding to the Gerson Therapy before, and one of the things that you may have noticed although they didn’t come right out and say that is they don’t seem to have the greatest respect for the vast majority in the dental business because of a lot of things that they have done that have been very harmful to people with the best of intentions, many of them, inadvertently through bad knowledge that’s been passed on for a long time.

So, we’re very fortunate to have one of the good guys here who does not represent the majority of those in his field and who actually does recognize that they mouth is part of the greater human body and not something completely separate from it. So, please welcome Dr. Daniel Vinograd.

Thank you so much. It’s great being here once again. It’s not once again for you.  It’s probably your first time. Where are you guys from?  Can you give me, more or less, an idea?  US? Mostly.  Louisiana?  Wonderful.  Great, great.  Awesome. Well, it never ceases to amaze me how people from all over the globe will come together when they have a certain commonality, and so I’m very, very pleased to be with you guys today.

I’d like to start by talking a little bit about the internet, and why am I starting this talk about the internet? Most of my patients or the first time patients that come to see me have done a tremendous amount of research, mostly on the internet, right? So, the internet is a fantastic tool for us to gain information. However, we gain a lot of really good information from the internet, and we get a lot of really bad information from the internet.

So, we always used to say, “They said this…”, “They said that…” Who is they? In the internet, who is “they”?  Who is writing all this stuff?  Over the years, the people that are actually dominating the internet have gotten quite sophisticated. You have very, very smart people now helping people dominate the internet. So, who’s dominating the internet now? People that are savvy about how to work the internet. So, the information that is apparent on the internet is not always the best. How do we know what is good information and what is bad information?  [That is the key.  Does that mean that we say, “No the internet is evil. I’m never going to go back there again” because it’s got a bunch of lies and information?

Of course not, but it is really important for us to have awareness. Again, the patient’s coming to see doc.    “I read this on the internet,” like it was absolute.   So, we have to backtrack a little bit and say, “Well, where is the information coming from?” How does that fit into your reality?   So, the most important thing that I want to do today, if I’m successful, is I to give you some tools so that you guys can all make sense of what you’re reading, and you can make up your own mind as to what is good information and what is not.

What you don’t know so that you can ask the right questions, that you have the solid knowledge of what it is that you’re going to learn, not only to trust people around you. When you start hearing them talk, you can start separating reality from fiction. You can start separating people who are giving you information  versus people who are trying to sell you something, and most importantly, when can you really trust your own instincts, which is an incredible source for each one of us.

We have an incredible amount of evolutionary intelligence in each of our bodies that we can tap into. So, I would encourage you to tap into that.  Don’t disregard your instincts. Also, start trying to understand who it is that we can trust, and who it is that we can’t. So, I practice what I call biological dentistry, and why do I call it biological dentistry? Because there’s holistic dentistry and amalgam-free dentistry and there are all these terms that have been coined, but bottom line, a dentist will see himself as either a business person,

I know a lot of dentists who are basically just business people. Some of them have large clinics and manage them. I’m not judging anybody.  I’m just basically identifying that they are mostly interested in the business aspect of it.I know a lot of dentists who are incredible engineers.  They’re technicians.They can do a lot of really fine work. There are other dentists who are incredibly caring human beings, and they’re all the combinations above.

In my view, what is a dentist? In my view, a dentist really should be a healer.  Right?   A dentist should be a person that is helping you heal and that is treating you like any other specialist with a certain part of your organism that is actually connected to everything else.

So, for us, and I’ll tell you.  When I came out of dental school, I was treating mouths. I wasn’t treating patients.  I was treating mouths because this is the focus of my training. My training is you have tooth number 18 MOD. This was the lingo.  You have, wait a second. Did we forget that there’s a person behind that?  So, overtime, I have to be honest with you.  When I first started practicing dentistry, it was dissatisfying to me until I finally realized it’s not about a crown. Of course, it is about a crown, but it is not just about a crown. It’s about treating a person, and how is this crown going to affect everything?

So, having said that, I will talk about what is happening with dentistry as a whole. So, from its inception, dentistry has been looking at the repair business of the mouths. So, how do we repair a mouth?  How do we actually take are of broken tooth? That was a big challenge because materials were really not great, and so, the biggest challenge was how do we get something that’s strong enough? I mean, can you imagine the forces that we put on a mouth? Masticational forces.  That’s tremendous. If you’ve ever had a high spot in your mouth between your upper and your lower teeth, you know that can get sore in a hurry because you’re putting incredible amount of pressure in a very, very small area.  You have a lot of muscles.

You have a lot of functional apparatuses that are working towards really grinding the food down. So, it’s very challenging to actually get a material that is going to withstand for many years the masticational forces. So, a lot of the people were really talking about materials that are strong that resist friction, that resist compression.

So, I have a very good friend who was the head of Dental Materials at UCLA, University of California, Los Angeles, and I would always hear him talking about all the research that’s been done about the elasticity of this material, about how this material compares to the expansion and contraction of the tooth, and there was really no regard at all to the physiologic effects of what we’re putting in people’s mouths.

I understand where they’re coming from. They had this huge challenge from an engineering point of view, and they’re just putting their energy and effort into it. Unfortunately, again, we were forgetting we are talking about human beings. Case in point, dental amalgams that a 50% mercury.  I will talk about that a little bit more. They were actually trying to see how they could actually take child’s tooth, and treat it so that they maintain the tooth after the nerve has been infected. The solution?  Formaldehyde.  It’s a form of cresol.  Highly carcinogenic. It’s still being used today, but it actually modifies the nerve. The problems go away.  Obviously, we’re creating a huge amount of new problems when we start using a lot of this.

Root canal sealers were among the most toxic materials as well.  We fail to see the connection between the mouth and the rest of the body isn’t really affected by a lot of materials that we use. Also, by the bacteria that we have in our mouths.  A great deal of information today about how bacteria in the mouth affects the rest of the body.  We’ll talk about that as well.

I will start with mercury amalgams because this is something that I think has been out in the media quite a bit, and it’s really affected a number of us. Anybody ever have amalgams placed in their mouth before? Right.  So, just look around you.  It’s just about everybody, and why were those amalgams placed again? Amalgam is a wonderful material if you’re just looking at a robot where you’re going to put something in physically.

In 1833, there were a couple of French guys that came over to the US and brought amalgam. Then, in 1844, the amalgam was just widely used. In New York, it was used as the restoration of choice. There was a great group of brilliant people, the American Society of Dental Surgeons, that came out, and we’re talking about 1844. We’re not talking about 2010 or 2013. They said, “Wait a minute.  This amalgam is filled with mercury. It’s 50% mercury.” So, they actually were the most prestigious dental group in this era, and they actually said, “If you want to belong to us, the most prestigious organization in the nation, you have to sign a contract that you will not use amalgam.” Brilliant.  Here are our first heroes, right? You could put a cape on them and a big S or whatever you want to put, a big D.

Unfortunately, in 1856, they were disbanded, and the American Dental Association was founded. They were a little bit of an opposition group, which really was proactive in promoting dental amalgam. There was a large group within them that was the American Amalgamists Association that was really driving a lot of this amalgam proposing.

You should know that mercury’s one of the most toxic elements known to humans, and I think most of you know that.   When you think about 50% of the amalgam is mercury, it’s mind boggling, but people that are proponents of amalgam say,  “Yeah, but the amalgam gets fixed.  It gets set with the silver. So, it becomes inactive.” I’m not sure I buy that, and even if I would buy that, I’m not sure I would put it in my mouth or anybody that I care for or any of your guys’ mouth. Just in case, they’re wrong.

Here is from the Department of Health and Human Services. They are actually considering mercury to be the third most toxic material known to man. This is not me.  This is not some kind of a health-oriented healer talking.   This is the government of the United States. So, in the 70s, yeah I go back that far and a little more. In the 70s, I started asking my colleagues, “Guys, this is 50% mercury. Are you concerned at all that your putting this in people’s mouths?”

Most of them were good people, honestly, good people, well-intended people. A lot of them came out wanting to help people out in the healing profession. So, I don’t think there was a lot of mal-intent where they said, “I’m out to poison people,” but a lot of them had a mindset that was different. The mindset then was anybody who’s proposing that amalgam is toxic or shouldn’t be used is a quack, and this is mostly what I got from them when I spoke with them. So, you don’t have to take my word for it. You don’t even have to take the government’s word for it.

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Invisalign vs Braces (Infographic)


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The Best Toothpaste is Homemade Toothpaste (Infographic)

the best toothpaste recipe

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Root Canal: Holistic Commentary on Dr. Mercola’s Video


Dear Dr Mercola:

I have followed your work with great enthusiasm over many years and appreciate the tremendous impact you have had through education and good product availability. I am also a Weston Price fan.

I stopped doing root canals in the 80’s when I became aware of the great deficiencies with the treatment and the repercussions of traditionally treated teeth.

I just finished watching your video on root canals and wanted to share some thoughts:

-If my patients decide to extract a tooth that is infected or has existing root canal I provide the following information about their options:

a) No replacement. Sometimes the best option depending on the location and function of the extracted tooth: Often a second molar with limited occlusion.

b) Replace with a removable bridge. Cost is low but quality of life not great.

c) Fixed bridge- no metal. Good option when adjacent teeth already have large restorations.

d) Maryland Bridge. Also a fixed bridge, requiring much less destruction of adjacent teeth. Works well in most instances, but may have to be re cemented on occasion.

e) Implant. I use Bicon implants, which are much less invasive due to their design, but are titanium. the alternative is Zirconia implants, very bio-compatible, but not without problems: large in size and one piece only, which requires more aggressive bone removal for placement have less osseo-integration and can suffer micro-fractures, because the often need to be reshaped in the mouth with a bur.

-I often have patients do a serum test that will give me the bio-reactivity of each patient to hundreds of dental materials, and will use bicons when titanium is not one of them.

-On the question of galvanism (electrical currents moving through the saliva due to dissimilar metals in the mouth) it is a non issue with titanium implants, since the titanium is integrated and surrounded by bone, and fully covered by a ceramic restoration.

-Having said all of the above, I now offer to perform bio-compatible root canals and here is why:

a) The main issue with traditional root canals is that he materials used, were toxic, hydrophobic and failed to properly address the issue of disinfecting and sealing the main and the accessory canals inside the tooth.

b) Today, we can more aggressively remove infected tissue with accurate computer driven rotary instruments. Can disinfect the canals with ozone and most importantly, can seal them with bio-compatible, osteogenic and hydrophilic  materials. The material I use, BC sealer has a ph of 12.8 and does not solidify and maintains this ph  or 24 to 48 hours, sterilizing the main and accessory canals. In addition, because it is hydrophilic, it tends to expand with the natural moisture from the surrounding tissues and created a seal, not allwoing the mini pockets that would host bacteria in the past with the use of hydrophobic sealers. Finally, it has osteogenic properties, which further help create healthy tissue inside and  around the tooth.

I have been performing these procedures selectively (I still would not perform this procedure on a severely immune-compromised patient) for over 5 years, with great results, monitoring the local as well as systemic effects in my patients.

If you have further interest on my views on this topic, I have uploaded my latest talk at the Gerson Institute on my website: http://drvinograd.com/holistic-dentist/june-2013-holistic-dentistry-biocompatible-protocols-lecture-to-gerson-institute/.

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Dr. Mercola Discusses Root Canals (Transcribed)

See Dr. Vinograd’s remarks next week here: Root Canals (commentary) & Podcast on the subject Episode 3: Root Canal.

Hello, this is Dr. Mercola, and it’s always been surprising to me how even physicians fail to appreciate how important the mouth is and the health of our teeth is to our total health.  If you’ve been following this site for a while, you know we’ve been placing great importance on the dangers of mercury in dentistry and how it should be avoided.  In fact, there is now way, I think, it should ever be used.  You just need to avoid it like the plague because it is a potent neurotoxin.

It’s a potent biohazard and should not be available, but is this the only problem with having proper dental health?  Unfortunately, the answer is no because if you suffer with a chronic disease, it’s really important to understand there’s a factor in your illness that could be a result of root canal surgery.  That is because every year in the United States along, 25 million root canals are done, and nearly every dentist and physician is oblivious to the potential health risk that this operation produces.

I’m going to discuss the challenges with root canals.  This is somewhat controversial, but I believe it’s important.  I’ve known about this information for 20 years because it’s really vital to understand that over 95% of all dentists and physicians do not understand this issue because they have avoided this research that been available literally for over 100 years.

Fortunately, because I was educated about the dangers of root canal, I have been able to avoid of them my entire life.  Interestingly, after I learned about, I wound up having an infected tooth that was seriously infected that had to be surgically removed.  Now, traditional dentistry would have recommended root canal, now the interesting this is that I was about 40 years old during that time.  During my entire adult life, up to that point, I suffered from severe acne, chronic severe cystic acne that I tried everything for, and it wasn’t getting any better.  The moment, I had that tooth removed, the acne disappeared.  It was just like a miracle, which is pretty interesting.  For me, it made a very remarkable change in my own health.

Now, you might be wondering, “Well, Dr. Mercola, how did you get an infected tooth?”  Well, the challenge is, and really, if you’re a parent, you have to understand this, the reason that you get infected teeth or the beginning of that is because of your diet.  Dr. Price found that in his extensive research is all of that.  If you’re eating a healthy diet that’s essentially avoids sugars and grains, full of good vegetables, and healthy foods, and you’re avoiding the toxins, you just are aren’t going to get cavities.  If you look at cultures that are eating ideal types of diets, you’ll see that cavities are almost non-existent in that culture.  That’s what happens here.  So, parents, you have to be good with your kid and teach them these principles, so they can avoid these problems and complications in life.

Getting back to my own experience, I have two additional teeth removed since.  What I did initially with the first tooth is I had a partial put in, and then it was switched to a bridge.  So, I had two bridges, and I’m in a transition now to have an implant.  It’s actually a very special metal called zirconium, which I believe is far better than titanium.

Fortunately, I’ve had early mentors in this area, Dr. Tom Stone and Dr. Douglas Cook who was a biological dentist in northern Wisconsin.  They taught me this information about 20 years ago so I’ve been able to apply it to my own health personally and avoid root canals and recommend all my friends and family to avoid them, and I recommend you to consider avoiding it, too.

I’m going to provide you with the information, the material, the knowledge that you need to make that informed choice.  The pioneer in this work, in the toxicity of root canals, was actually done by Mayo Clinic and Dr. Weston Price.  They did this jointly back in 1910, over a century ago.  Now, Dr. Weston Price was known as the world’s greatest dentist.  He was a diligent researcher, and his work was revered by both the dental and medical professions.  His work took him around the world where he studied the teeth, diet, and bones of the populations without the benefit of living with modern food and avoiding the processed food.  He did 25 careful and impeccable researches, and he actually led a team of 90 researchers where their findings mark up there with the greatest medical discoveries of the 20th century.  Unfortunately, his information and the information he found out has been largely suppressed.

This all started because around 1900, Dr. Price had been treating root canal infections He became suspicious that these root canal teeth always remained infectious even though he treated them like all the other dental physicians did.  That thought kept preying on his mind, haunting him each time a patient consulted him for some serious debilitating disease for which the medical profession had no answer.

Then, one day, he recommended that a woman, who had been wheelchair bound for six years, have her root canal tooth extracted even though it looked find.  He then removed the tooth from the woman and implanted in under the skin of the rabbit.  Interestingly, the rabbit developed this similar, crippling arthritis, and in 10 days, the rabbit died.  Even more profoundly important is that the patient has spontaneous remission, and her crippling arthritis resolved, which was really quite profound.

So, Dr. Price came to learn that many chronic degenerative diseases can originate from root filled teeth, and the most frequent that he found were heart and circulatory diseases.  He also found 16 different bacterial agents that can contribute to that.

In Dr. Price’s time, it was not that easy to culture and identify these bacteria (they were anaerobes) because the technology did not exist in the 1920s.  Most of the bacteria that were recorded by organized dentistry during that time were of unknown origin, but today, there are far more sophisticated techniques like DNA analysis.  So, these bacteria can actually be very specifically identified.

The second most common diseases were those of the joints, arthritis and rheumatism.  In third place, almost tied for second, were diseases of the brain and nervous systems such as MS.  After that, any disease that you can name might have actually had a cause from root canal-filled teeth.  There may be the actual position of the tooth and the acupuncture meridian it occupies.  So, root canal tooth in one area may cause one symptom where, in another area, another area of the jaw would cause another symptom.

So, Dr. Price learned that primitive tribes with ideal nutrition, avoiding all processed foods, had perfect teeth without cavities or gum disease.  As soon as these natives, though, started adapting to the Western advanced types of diets of the advanced nations, their teeth became deformed, full of cavities.  They had gingivitis.  They started getting diabetes and all the other diseases of Western nations.  So, it was obvious to him that human degenerative diseases where fundamentally a nutritional problem.

So, he discovered, that it is mechanically impossible through this process to sterilize a root canal tooth which most dentists believe, that you can physically sterilize.  Dr. Price learned that it is impossible, and I’ll tell you why.  No matter what material or technique Dr. Price used, the root filling shrinks minutely and even microscopically, but it does shrink.  This shrinking prevents the inner canals from being sterilized.  So, this is the key:  Because of the bulk of the solid-appearing tooth, called the dentin, which consists of miles of tiny tubules.  This is what we believe now, but what’s taught in most dental schools and what most dentists believe is the tooth has only one to four major canals.  What they don’t appreciate and what’s not taught in dental school and is never really mention is these accessory canals.  Dr. Price identified as many as 75 accessory canals in a single tooth.

Now, this is the where the issue is because these microscopic organisms, typically aerobic bacteria reside in these tubules, and they fail to become sterilized because there’s essentially three miles of these tubules.  If you lay them end to end, there’s three miles of them.

When the tooth is sterilize is the root canal is formed, you create a different environment, and this environment is actually isolated from the normal environment of the body.  As a result of the oxygen presence, these bacteria which require oxygen actually mutate and morph to these dangerous anaerobes.  It’s bad enough that you have these mutated bacteria, but what happens is that these bacteria produce toxins.  These toxins can be released every time you chew.

So, what many people fail to realize is that a root canal tooth has no fluid circulating through it, but the maze of these tubules, these three mile tubules, remains.  So, these anaerobic bacteria that live there are remarkably safe from antibiotics.  You cannot kill them even with IV antibiotics because there’s no way for these antibiotics to reach them.  The bacteria migrate out into the surrounding tissues where they can hitchhike to other tissues in the body, and the new location can be any organ, gland, or tissue.  A colony will be set up which serves as a focus for chronic infections.

One of the things that makes it difficult to understand is that there is a large amount of relatively harmless bacteria common to the mouth.  They change.  They actually morph, and they adapt to these new conditions.  So, they shrink in size in these crammed quarters.  They don’t have the normal oxygen supply, and they morph.  They learn to exist and thrive with little food and little oxygen.  So, that need oxygen, these aerobic bacteria mutate, and they are able to get along without it, essentially changing into these anaerobic bacteria.  In the process of adapting, these formerly friendly normal organisms, become pathogenic, capable of producing disease bacteria, and they become more virulent and produce potentially very serious, potent toxins.

Now, Dr. Price’s important research completely alters the way we must now think how diseases develop and disappear.  Now, these root canal teeth don’t affect everyone.  This is a concept that I want you to understand because if you have a strong immune system, you may remain in perfect health for many years, even decades after root canal surgery.  Dr. Price learned that if you have a strong immune system, it’s capable of engulfing the bacteria in infection so that they are stabilized and are prevented from entering other sites.  However, once your immune system becomes compromised because of a severe accident, stress, or infection, your immune system can become so compromised that it can develop a degenerative disease because it is unable to control these pathogenic bacteria.

Interestingly, there’s no other area in medicine where a dead body part is kept in your body.  If you have your appendix, the surgery preserve it and keep it in there.  It surgically excises it and removes it.  God forbid, you were to have frostbite in one of your digits, in your finger or toes, we certainly want them to keep that toe or finger, but that’s not what happens.  If there is severe infection, it is amputated.  So, once a body dies, no matter how important it is, it is typically removed from the body except for your tooth because the standard of care in dentistry is to keep and preserve tooth structure.  There’s an important component to that because we definitely want to keep our teeth.

If you remove a tooth, you have to do something to address that because there will be a mechanical dysfunction that results from an absence of a tooth, but you don’t want to keep a dead tooth in your body, largely because the anaerobic bacteria in root canal teeth are flushed into your blood stream every time you bite down.  The start looking for a new home.  As I said, if you have a healthy immune system, this is not an issue, but the moment your immune system becomes compromised, look out.  You’re going to have a potential problem.

So, you create this permanent abscess in your body with this root canal operation, and it sets you up for some potentially serious degenerative diseases.  Whether these diseases occur shortly after root canal surgery or if they occur much later in life depends, again, on the health of your system.

Dr. Price wrote to incisive books in 1922, and they were nearly 1200 pages long about this research.  It covered not only this research but human health and dental conditions that were important enough, so much so that he should have won a Nobel Prize, but unfortunately, he didn’t.  Unfortunately, also, the American Dental Association denies his findings and claims that they have proven root canals to be safe.  However, they have no published data or actual research on this.  So, his work seems to have been deliberately buried, unread, and unappreciated for about 70 years.

At that time, there was an endodontist, a root canal surgeon, by the name of Dr. George Meinig.  Dr. Meinig was actually born in my hometown, Chicago, and he was born nearly 100 years ago.  He moved on and eventually became a captain of the United States Army during World War II then moved to California, Hollywood and became a dentist to the stars.  He practiced root canal therapy there, in Hollywood, and he actually taught this subject to others in the dental profession.  He eventually became one of the founding members of the American Association of Endodontists, and that’s the professional association for root canal therapists.

However, in the early 1990s, Dr. Meinig, in development with the Price Pottenger Nutrition Foundation, spent 18 months of intensive study of the meticulous 25 year root canal research that he found in Dr. Price’s book on dental infection.  In June 1993, Dr. Meinig published the book Root Canal Cover-up.  This book is still available on Amazon today.  If you want to pursue this topic in more detail, I strongly recommend that you pick up a copy of that book because it has all this information and goes into much more detail that I can on this video.

So, if you’re convinced, let me just say that I strongly recommend that you not have root canal therapy.  If you have one, let me caution you that there are specific areas that you need to be concerned about before you remove a root canal because you can make it worse.  As I said, I don’t believe anyone should ever get a root canal, but if you are considering one, you have to do your homework on this issue.  You can listen to this video again.  You can get Dr. Meinig’s Root Canal Cover-up, or you can go back to Dr. Price’s original research.

So, if you have one, you’ll still consider removing it because, remember, the immune system starts to crash, the likelihood that you’re going to potentially encounter some degenerative diseases increases.  You options, if you’re going to remove it, are quite simple.  You can either have a partial denture made, and that’s a little tooth that you place in and out.  That’s a partial because it’s not a full denture, and it would contain however many teeth were the root canal teeth.  There’s an upper and lower one you would use.  That’s the least expensive, and it’s also the least convenient.

The other option you can have is called a bridge.  Bridges are considerably more expensive. They typically destroy the adjacent teeth and create this bridge which looks like a normal tooth but there’s a space underneath between it and your gum.  Then, you have to regularly floss with it.

The last approach that you can use is an implant.  There’s some potential problems with implants.  The typical one uses titanium.  One of the concerns is that you have multiple types of metals in your mouth.  So, if you have titanium, and you have metal or a crown or a filling, that metal can form a battery between the two dissimilar metals and that cause a current that exceeds the current in your brain.  You want to be careful about putting that.  That’s why my favorite is the zirconium, but you really need to see a dentist to understand who’s knowledgeable, who’s trained in this.  Certainly, all dentists are trained in the therapy, but they’re not trained about the specifics of root canal danger.  So, you need to see someone who’s concerned about biological dentistry.  We’ll have some links for you on this page to find those dentists.

Remember, just pulling the toot is not enough.  Another interesting thing that Dr. Price found is that the bacteria in the tissues adjacent to the root canal can also be a problem because they just don’t reside on the tooth.  They permeate around the immediate tissue.  So, dentists are generally taught to remove a tooth and leave the periodontal ligament in the socket in a procedure similar to delivering a baby and leaving the placenta in the uterus.

Most experts now recommend slow drilling with a burr to remove one millimeter of the entire boney socket so you can get rid of those bacteria because there’s a risk that that bacteria can actually develop a cavitational necrosis.  The purpose of this is to move the periodontal ligament, which seems to always be infected with these toxins and the bacteria.  It is typically a Streptococcus that is living in these dental tubules.  So, again, the first millimeter is typically removed with a slow drill.

So, this is in direct contrast to what most dentist learn in dental school, which is to save the teeth, to perform a root canal to save the structure.  They really do think that they are doing the best they can for you, but they are unaware of the research that Dr. Price did.  If they are aware of it, they’re convinced that the American Dental Association knows better and has disproven this when they haven’t.

It’s really an important topic.  When I was practicing medicine, if a person came in, we would routinely look for anyone who’s had a root canal.  It didn’t mean that they had to remove it at that time, but it was always a factor that we would consider that could be a hidden variable that we weren’t aware of that would prevent the person from achieving their highest level of health.

So, it’s really an important information to have.  Most people are not aware of this.  Hopefully, this information will start to spread.  People will be knowledgeable that this could be one of the hidden factors that may be contributing to any degenerative disease that they’re having because it’s the paying attention to details that we need to have to find out the mysteries so that we can truly take control of our health.

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Inflammation and Oral Systemic Connection P3

Some of your patients are already at risk for developing diabetes.  They may be type II diabetics already, or they may be prediabetics.  I learned a couple of years ago from Dr. Bale that diabetes just didn’t happen.  He tells a story, and I’ll say this very quickly.  Dr. Bale tells a story prior to the Bale/Doneen method that went to the hospital, had a heart attack, recovered from the heart attack, came back home, and in describing his experience at the hospital as fine, but said, “Guess what?  While I was in the hospital, I was developing diabetes.”  It happens all the time, but what Dr. Bale will tell you that you don’t develop diabetes in the hospital.  This is a 10-20 year evolution.

Some of our patients are prediabetic or already diabetic.  If you know what to look at in your patients’ oral health, you can diagnose 73% accuracy prediabetes or diabetes looking at the right parameters by doing a good oral health exam.  We’ll explain what that is, probably 5 minutes to be that accurate.  One simple test at that, you as a health practitioner can accurately diagnose with a 92% accuracy prediabetes or diabetes.  This is incredible information.  It has now been published, and we need to know about it.

So, how about your patient’s attitude?  How will this change your practice?  Will I have time for this?  Will it help my practice?  Will it hurt my practice?  Let me show you that these studies have already been done.  Patients that have gone through this screening, in other words, medical screening in a dental setting both in the private dental world and in the educational institutions, patients’ attitudes when dentists get involved in general health is extremely positive.  We’ll discuss what patients said. We’ll discuss what the literature clearly says about the powerful positive impact of bringing this kind of information to practice.  It grows your practice, and it also grows your reputation as a health care provider in the entire community to our practice.  Very positive there.

The last slide that I will show you is don’t forget yourself because your lifetime risk is the same as everyone else.  All of us, as human beings, have a lifetime risk of developing coronary heart disease.  If you’re a male and you’re 40 years or older, your lifetime risk of developing coronary heart disease is almost 50%.  You have a 1 in 2 chance of developing some kind of coronary disease.  I will tell you this, though, that Dr. Bale will tell you that this is preventable if you know what to do and you are looking at the right things and you are in the right position.

If you are a female, you have about a 32% risk of developing coronary heart disease.  Just looking at that risk that should be motivating for all of us to determine what our level of risk is because risk factors are equivalent to greater risks.  Risk factors like diabetes don’t just occur suddenly.  They occur in younger individuals, and it’s only once we get into our 40s and 50s decades that these risk factors ultimately culminate into the event.  That’s what we want to prevent.

So, in this course, you’re going to learn from two experts that deal with heart attacks and strokes and diabetes on a daily basis.  You’re going to look at your own health and determine if you are at risk.  You’re going to look at the health of your spouse, the health of your children, the health of your parents, and the health of your whole extended family.  So, please come to this course for your own personal reasons.  Also, please come to the course to learn about how you can protect your friends that are your patients.

It’s been a great privilege for me to be a part of Dr. Bale and Ms. Doneen’s work, and I guarantee you that this will be the most important course that you have ever attended. So, thank you Dr. Bale for your work and nurse practitioner Doneen, and thank you also Crown Council for the wonderful work that you guys are doing.  Please consider adding this important work to the causes that you are so good at doing.  Thank you.

Dr. Bale:              Dr. Nabors, thanks.  Amy and I feel indebted to Dr. Nabors because we’ve been aware of the connection for a lot of years, working with our patients to maintain oral health, but we ran into Dr. Nabors because he was able to really objectify the bacterial burden with the testing he brought to the United States with the salivary diagnostics.  So, that move we were doing went on to a much more solid platform of objectivity for our work to prevent heart attacks.

I’m going to fly through the next four slides because I want to leave a full 15 minutes for Q&A and basically just say I’m very excited about the potential for more oral medicine specialists in this country.  We need them.  We deliver a two-day course for medical providers and dental health providers come to that, and they’ve always been pleased when it happens.  That’s why I come to San Antonio now.  We have medical providers that will be attending our two-day course coming up.  After they go through our course, then they’re much more aware of the oral systemic connection, and they need to partner oral medicine specialists.  I had a patient who needed to find an oral medicine specialist to partner with, and he lives in Phoenix, Arizona.  We found somebody who wants to leave where they’re working.  They’re celebrating, testing.  We need more fighters out there.

Anybody coming to the November 2nd course is going to leave that course being able to call themselves an oral medicine specialist, and medical providers who through another course will certainly need to collaborate around the country with you in the effort to maintain cardiovascular wellness.

So, we do need to rewrite the American Heart Association impact goals for the current decade.  Ideal cardiovascular health equals the absence of clinically manifested disease and optimal control of oral health.  So thanks again for being in on the call.  I’m excited about what you’re doing.  I appreciate all your help in preventing cardiovascular events in this country.  So, thank you.

Caller 1:               I have a few questions.  The first one is, how do you suggest that periodontal disease should be defined?  Please address active versus inactive periodontal disease, controlled versus uncontrolled.

Dr. Bale:              Dr. Nabors, do you want to take that?

Dr. Nabors:         Well, I would certainly love to, but I would say that those who are listening may think I’m biased.  So, Dr. Bale actually has case studies that show the relevance of what we’re trying to do together.  So, I would actually ask you Dr. Bale to answer that question.

Dr. Bale:              Yeah.  I think any definition of periodontal disease certainly has to include bacterial burden and certainly the bacteria we currently know that carries a huge risks such as the Porphyromonas gingivalis, Tannerella forsynthensis.  We know these periodontal Gram-negative bacteria can drive arterial inflammation, and they could do it in several ways.  Certainly, one of the ways that’s well-defined at this point is through the lipopolysaccharides that are created by these Gram-negative germs, and they stimulate toll-like receptor forms, toll-like receptor 2, which are critical drivers of the inflammation in our arteries.

In addition to that, several of these bacteria have been shown to increase the permeability of the inside lining of the artery, as you know, called the endothelium.  When you increase the permeability of the endothelium, you’re opening up the wall of the artery for injury.  So, I think any definition of periodontal disease has to address bacterial burden, and we do have excellent tests for that now.  The bacteria are clinical, and they could certainly be sub-clinical.  I do have a case I’ll be talking about in our course where he had subclinical periodontal disease in term of attachment loss and pocket depth.  You would give him a gold star, but the more sophisticated salivary test showed that he had a very significant bacterial burden, and he had arterial inflammation.  He’s a very high-risk patient not only for heart attack but also for ischemic stroke.  A critical part of getting his artery cooled off was addressing his periodontal bacterial burden.

Dr. Nabors:         May I add to that, too, Dr. Bale?  I think we certainly want to encourage any practitioner to follow the ADA guidelines as well in defining periodontal disease, especially on bleeding and pocket depth.  Unfortunately, we don’t have a perfect way of diagnosing periodontal disease.  We do have a classification system, not a diagnostic system.  The classification system must involve the ADA I, II, III, IV, V or the AAP classification.  Either one works.  Most of us use the ADA but bother are important.

What Dr. Bale is saying is that when you add the bacterial burden to it simply increases the level of risk, most for bone loss, and certainly, the level of risk for us that may be at risk for heart disease.

Caller 1:               What is the best way to teach this information to a patient who doesn’t feel or see any impact of periodontal disease?

Dr. Bale:              Now, let me take that.  We will be addressing that in a big way in our November 2nd course.  My partner, Amy Doneen, will spend a whole hour addressing how you communicate with patients the potential cardiovascular risk.  We have ways where we’re going to talk about how you can educate the patient.  We have an acronym or a method called EDRA, and the E stands for education.  So, we have great terminology, and Dr. Nabors has developed the terminology along with us that you will be able to utilize that the patient will understand.

For example, at the endothelium we’re talking about, the inside lining of the artery, you let them know that’s the tennis court, and how hot it is and permeable it is, is the most important thing you can know about your cardiovascular health.  We have ways of identifying subclinical plaque in the wall of the artery.  Actually, some of that testing will be available at the course for individuals.

If you want to find out about your own potential risk, whenever we’re addressing an audience that we’re teaching, we always let them know they’re the most important people in there, not the patients, because if they don’t take care of themselves they’re not going to be taking care of any patient.

So, a lot of people that come to our courses inadvertently find out, “Hey, you know, I got a little risk, but at least I found out before I had an event.”  We’re actually going to do two simulated visits as part of the course, as part of the CE we applied for.  We’re going to have a patient visiting a dental professional, a patient visiting a medical professional, and how you communicate to the patient and how the dental provider communicates with the medical provider and how the medical provider communicates with the dental provider.  All that communication.  Whoever has the communication, they’re right on the money.  If you don’t know how to educate, you don’t know how to communicate.  That’s your death.

Dr. Nabors:         May I add something to those wonderful comments, and that is our own Steve Anderson will be there as well.  At the end of programs, Steve is going to talk to us about implementation and how we can discuss this in terms our patients can understand.  So, we’re really looking forward to him being there.

I would also like to add that if I understand the question and that is sometimes our patient may be reluctant to do a test, we certainly understand that because testing is very routine in the world of general medicine and not as routine in our world, but Dr. Bale and Ms. Doneen are going to present some unique cases wherein they not only use serum risk factors where they were looking at specific markers that indicate risk.  They also discover from using the salivary test.  Sometimes, it’s actually the bacterial burden that tips them off.  Is that not right Dr. Bale?

Sometimes, there’s cases where the salivary test actually help to find what you’re treatment is going to be, right?

Dr. Bale:              Absolutely.  The patient I saw yesterday that flew in from Phoenix to see me has got a periodontal issue, and we discovered it.  That’s why I had to find a dentist quickly, an oral medicine specialist in the Phoenix, Arizona area, and we were able to do that.  He flew back yesterday, and he’s probably calling the office right now to make an appointment.

Caller 1:             I have a question about that.  May I ask if you may talk a little bit about where the access is to doing the saliva test.  My members want to know if that’s available to them, and can you talk about that?

Steve:                   I’ll weigh in on that.  Dr. Nabors pioneered one of the earliest salivary tests today in the brand Oral DNA, and you can go on the internet, just search for Oral DNA.  The supply’s ordered through Henry Schneid.  The supplies, you take the salivary sample, send in your oral DNA, and then the results are provided online.  So, Dr. Nabors has been very closely involved with Oral DNA for several years, founded it and developed the whole system.  I believe, Dr. Nabors, that would be considered the standard but not the most-widely used salivary diagnostic test?

Dr. Nabors:         Yes, that is correct, and thank you Steve for doing that.  Please be aware, too, that everything is HIPAA compliant.  The laboratory’s completely [1:00:36], and Steve said they’re very easy to get and start doing that.

If you have questions, you can e-mail me at TNabors@baledoneen.com. Even though I’m not associated directly on day-to-day basis, I’m certainly very interested in learning how you can add value to the dental experience.

Steve:                   If I could just weigh in on how you raise patient awareness.  I’ll just give this one quick tip that I would say to the vast majority in the Crown Council.  For years, we passed a hurdle when you diagnosed periodontal disease in a new patient, you would simply ask, “How long have you had this infection?”  The response from the patient will always be, “What infection?”  When you show them, they commonly respond to this, “It doesn’t hurt.”  Your response to that is, I’m always amazed, “An infection this serious doesn’t hurt until it’s too late.”  Then, the next step in that, where medicine and dentistry come together, is to ask the patient who they know that heart disease or has high cholesterol, high blood sugar.

Of course, everyone know someone that has one or more of those conditions.  The response to that is periodontal disease is similar to those except they don’t hurt until it’s too late.  That’s why when we see the signs of it, we get very concerned, and want to get it treated before it’s too late.  Most people can relate to that because they’re very familiar with the other conditions.  When you frame it in that way, it makes more sense.  That’s a short answer to an obviously more-involved way of presenting things, but for those that may not be familiar with that, that’s a quick introduction and quick review.

Listen, Dr. Bales, Dr. Nabors.  Thank you again for sharing.  You accomplished the near impossible.  I asked the two of you to cram two days into one hour.  I appreciate you completing the task and making everyone aware of the resources that are available in your course that you’ll do November 2 in Las Vegas.  If you would like to know more, it is definitely a direction that dentistry is going rapidly.  We appreciate your pioneering work in educating all of us in how to take care your practice in that direction to better serve our patients.  So, thank you again for being with us today, and thanks for all the Crown Council members for being here in our webinar today.  We wish you a great day.

Thank you!

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Dr. Vinograd’s 3rd Lecture on Holistic Dentistry at The Gerson Institute

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Inflammation and Oral Systemic Connection P2

So, there is evidence that periodontal disease can actually trigger cardiovascular events.  Well, there’s a wealth of information out there.  I’m just going to bring up one brief study that I think is simple to explain and has a huge impact.  They looked at 628 at Pima Indians, and they used the Pima Indians because there’s a very low rate of cigarette smoking in that tribe.  They wanted to see if periodontal disease has any risk on these individuals dying of cardiovascular disease over a period of time.  Within 11 years, about a third of those individuals dropped dead; 204 died.

They sorted out the cardiorenal deaths, which was a majority of the deaths, and what they found was a bit shocking.  If the patient had no or mild periodontal disease, no Pima Indians suffered a cardiorenal death, none.  There were zero deaths if that was the case.  If they had severe periodontal disease, they were three times more likely to suffer a cardiorenal death.  Again, they made multiple adjustments for other potential risk factors.  That’s a very impressive study that periodontal disease is associated with the risk of cardiovascular events.  We’ll, of course, present additional evidence in that regard.

Do we have any evidence that periodontal treatment can actually impact cardiovascular risk?  There’s a wealth of that information as well.  The one study to talk about today deals with type II diabetics, 371 of them, and about half of them received excellent treatment for periodontal disease.  The others did not get treated, and they looked to see if it had any impact on the overall sugar control, the A1c.  The ones that had treatment had a very significant drop in the hemoglobin A1c of 0.4%, demonstrating much better glycemic control, which is related to cardiovascular risk.  In our course in November, we’ll talk about additional evidence in that regard.

So, what did the American Heart Association conclude in that highly publicized paper in April?  It was published in an excellent journal.  They had several huge conclusions.  One, there’s level A evidence that periodontal disease is independently associated with arterial disease.  That’s a huge conclusion.  Level A evidence is extremely difficult to obtain.  It was published in our journal JAMA several ago that the cardiovascular guideline, the vast majority of those are based on less than Level A evidence; 20% or less of the guideline’s actually Level A.  So, that’s very impressive that there’s Level A evidence, and independent means it’s been adjusted for the several risk factors.  Periodontal disease is still associated with arterial disease.  That’s a huge statement.  They also concluded that the evidence that’s out there looking at periodontal treatment does show a trend for cardiovascular risk

As you know, the unfortunate additional conclusion that got most of the press was, periodontal disease doesn’t cause arterial disease.  They weren’t able to prove that periodontal disease causes arterial disease.  Of course, that’s what the press latched on to, and crazy statements started flying around.  “Periodontal health doesn’t matter for cardiovascular health.”  That’s ridiculous.

In order to show causality, it’s extremely, extremely difficult to do that.  Number one, you have to have a definition that is extremely objective for pediondontal disease before you can show causality.  We believe that should include burden of bacteria.  Certain items at all aren’t subjective.  So, that’s a hurdle that has to be overcome before you’re going to show causality.  Another hurdle is in the studies, they’re trying to show that the treatment protocols have to be very objective and have to have objective points to prove that the treatments were effective, and again, probably including something showing effectively  that yes, we eradicated the bacterial burden.  Then, there are numerous known risk factors for cardiovascular disease.  Those are confounding.  Number four, to prove causality, all of those have to be controlled.  You have to have baseline from the control group to the treatment group.  You have to be matched where there’s no significant difference in the two groups of baseline.  By the end of the study, there can still be no significant difference in the known risk factors.  That’s a huge hurdle to overcome.

We do now know, and we’ll talk about this in our course in November, but most of the time, when there’s a plaque “rupture” where you’re going to get an event that blocks the flow of blood, a clot, that causes heart attack or ischemic stroke, we now know most of those “events” are not symptomatic.  The vast majority of them are asymptomatic.  You get small damages that, overtime, can lead to heart failure or dementia.  Sometimes, it just simply heals over, and the plaque on the wall of the artery continues to grow.

So, if you’re going to do a study to show causality, any study that’s going to include cardiovascular disease, in the future, are going to include being able to measure those asymptomatic events.  So, causality is going to be very tough to prove.  It’s going to take time and an extremely well-designed study and a better definition.

The fortunate thing is that causality is not a pre-requisite for including periodontal disease assessment and management in a cardiovascular wellness program.  If we had to show causality before we included things in our program, we would hardly be doing anything.  Few things have been show to actually have causality.  That’s not necessary.  Simply having Level A evidence, which is extremely difficult to accumulate, having Level A evidence that periodontal disease is independently associated with arterial disease along with evidence of therapy reducing that risk is plenty of information to demand that any cardiovascular wellness program include oral health and assessment of periodontal disease and managing that disease in their program to maintain cardiovascular wellness.

So, I look forward to hearing Dr. Nabors now.  He’s got a few more slides to go through with you.  I’ll just say a few more things in the end, but I really appreciate you being on-call.  We have to have your help to reduce the number of heart attacks and ischemic strokes in this country.  Periodontal disease is at the root of a lot of those.  Thanks.

Dr. Nabors:         Thank you so much, Dr. Bale, and I believe the listeners today can truly hear in the voice Dr. Bale how dedicated he is to preventing heart attacks and stroke and also his partner Amy Doneen.  These two individuals are very unique, and I think you can hear that in their voice and in the presentation that Dr. Bale just made.  I’ll tell you that Dr. Bale and Ms. Doneen’s speaking for 2 day programs about [30:58], and I’m always fascinated with their ability to keep the audience on the edge of their seats and providing new information every time they speak.

We mentioned here, and I’m privileged to be a part of what Dr. Bale’s doing and what Amy Doneen is doing.  I think all of us should have the privilege to look into our patients, not just our ill patients, but as our friends and family, that we now have a greater responsibility to help determine if our patients may be at risk for heart disease or ischemic stroke or diabetes.

I was also privileged to be a part of their time in writing this CE course called Inculpatory Evidence:  Periodontal Disease Assessment and Treatment is an Essential Element in Cardiovascular Wellness Programs.  That is being published by Pinwell and will be in Dental Economics this month.  We should see that publication in a matter of days.  So, please look at Dental Economics, and look at your web-based Dental Economics material.  You can take a 2-hour CE course perhaps, prior to coming to Las Vegas.

As Dr. Bale said earlier said today, as we look at our responsibility as health care providers, we really emphasize the prevalence of cardiovascular disease and the causes of cardiovascular disease.  He also helps us understand the important role that chronic infections play, and, in particular, the chronic infection that is called periodontal disease plays as an independent risk for factor for vascular events.  He also says, in that slide, that dentists can also play a role as screeners and as monitors and educators for our patient bases in helping them live longer.

This particular slide here is from a study that was done in 2002 by the Columbia University Columbia School of Dental Medicine.  There have been about five studies that have been done since 2002, one concluding in 2010, that clearly show that dentists can play an important role in systemic health.  Certainly, by observation and treatment of periodontal disease and being able to define periodontal disease more accurately by looking at more accurate parameters of periodontal disease risk.  It clearly shows, too, that dentists need to take a more proactive role in looking at health histories and looking at a number of issues.

In 1999, this goes back 13 years, the Journal of the American Medical Association said thatdentists can have a large impact on vascular diseases and diabetes in three areas.  Number one, as screeners; number two, as educators; number three, as monitors of risk factors.  We will be discussing all three of these areas in our course so that when you leave, you’ll know what it means to be a screener, an educator, and monitor of risk factors.

I’ll say this.  It’s not going to change the amount of time that you spend with the patients significantly. I realize what our training is, and that is to make sure the oral health is as good as we can possibly get.  It may require just a few more minutes to look at these very specific elements that you can learn in this course so that you can help advise your patients that may be at risk because you discovered their risk and save their life.  You know that this is happening today.  As we continue to look at this study in the Journal of the American Heart Association, we understand what we can do and what we need to know.

While we’ve been talking about the systemic connection for a number of years, I would also say that many of us have not changed our practice significantly.  I would also suggest that we can change it significantly, continue to do the things that we do and do well but also add this as a very important aspect of general health and well-being of our patient bases.  So, what we will learn at this course will be, we will help define our patients at risk for diabetes or cardiovascular diseases.  In other words, you will be able to look at your patients based on their medical history.  What are the real significant findings in the questionnaire that you are already getting?  We’ll offer maybe a revised version of the medical history.  In order words, the same medical history that Dr. Bale and nurse practitioner Doneen use in their review to determine from medical history, what risk may lie unnoticed in the medical history?

Blood pressure’s significantly important here.  Many of you are already taking blood pressure, and I will tell you from what I learned from Dr. Bale and Ms. Doneen is that blood pressure is a big deal.  We were taught primarily to use blood pressure to educate our patients, but we want to know if our patient is safe at the time that we are doing our dental procedures.  We have a responsibility to do that.  We can take our knowledge based on blood pressure where it is, and we can help educate our patients.  I will tell you that we will learn in this course that pre-hypertension is dangerous and that hypertension is ultimately a killer.  We need to know which of our patients are pre-hypertensive or which of our patients are in fact hypertensive.

Also in oral health, there are a significant things we can look in our patient’s mouth by just doing a good clinical exam.  I will also suggest to you that we will learn by using salivary diagnostics.  We can do an improved oral health exam, and we can help identify individuals that may be at risk for systemic disease based on our oral health findings.

Then, lastly, we really do need to understand risk factors.  It’s been about 2.5 years that I have been sitting at the [38:22] of Dr. Bale and Ms. Doneen, and I can tell you, I have a much higher regard for risk factors than I ever had before because we can look at risk factors.  You can look at your patients and the risk factors associated with the medical history, their blood pressure, and their oral health.  Then, you can add numerous risk factors that you will learn at this course, and you can know very, very quickly which of your patients are at extreme danger.

One such report that was published just in November 2011, is that if you know what to look for during an oral health exam, you can identify individuals that have a 63% increase risk for heart attack with no other test.  We are certainly advising that you learn what tests are available as you are working with your physician colleagues in your community, but this is striking news.  You can look at oral health and come up with this type of figure for your patient that may be at risk for heart attack.

I mentioned blood pressure, and the things that we will be looking at more closely as we listen and learn from Dr. Bale and Ms. Doneen, these two studies were published this month in [39:51], which came out of Europe, which was a perspective urban and rural epidemiology study.  It was published online September 5th of this year.  Then, also we have our CDC study that was published September 11th of this year.  They are in agreement that there is approximately 40% of the world population, including US population that are pre-hypertensive or hypertensive.  That’s a huge number.

For those of us in the dental setting, this is particularly important because we see our patients every six months or every three months based on their oral health status.   Approximately 50% of those who are pre-hypertensive or hypertensive are undiagnosed.  So, if you’re taking blood pressure of your patients, this is incredibly important to the health of your patient to be able to determine if they are pre-hypertensive of hypertensive.  As Dr. Bale stated, this is one of the leading causes and major causes that he and nurse practitioner Doneen are fighting today.  We can be a part of that fight just by understand the role of blood pressure, how important that is, and how important our role can be by taking blood pressure on every one of our patients.

Why is that important?  Blood pressure screening can prevent 46,000 deaths per year in the United States alone.  For those of us in the oral health profession, we’ll join with general health practitioners as a team, and that’s what the CDC was saying.  Clearly, when there’s a team effort, we discover more pre-hypertensive patients and hypertensive patients when everyone understands the significant risk factor associated with deaths in the United States.

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Dr. Daniel Vinograd, DDS |
10450 Friars Rd, San Diego, CA 92120 |
Phone: 619-630-7174    •    Dr. Vinograd, DDS, is a Dentist in San Diego, CA, offering services as a periodontist, and providing teeth whitening, dental crowns, invisalign, implants, lumineers, dentures, root canals, holistic, family and cosmetic dentistry.

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