The following describes Dr. Joseph Da Cruz’s personal philosophy on dentistry, medicine, collaboration within the medical field and the role dentistry plays in preventative and corrective health care for patients.
I believe the current perception of the dental field, viewed both by medical physicians and the broader community, is somewhat narrow and does not reflect the true capacity that dentistry can offer patients.
A common understanding of dentistry is, it is a surgically focused approach to treatment, dealing with fillings, extractions and dentures. While all of these features predominate in dentistry, the capacity for treatment and benefit to patients can extend further than surgical treatment alone.
Dentists can provide treatment for conditions previously thought not to have been connected to dentistry. Adjacent and associated structures that extend from the maxillo-facial region have profound effects on the human body.
The trigeminal cranial nerve is one such structure capable of these effects along with the seventh to twelfth cranial nerves interacting with each other and the Trigeminal which is the biggest one. As dentists we are giving this cranial nerve the greatest importance. In fact all cranial nerves need to be observed.
The trigeminal nerve provides main sensory feed-back with touch, pain, temperature and proprioception from the oral and facial regions of the head. It has a motor component to muscles of mastication as well as tensor tympani (connects to the middle ear), tensor veli palatini (hearing issues), mylohyoid (muscle under the jaw that connects to the hyoid bone) and anterior belly of digastric (muscle involved in swallowing). If compromised this can create a wide array of physiological and psychological issues and pain. The best example is what appears to be toothache could be clenching, bruxism, TMD and pain that is not clear, but other conditions like neuropathic, neuralgic and central pain can also arise and needs to be investigated. It is interesting to note that the trigeminal branches also carry in some areas sympathetic (muscle tension) and parasympathetic fibres (relaxation) which deals with circulation and secretion.
For this reason, dentists can have a significant impact on human health through knowledge of cranial sensory and motor feed-back. For example migraines, head aches, tension, sleep disorders, chronic fatigue, TMJ disorders and postural issues. Even mood, energy and sleep are all affected. Any form of stress causes sympathetic dominance and a tightening effect on the mind and body. So it is the neurology and circulation that must be given highest importance.
The potential influence dentistry can have on the functional neurology of the human body suggest more collaborative work is needed between dentists, neurologists, physicians and allied health practitioners. This collaboration is presently happening with sleep medicine and dentistry but is just the tip of the iceberg.
Why? Because you can consider the mouth and the oral cavity as a mirror or a window to the rest of the body. Unfortunately this is currently not the case and consequently, many dentists feel powerless to treat patient needs, in the area of anatomical and non anatomical neurological and circulation management. For example cold hands and feet. Dentists are generally observing health implications in the mouth exclusively. However, there are a growing number of dentist and doctors who are recognising the link between the mouth and the human body.
It is now accepted that certain clinical markers in the oral cavity can infer systemic pathology. Dental radiographs can provide early warning signs of osteoporosis. While sleep Apnoea and disordered breathing may infer an increased risk of developing cardiovascular disease. I believe that there is a strong link between respiratory problems and blood pathology imbalance. If anaerobic respiration is conducted partly in sleep apnoea, then more acidic conditions are produced in the blood. The type of respiration determines the level of oxygenation one will receive. There can be upper chest breathing or diaphragm breathing which is better. Dentists can observe pathology of the oral cavity and infer possible systemic pathology. This type of detection is excellent for discovering early warning signals and I believe other warning markers should be explored further, example gum infections and tissues breakdown.
Dental caries is one such condition where sugar is not only affecting the oral cavity alone, but rather it is a blood acidosis condition affecting the whole body. Bicarbonates and minerals from blood are in saliva which is a part of the blood. Another area that needs to be explored is connective tissue break down in the mouth. Possible it can be a combination of low level Scurvy and lack of Vitamins D, A, E, K, Vitamin C and B. Also there may be a lack of alkaline minerals for buffering. Dentists can observe clinical markers of connective tissue break down in the mouth and infer connective tissue break down is occurring systemically due to a blood acidosis and the whole vascular system. Blood tests are useful to look at a bigger picture. More extensive training of dentists and more collaborative work with medical physicians can potentially provide more protective and earlier preventative care for patients.
Currently, I believe that there are patients who have fallen through the cracks of the medical field and cannot be treated as their conditions are not completely understood within the current medical format and it is considered all in their head or psychosomatic. The biggest clue lies in the next paragraph which makes the connection and involves structural pathology and function that can be rectified with treatment of occlusion, malocclusion, growth and development, TMD, airway and the cervical vertebrae.
The cranial cervical junction is a critical area that separate the head from the rest of the body. The sensory information from the body is modulated through the central nervous system and modulated in the brain. The motor response is then expressed from the brain to the rest of the body. The correct position of the lower jaw, as well as the amount of opening of the lower jaw in relation to the upper jaw is very important. The turning of the head from one shoulder to the other will determine a major component of the rest of the body especially neurology and circulation. This is my hypothesis of sensory motor feed back from the cranial cervical junction that relates to function and symptoms. Better the function, less the symptoms. If the muscles are happy the nervous system is settled and doing its job. When there is an imbalance we see lots of unrelated conditions or co-morbidities.
If this area is addressed and function is restored, than from my observation of treatment of many cases, a whole lot of symptoms and co-morbidities disappear or are reduced. This is not a guarantee for everyone as everyone is unique and has associated illnesses. It is another big part of the puzzle of chronic illness.
These patients can experience a variety of symptoms like headaches, migraines, chronic fatigue, chronic postural pain, circulation disturbances, racing heart, low or high blood pressure, dizziness or other chronic symptom management issues that affect their normal day-to-day quality of life.
From my experience in holistic dentistry, many patients present with these chronic health with strange symptom problems despite having seen a multitude of medical physicians and all the markers seem normal. Unfortunately the connection of cranial distortions, TMD, malocclusion, sleep dentistry, physiological acidosis and motor reflexes is not currently understood. Collaborating with other physicians has shown me that these features are all interrelated.
Chronic pain problems (mentioned above) and other symptoms often result from compensation mechanisms through structural abnormalities or trauma that has not been addressed in dentistry or medicine alone. Collaborative dentistry and medicine can provide assistance and can improve quality of life for many people who have been unable to get resolution by the current medical format. A great deal of care is needed with patients who exhibit allodynia.
Allodynia is an unusual symptom that can result from several nerve-related conditions. When you’re experiencing it, you feel pain from stimuli that don’t normally cause pain. For example, lightly touching your skin or brushing your hair might feel painful.
Collaborative work between dentists and medical physicians is only one aspect of a holistic approach to treatment. Working with cranial osteopaths, chiropractors, physical therapist who understand cranial distortions and their effects on the mouth’s functional matrix is also an important aspect of treatment. There is a link between the structure of the cranial base (sphenobasilar synchondrosis). The maxilla and mandible both influence one another and both affect postural related muscles.
The cranium’s influence on posture is considered to be a descending pattern where distortions in the cranial bone structure create a descending signal muscle pattern, distorting posture and eventually foot position behaviour. Thus improper foot position may be compensating for a distortion originating from the cranium. Conversely genetic distortions such as club foot or foot pronation may create ascending patterns, distorting posture and eventually jaw position. This may eventually lead to TMJ pain, TMD or even breathing problems.
Treatments from dentists and other physicians can indirectly influence other areas of the body, that is why a whole body approach to health treatment should be explored. Doctors and even dentists do not understand occlusion sufficiently and it’s signalling phenomena on the body. This is a subtle observation.
The AACP (American and Australian Academy of Craniofacial Pain) is one body that is doing something in this area of dentistry and medicine, which I am a current member.
Cross disciplinary study between medicine and dentistry is an effective way to achieve a whole body approach to health treatment. This can allow practitioners to be mindful of their treatment and its affect on other areas of the human body. Medical practitioners who look at hormone imbalance, blood pathology and immunology to treat patients can create benefits for the integrity of bone and gum tissue repair in the oral cavity thereby enhancing the success of dental treatment. Conversely, if dentists change their operational behaviour they can improve the patient’s health in other areas.
Stopping the use of mercury fillings, dentists can reduce patient toxicity exposure, thus improving patient’s blood pathology. Another area of dentistry that can prevent harm to patients, is reducing the unnecessary removal of teeth for orthodontic treatment, especially maxillary and mandibular premolars. Removal of key teeth in the maxillary arch can contribute to the collapse of the maxilla and retrusion of the lower jaw. This is iatrogenic dentistry. This can create a cascade of events leading to obstructive breathing problems and subclinical defects (e.g. blood acidosis). From my experience, patients who present with obstructive airway breathing problems have a higher risk of health related problems. For example, obstructive airway problems can increase the risk of developing chronic-fatigue. While this may not be the definitive cause of chronic-fatigue, a significant proportion of patients who have presented with chronic-fatigue have had associated obstructive breathing difficulties.
Airway obstruction leads to breathing problems and subsequently affects deep recovery sleep and REM sleeping patterns, which are important for physical and mental recovery and stability. This has a profound influence on the human body. Breathing problems are a form of stress that impede the body’s ability to handle other physiological and psychological stresses in life. When a person cannot cope with physiological and psychological stresses that were previously not stressful, they are considered to be in survival mode. In this state, a person cannot process or comprehend complex difficult tasks. I believe that if a patient cannot breath properly then they cannot think clearly. On the other hand, if a patient is able to breath properly, then they are able to think clearly and comprehend more difficult tasks. These ideas relate to work by Dr. John Diamond. I have had the privilege to work closely with, Dr. Diamond on this topic.
We both believe improving the breathing patterns of patients can lead to a cascade of events that improve the overall health status of the patient’s quality of life. By improving oxygenation, one can reduce sub clinical defects (Sam Queen) which can affect a patient’s physiology. These include responses to allergens, androgen functioning, structure and strength. I am a strong believer that those who have good health are those who posses good maxillary facial architecture, good jaw position, breathe well and ultimately sleep well.
There is a long road ahead and we do not know how to get there but we must start somewhere. My aim is to give dentistry greater importance by providing a whole body approach to treatment, thus offering a more effective, preventative health treatment and quality of care to patients. I am open to work with other individuals and universities to share clinical knowledge that opens up this field.
Dr. Joseph Da Cruz