Functional Medicine Dentistry is a whole-body approach to dental care that emphasizes finding the root cause of issues, educating on proper prevention of oral disease and its links to systemic issues, and aiming to use the most biocompatible and least toxic materials available. Those practicing functional dentistry attended a conventional dental school and then must further focus their practices in functional dentistry through various continuing education endeavors.
Functional Dentistry vs. Conventional Dentistry
The most significant difference between functional and conventional dentistry is its focus on oral health and its relationship to whole-body health.
Conventional dentistry focuses on brushing, flossing, mouthwash, fluoride applications, and visiting a dentist two to four times a year for cleanings and debridements. It generally addresses only end-stage dental disease and rarely makes connections to how oral disease may affect the body in a downstream and bidirectional manner. The focus tends to be very myopic, with attention on the teeth and the mouth rather than how they influence other parts of your body.
Functional dentists understand how oral health impacts systemic health and vice versa. The approach is one where the root causes must be understood and determined, heavily emphasizing the oral microbiome, gut health, inflammation, genetics, and hormones. Functional dentists examine their patients' eating, sleeping, breathing, and lifestyle habits to uncover the root cause of oral microbiome imbalances and focus much of their practices on airway health.
Oral Health Issues That Can Be Making You Sick
Chronically inflamed gums, failing root canals, improperly fitting crowns, fillings from unideal materials and metals, and fixed or permanent retainers can all affect your oral microbiome and, potentially, your overall health. You might not realize it, but each of your teeth is a living organ. Although your teeth may look inanimate, they are made up of microscopic tubules through which fluid and nutrients flow. Teeth have nerve, blood, and lymph supplies and therefore communicate with the rest of your body. The mouth, being a dark, wet, and low-oxygen area, is the perfect environment for anaerobic pathogens to thrive if given the opportunity. Unfortunately, what happens in the mouth can affect the entire system.
The Oral Microbiome
A significant emphasis in Functional Dentistry is having and maintaining a thriving and balanced oral microbiome. Like other microbiomes of the body (gut, skin, vaginal, sinus, etc.), the oral microbiome is a collection of bacteria (800+ currently identified), along with viruses, fungi, and parasites that affect the progression of health and disease. The mouth is the start of the alimentary canal (gut), and we are constantly seeding our GI tract with microbes through daily swallowing, so the oral microbiome matters to your systemic wellness. Many Functional Dentists will offer oral microbiome testing to help uncover and understand your personal microbial health and diversity.
There is a lot of back and forth if root canals can make you sick. The thought is that bacteria, viruses, and fungi can become trapped if not properly eradicated during the treatment. Once trapped and sealed, it becomes the perfect breeding ground for these microbes to multiply and slowly affect other parts of your body.
Although root canals may be a necessary component of dentistry, functional dentists are more likely to use ozone gas and water, biomimetic materials, and laser during their procedures and will provide a list of alternative options while teaching you how to properly care for your teeth so that you don't need another root canal in the future.
They will also educate you on the recommendation to take regular CBCT or 3D images of your root canaled teeth (traditional xrays are not enough!) to ensure they are properly functioning and not failing or creating low, grade chronic inflammation and microbial leakage.
Metal in Your Mouth
A common issue with metal dental devices and amalgam fillings is heavy metal toxicity, sensitivities, and reactions. Saliva is an excellent medium to break down these metals into metal ions. Research has shown that materials in teeth can release some amounts of mercury, nickel, chromium, and iron in silver fillings, dental crowns, and permanent metal retainers, not to mention galvanic currents that can occur when mixed metals are used in the mouth.
Airway and Sleep Health
Most Functional Dentists will tell you that how we breathe (nasal breathing is optimal) and how well we sleep are foundations for optimal health. A Functional Dentist should have additional training in airway and sleep screening and can help you get to the root cause of your mouth breathing, snoring, restless sleep, insomnia, grinding, and other functional airway issues.
Functional Dentistry Labs
Some Functional Dentists will use specialty labs to test for heavy metals, metal sensitivities and allergies, and inflammatory markers in their patients as an add-on service to confirm if the patient is reacting to a suspected metal or if there is any lingering inflammation that may not be seen to the naked eye. These tests are commonly out-of-pocket costs but well worth the information that comes with them.
Other tests Functional Dentists may offer include:
A deficiency of vitamin D3 can cause delayed tooth eruption or abnormal calcification of enamel and dentin, also known as under-mineralization or hypoplastic teeth. Since vitamin D has a significant function in tooth development, any defect in tooth enamel surfaces induced by such vitamin deficiency makes the tooth more susceptible to caries and breakage or wear. As a result, knowing a patient's Vitamin D levels, especially if they are prone to cavities or demineralization, is important to stop the process from continuing by getting levels back to optimal ranges.
More of us are valuing the importance of vitamins, immune-boosting foods, and healthy lifestyle choices and their relationship to healthy bodies and mouths. Deficiencies in micronutrients can cause adverse oral health effects and worsen oral diseases. Micronutrient deficiencies can affect dental development, gum health, and bone strength. Your Functional Dentist may wish to test your micronutrient levels as part of your oral healthcare plan if they suspect underlying issues.
Oral Microbiome Testing
Our mouths are the gateway to our bodies, and what happens in the mouth doesn't stay in the mouth. Understanding how your oral microbiome is related to overall health conditions like diabetes, cardiovascular disease, fertility, cancer, and mental health is critical, and without measuring your oral microbiome, we have no gauge as to what your susceptibility may be to various oral or systemic diseases or what pathogens we are dealing with. Functional Dentists will often test your oral microbiome as part of their baseline new patient exams to better create a personalized treatment plan and bio-individual protocol tailored to your needs.
Diabetes is a chronic, inflammation-related metabolic disease diagnosed by hyperglycemia. Elevated blood glucose levels can negatively influence the inflammatory response to dental plaque, contributing to gingivitis and periodontal disease. As a result, periodontitis and diabetes mutually and adversely affect each other, and your Functional Dentist may wish to test your HbA1c to understand your status.
Gut Microbiome Testing
We know that the oral and gut microbiomes have a bidirectional relationship where microbes can translate from one to the other, ultimately influencing each other. Functional Dentists believe you cannot have a healthy mouth without a healthy gut and vice versa. If your oral health is not improving with specific recommendations, digging deeper into your gut health and its biome health will be indicated.
If your dentist doesn't offer these tests, you can ask your Integrative Medical Practitioner to order them. Functional Dentists will work collaboratively with your medical providers to ensure you are under optimal care.
It's critical to let your provider know of any changes to your dental health, like new materials in the mouth, gum inflammation, and periodontal health status, so that they can keep track of your systemic health, as many changes in the mouth can impact whole body health.
How To Find a Functional Dentist
You can find a Functional Dentist in your area using different search terms online. If Functional Dentistry doesn't give you the results you are looking for, try similar search terms, including "biologic dentistry" or "holistic dentistry."
Another option is to look at the following organizations and databases, as they will have lists of dentists with additional training who should take more functional approaches to their care:
- International Academy of Oral Medicine & Toxicology (IAOMT)
- American Academy of Dental Sleep Medicine (AADSM)
- American Academy of Oral Systemic Health (AAOSH)
- International Academy for Biologic Dentistry and Medicine (IABDM)
- Holistic Dentistry
- Campaign for Mercury-Free Dentistry
- Mercury-Safe Dentistry Directory
- Ask the Dentist's Functional Dentist-Finder
Before making an appointment with a new dentist, you should put together a list of questions to ensure they are the right fit for you. Never feel pressured to stay at an office that doesn't meet your goals or preferences.
Some important questions you could ask before or during an appointment include:
- Do you use mercury-free fillings in your dental office?
- Are your composites BPA-free? Ceramic-based?
- What are your dental procedures for removing mercury fillings? Are you SMART (Safe Mercury Amalgam Removal Technique) Certified?
- What alternatives to root canals do you offer?
- Do you use digital x-rays instead of film?
- Do you offer alternatives to metal implants?
- Do you offer ozone treatments?
- Does your office offer alternative antibiotics or nontoxic alternatives to pain medication if indicated?
- Does your office offer alternatives to drill-based oral cavity treatment, such as laser dentistry or remineralization and arrest protocols?
- Does your office offer oral microbiome testing or other routine functional tests?
- Do you support a patient's wish to avoid fluoride-containing products and materials?
- Do you go over Functional Nutrition relating to oral health, along with any personalized dietary strategies?
- Besides cleanings and debridements, how do you manage gum and periodontal diseases in your office?
In summary, Functional Dentistry is an approach to oral and dental health that focuses on solving problems at their root cause rather than treating symptoms as they become more end-stage. Functional Dentists can be considered more "physicians of the mouth," whereas conventional dentists tend to take on a “technician" role when dealing with dental issues.
There are several ways to tell if you're dealing with a functional dentist (or at least someone more open to holistic concepts) versus a conventional one, including their recommendations on what causes and how to address cavities, their perspectives on certain procedures, and their insights on how your oral health issues may be impacting your whole body health and vice versa.
Several organizations manage databases of functional dentists (also called biologic dentists, integrative, or holistic dentists), but you can also call a dental office or check out their website to determine whether that dentist is someone whose practice philosophy resonates with you.
The mouth matters, and its connection to systemic wellness cannot be overemphasized. Finding a Functional Dental provider that mirrors this sentiment will enable you to tackle your health from where it begins…in the mouth!