by Linda Sechrist

Research conducted since 2005 has brought to light important information about new and old practices of dentistry as well as orthodontics. Little of this knowledge has made it into mainstream media, leaving the general public unaware of issues such as problems associated with root canals, mercury amalgam fillings and some dental implants. Most importantly, the connection between the health of the body and the health of the mouth has largely been ignored.

A new philosophy

The philosophical shift in dental practice and to health care in general is leading cutting-edge dentists towards the least toxic way to accomplish treatment while treading lightly on a patient’s biological terrain. This individualized, more integrated and more environmentally friendly approach to oral health care is practiced locally by Yasmin Chebbi, DMD, with offices in Newton and Brookline; Iveta Iontcheva-Barehmi, DMD, owner of Boston Dental Wellness, in Boston; Amparo David, DMD, owner of Dentistry by Dr. David, in Bolton, and Jean Marie Nordin, DDS, co-owner of Groton Wellness, in Groton. 

Sleep apnea and oral sleep devices 

Chebbi specializes in sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts. “Three types of sleep apnea are generally related to a bigger problem. Obstructive sleep apnea occurs when throat muscles relax. Central sleep apnea happens when the brain doesn’t send proper signals to the muscles controlling breathing, and complex sleep apnea syndrome occurs in individuals that have obstructive sleep apnea and central sleep apnea,” explains Chebbi. 

The solution Chebbi offers is frequently a custom-fitted, effective, comfortable and durable sleep apnea dental device. “For adults, it’s a great alternative to continuous positive airway pressure (CPAP) therapy or corrective surgery. In some cases, it’s a lifesaving device as a stroke is possible when the brain is not getting enough oxygen. For children, the device has been known to help with mood when children get more uninterrupted sleep,” she says. 

According to the Mayo Clinic, symptoms of sleep apnea include loud snoring, gasping for air during sleep, awakening with a dry mouth, morning headache, difficulty staying asleep, excessive daytime sleepiness, difficulty paying attention and irritability. 

Root canals, tooth extractions and gum disease

Iontcheva-Barehmi’s holistic and biological approach to dentistry is founded on the philosophy that everything within the whole body is connected. This philosophy is why initial patient visits allow for questions about medical history, emotional well-being and energy levels; far more than checking for cavities or a bad root canal.

“Teeth are related to organs, tissues and glands along the body’s meridians, energy channels through which the life force flows,” says the integrative periodontist, who prefers to extract teeth when necessary and use Zirconium implants, rather than performing a root canal. 

Iontcheva-Barehmi explains, “The mouth is connected to the whole body, so it’s logical that the connection between the meridians and teeth can indicate an individual’s overall health and wellness. Tooth extractions protect patients from tooth-related disease and systemic infections that can be harmful to overall health. A failing root canal is a chronic abscess around the root of the tooth. It has direct connection with the blood stream and disseminates infection through the whole body. This is the reason why holistic dentists recommend extractions. The best research on this was done by Dr. Weston Price.”

Doctors practicing functional medicine are more likely to refer patients to holistic dentists. Cardiologists are particularly aware of a 2014 PubMed study, in which researchers looked at individuals with gum disease and heart disease. Individuals that received adequate care for gum disease had 10 to 40 percent lower cardiovascular care costs than those who didn’t get proper oral care. Another study revealed that gum disease increases an individual’s risk of heart disease by approximately 20 percent. Given such evidence, the American Dental Association and American Heart Association have acknowledged the relationship between gum disease and heart disease. 

Treating gum disease

To treat gum disease, David refers patients to the periodontist on staff. “I can tell that a patient has internal inflammation by looking at the gums and tongue. In fact, gum disease has been linked to health problems such as diabetes, heart disease, stroke and premature births or low-birth weight babies,” says David, whose preventive and healing suggestions for healthy gums, which are the foundation of oral health, includes chewable oral probiotics, daily coconut oil pulling, flossing, using an electric toothbrush and regularly using a Waterpik. “I suggest adding one or two drops of tea tree oil and iodine to the water in the pick,” notes David, who recommends that a patient’s diet include less sugar and carbohydrates and more vegetables, proteins and fruits. 

“We treat gums with ozone after a deep cleaning because it kills bacteria on contact. Patients maintain healthier gums using ozonated oils twice a day and by using a good toothpaste such as Ora Restore Mineralizer with no Glycerin or fluoride,” says David, who is the founder of the TMJ and Sleep Center, in Bolton. “Temporomandibular Mandibular Joint (TMJ) problems are tied to sleep disorders; it is not uncommon to see a patient that has chronic jaw pain not being able to feel rested. Many adolescents have TMJ problems and often after extraction or retraction orthodontics.” 

Early interventions beyond conventional solutions

Nordin also finds a prevalence of sleep apnea in her patients. “Generally, adult patients with sleep apnea are more likely to have an oral cavity that has been made smaller by tooth extractions, an accelerated deterioration of the oral cavity due to bone loss around the teeth, and teeth dying from trauma and gum recession. When I see this, I get a medical and oral history and prescribe a dental mouthguard or a dental sleep device,” says Nordin, who added pediatric orthodontics to her practice after learning from her innovative mentor, James Bronson, DDS, founder of Bronson Family Dentistry, in Virginia, that there were early innovative interventions. 

“We developed a program for children that involves a comprehensive evaluation on the first visit. We look at breathing habits, the way their tongue swallows and the function of the muscles. In medicine, we believe that form follows function, therefore, we observe what muscles around the mouth actually do when the individual swallows. It is really the way you breathe and swallow, as well as how the muscles work, that plays a significant role in where teeth end up and line up,” explains Nordin. 

Pediatric crowding can be identified in 2-, 3-, 4- and 5-year-old patients. “We can start them on a removable myobrace mouthpiece that can be worn at night and an hour during the day. The mouthpiece begins to change the way the tongue works, waking it up and strengthening it. If a child is born with the physiological problem of a tongue-tie, that can’t swallow properly or get up onto the pallet, that tongue will never expand the pallet like it supposed to,” she clarifies. 

Nordin identifies children that are chronic mouth breathers. Their face will grow long and narrow, which in the long-term can cause cardiovascular disease. In the short-term it can cause anxiety because the nitric oxide receptors, located in the nose, signal arteries and veins to relax. “A cardiologist knows about this phenomenon,” says Nordin, who deeply appreciates that dysfunction can be unwound before a child is 9 years old. Before it’s time for braces, Nordin has laid the foundation for a stable occlusion so that the child doesn’t have to wear retainers into adulthood to keep the teeth from moving back. 

While early interceptive myofunctional orthodontic treatment methods, such as myobrace appliances, have proven effective for children, there is also good news for adults that suffer from breathing problems that cause sleep apnea. Nordin employs a myofunctional therapist. 

These new philosophies and biological dental protocols are definitely improving overall health and wellness. 

Yasmin Chebbi, DMD, 284 Harvard St., Brookline, 617-684-1883, YasminChebbi
DMD.com. See ad on page 21 and Resource Listing on page 38.

Iveta Iontcheva-Barehmi, DMD, 1842 Beacon St., Ste. 305, Boston, 617-868-1516, BostonDentalWellness.com. See ad on page 22 and Resource Listing on page 36.

Jean Marie Nordin, DDS, Groton Wellness, 495 Main St., Groton, 978-449-9919,
GrotonWellness.com. See ad on page 2 and Resource Listing on page 36.

Amparo David, DMD, Dentistry by Dr. David, 563 Main St., Bolton. 978-779-2888. BoltonDental.com. See ad on page 7 and Resource Listing on page 36.