‘Holistic’ dentistry: more poppycock than panacea?

All dentists should be practising evidence-based dentistry for the sake of their patients. John Dill/Flickr, CC BY-SA

Many Australian dentists’ websites proudly advertise that they practise holistic dentistry, a philosophy that promotes health and wellness rather than simply treating disease, and considers the whole body and mind, not just teeth.

It sounds exciting. The implication is that this practice is very different – and superior – to the type of dentistry being practised by mainstream dental professionals. But different doesn’t actually mean superior.

Most holistic dental surgeries embrace and encourage alternative therapies. A quick internet search finds Australian dentists practising or endorsing homeopathy, naturopathy, Bach flower essences, acupuncture, traditional Chinese medicine, chiropractic, ayurvedic medicine, osteopathy, kinesiology, crystals, aromatherapy, reiki, vibrational healing, Buteyko and esoteric chakra-puncture.

Since all dentists are registered by the Australian Health Practitioner Regulation Agency, the public tends to assume they must be reputable and their treatments, even if out of the ordinary, must be effective. And, surely, we have to respect the centuries of ancient wisdom from whence many of these therapies came, right? Well, yes and no.

Not quite right

Many ancient remedies have given us modern medical treatments. Hippocrates recognised that powdered willow bark (containing aspirin) alleviated headaches. South Americans used cinchona bark (containing quinine) to treat malaria. Traditional Chinese medicine gave us ephedrine, a commonly used stimulant and decongestant, and the anti-malarial drug artemisinin. Both are now effective pharmaceuticals.

But doing something for centuries doesn’t automatically make it right. From the time of the ancient Greeks and Mesopotamians up to the late 19th century, misguided medicos bled patients, sometimes to death, in vain attempts to treat a multitude of ills. Bloodletting is still a core belief in some traditional health systems.

Doing something for centuries doesn’t automatically make it right. Marcel Douwe Dekker/Flickr, CC BY-SA

And traditional Chinese medicine also uses rhino horns, tiger penises, shark fins and bear bile. Even ignoring the appallingly cruel way these “medicines” are obtained, none has any proven health benefits. Rhino horns are more expensive by weight than gold. As they consist largely of the protein keratin, purchasers could have saved a fortune by chewing their toenails.

Former Victorian dentist and self-styled “professor” Noel Campbell was practising (very) alternative dentistry in the late 1990s when charged with administering ozone to a patient’s rectum to relieve her facial pain. Not surprisingly, it didn’t work.

Campbell avoided disciplinary action by allowing his dental registration to lapse but continues to provide unproven alternative therapies to patients with cancer and other conditions through his website. And he’s not alone.

The recent cases of Wellness Warrior Jessica Ainscough and The Whole Pantry’s Belle Gibson show the importance of safe and effective health-care recommendations being based on more than a pretty smile and social media presence.

Importance of evidence

But aren’t some alternative therapies safe and effective? And how can we tell the difference? Thankfully, we have very good ways of determining if health treatments are effective.

The concept of evidence-based health care has arisen over the past few decades and is now almost universally accepted as the required standard for professional health practice.

Evidence-based dentistry accepts patients’ needs and preferences, while insisting treatments be based on the highest-quality scientific evidence and regular systematic reviews of published research.

Currently, most alternative therapies have a very limited evidence base to support their practice, and research methodologies are often poor. If a beneficial effect is shown, it’s often no greater than that achieved by placebo treatment, and less than that achieved by mainstream health care.

Most “natural” medications have never been placed on the Australian Register of Therapeutic Goods simply because they’ve never shown effectiveness. And alternative therapies found to be safe and effective become part of the mainstream health-care arsenal.

Does that really matter though, as long as patients receive the treatment they want and feel better as a result? Yes, it does matter.

A patient-dentist relationship must be based on trust and professionalism. The Guy With The Yellow Bike/Flickr, CC BY-NC

Most holistic dental practices will provide a wonderfully caring and nurturing environment for patients, but a patient-dentist relationship must also be based on trust and professionalism. A dentist who provides or endorses treatment options based on centuries of “eye of newt and toe of frog” without finding out if any beneficial effect is real or merely a placebo is not acting in the patient’s best interests, even if their belief is genuine.

Not only is any placebo effect unlikely to be maintained in the long term, patients may have wasted considerable amounts of money and been deprived of legitimate treatments that could have provided much greater benefits.

Still the same

More than 2,000 years ago, Hippocrates wrote:

There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.

The public expects all health professionals to practise competently, ethically and professionally. Would you prefer a dentist who provides treatment and advice based on evidence from the most recent and highest-quality research studies, or based on clouds of dubious and scientifically unsupported mysticism?

In 1948, the preamble to the constitution of the World Health Organisation defined health as “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”. This description still holds up today, and sits very well with the concept of holistic dentistry. So holistic dentistry is really nothing new.

All dentists should be practising holistic dentistry. And they should all be practising evidence-based dentistry, too.