Biological Dentistry

Biological Dentistry is a concept of modern dentistry that focuses primarily on strengthening overall health.

There is no other medical discipline in which so many different materials are brought into the human body as in dentistry. No other medical field works with so many chemical materials. Various synthetic substances such as composites, metals and varnishes are used by dentists and put into the patient’s mouth. These enter the body via the oral mucosa and the digestive tract.

The proportion of people with chronic diseases is constantly increasing. There are now very few people who can be described as medically healthy.

In the graph below, you can see the exponential increase in some chronic inflammatory diseases. The graph ends in the year 2000. It can be assumed that today, in 2023, the incidence is much higher.

The following chart shows the development cycle of chronic diseases. Please note that many influencing factors mainly originate in the oral cavity (underlined in red).

The concept of biological dentistry is based on reducing the harmful load of the oral cavity to a minimum and strengthening one’s health in the best possible way.

The materials, equipment and treatment techniques used are selected and adjusted accordingly. The holistic view of these interactions allows the dentist to reduce the burden of the oral cavity to a minimum and improve the patients overall health.

Biological Dentistry vs. Classical Dentistry

Biological dentistry originates from the teachings of classical dentistry and has many similarities. For example, the measures to preserve vital/living with fillings and crowns is similar.

However, what distinguishes biological dentistry from classical dentistry is the selection of biocompataible materials and treatment techniques. All materials are selected according to the health and biology of the body. Other important criteria, such as durability and aesthetics, must not be neglected.

Examples of the choice of materials are:

• Ceramic implants instead of titanium implants
• Ceramic crowns instead of metal crowns
• Composites without plasticizers instead of composites with plasticizers

There are also differences in treatment techniques. Here are some examples: Here are some examples:

• Metals and amalgam are removed with protective measures. This is done for the safety of both patients and staff.
• When treating tooth decay, everything is done to ensure that the tooth does not die.
• Surgical treatments are performed as atraumatic as possible. The use of ozone and A-PRF membranes support wound and bone healing.
• When possible, antibiotics are not used.

Difference between Environmental Dentistry and Holistic Dentistry

The concept of environmental dentistry and holistic dentistry also consider the mouth and the body as a connected unit. For example, an inflammation in the jaw, a diseased tooth or a toxic dental material in the mouth can lead to chronic inflammation in a joint.

Biological dentistry, as well as holistic dentistry and environmental dentistry, aim to reduce the triggers and irritants that affect the body. The body should be strengthened as best as possible.

In our practice, we combine all proven and effective methods of these dental disciplines to offer you the ideal concept.

Exposure to metals in the mouth

Metallic dental restorations are problematic for the body in terms of the immune system and toxicology. Through abrasion during chewing and oxidation processes (corrosion), the metals get into the surrounding tissue and the entire body.

Metallic ions and metal particles emitted can cause inflammation of the gum in the oral cavity.

The metallic substances that are swallowed can cause chronic inflammation of the intestinal mucosa. As a result, permeability of the intestinal walls (leaky gut) increases, which means that undigested food, intestinal bacteria and intestinal toxins can enter the human organism.

This increased intestinal permeability then has a systemic effect on the entire body and can cause various non-specific symptoms.

Toxicology:

Many metals are capable of causing oxidative and nitrosative cellular stress, resulting in the body being flooded with free radicals. These are very reactive and can severely damage various components in the body, enzymes and cells.

Furthermore, metals can compete/react with vital minerals and trace elements and displace them from their function, which can negatively affect metabolic processes.

Immune system:

The body reacts to metal ions or metal particles by ramping up the immune system. Various immune cells, such as lymphocytes or macrophages, begin to fight the metallic particles. This in turn causes even more oxidative and nitrosative cell stress and depletes the body of a lot of energy. The activation of the macrophages upon contact with titanium can be determined, for example, by the titanium stimulation test. The activation of lymphocytes, upon contact with various metals, is detected by the lymphocyte transformation test (LTT).

Since such continuous stresses have consequences on the body’s health, chronic diseases can start to manifest. The aim of biological dentistry is to recognize and eliminate these influences on the body.

Many studies have been conducted on the health effects of metals on the body. Read more on the website of the Institute for Medical Diagnostics Berlin (IMD).

Ceramic is the material of choice

Dental ceramics show the best biological compatibility and are clearly preferable to metallic alloys. Bacteria show a significantly lower attachment to ceramics, resulting in less biofilm and plaque buildup. As a result, adjacent soft tissue in the mouth is less likely to be affected by inflammation and forms a stable connection with ceramic.

In the concept of Biological Dentistry, no metals are used. Ceramics are clearly the material of choice.

Ceramics are non-toxic and have a neutral effect the body and it’s immune system.

By using ceramic implants, ceramic implant abutments and ceramic crowns, even edentulous patients can receive fixed dental prostheses in our practice in a fast and compatible manner.

Ceramic inlays and partial crowns are ideal alternatives to composite fillings and can be produced by the dental technician and fitted by the dentist in a single session (chairside). Inlays are cemented with a high quality cement, which is safe for health of patients.

Safe amalgam removal with protective measures

Amalgam used to be the most common material for dental fillings. Today, the use of amalgam is steadily declining, although there are still many dentists who swear by it. The reasons for this are ease of processing, low cost and high durability of the material.

In Germany, amalgam is still covered by health insurance and anyone who wants a filling made of composites pays the surcharge themselves.

Amalgam consists mostly of mercury, which is one of the most toxic elements on earth. As soon as amalgam fillings are removed and no longer in the mouth, they are declared as hazardous waste and must be separated carefully and be disposed of professionally.

Many studies also prove the toxicity of amalgam. In 1983, M. Wolff’s research team showed that mercury constantly evaporates from amalgam fillings in the mouth. The team’s opinion was that amalgam would not receive FDA (Food & Drug Administration) approval if it were launched today.

During amalgam removal, very high concentrations of mercury can be released into the oral cavity and surrounding air, which can put a massive strain on the body. Therefore, when removing amalgam, care should be taken to ensure maximum protection for the patient, assistant and dentist:

• An amalgam filling should be extracted in one piece, using the appropriate technique. This means that exposure to mercury can be reduced to a minimum.
• Powerful extraoral suction unit with an effective filter system for heavy metals.
• Suction cup that is placed around the tooth and encloses it from all sides. This greatly improves the suction of possible metal particles.
• Gold coated nose guard for the patient and gold coated mouth guard for the assistant and dentist.
• Rubber dam, a tension rubber around the tooth, is used depending on the situation, as its use can have not only advantages but also disadvantages.

After the amalgam is removed, there are two options for restoratiom of the tooth:

• A high quality composite filling.

• A ceramic filling that is cemented into the tooth.

Composites with high compatibility

Composites are mainly used in dentistry for fillings and have largely replaced amalgam.

Composites are also foreign materials and can have a toxic effect and cause activation of the immune system. How the immune system reacts to composite molecules can be determined, as with metal, by a lymphocyte transformation test.

When it comes to the biological compatibility of composites, two aspects are of particular importance: the choice of material and the degree of molecular cross-linking (polymerization) in the composite.

In our practice we use the Swiss quality product Saremco Green Line, which contains no BisphenolA (BPA), Bis-GMA, HEMA, TEGDMA and fluoride.

In addition, Admira Fusion from VOCO is used. A composite that has a high ceramic content, is also used.

For optimal cross-linking of composite molecules, each layer is thoroughly cured with a powerful UV lamp. After the filling is placed it is additionally polymerized several times.

After placing the composite filling, a layer of uncured, reactive resin molecules always forms on surface of the filling. This layer is called the oxygen inhibition layer. The oxygen is able to prevent complete polymerization or crosslinking of composite molecules, which increases the toxicity of the filling. The oxygen inhibition layer should be completely removed after completion of the dental filling.

The use of proven, high-quality composites, deep and thorough polymerization as well as the removal of the oxygen inhibition layer ideally improve the biocompatibility of the material.

As a healthier alternative to composite fillings, laboratory-made ceramic fillings can be produced and cemented in an uncomplicated way. These have a higher longevity and show less stress than common fillings made of composite.

Ceramic fillings / ceramic inlays

Ceramic fillings or ceramic inlays should be preferred over composite fillings whenever possible. These are individually produced ceramic dental restorations made from one piece, which refill the hole in the tooth.

The picture displays the use of ceramic inlays after amalgam removal.

Jaw inflammation – a chronic burden

There are various forms of inflammation in the jaw.

In X-ray images, for example in a digital volume tomography (also known as DVT, 3D X-Ray, Dental Cone-beam CT), they are shown as dark areas that can easily be distinguished from healthy bone.

• Inflammation of shifted or partially erupted wisdom teeth
• Inflammation of damaged or root canal treated teeth
• Inflammation of foreign bodies remaining in the jaw bone, such as metal splinters, overpressed root filling material, tooth fragments, etc.
• Other forms of jaw osteitis

Such inflammatory processes in the jawbone can be a permanent burden on one’s health. The immune system is put into a continuously active state, which means that it requires more energy. This energy is then missing for daily activities – the affected person feels tired and exhausted.

Due to the proximity to the brain and the very good blood supply to the head, there is a considerable negative impact of jaw inflammation on the body.

In Biological Dentistry, the treatment of jaw inflammation is to remove it completely. Wound healing is ideally supported by minimally invasive surgical and techniques using A-PRF and ozone. If teeth are removed, compatible ceramic implants can be placed immediately – bone resorption and the need for a bone graft later on are avoided.

Ozone in biological dentistry

Ozone is a gaseous molecule consisting of three oxygen atoms (O3). The main property is an effective disinfection.

Ozone is very important in biological dentistry. It can be used effectively in various pathological processes such as caries or periodontitis.

Developing caries can be treated without breaking into the surface of the tooth. The ozone molecules penetrate deep into the softened tooth structure and eliminate the bacteria causing the caries.

Also in the case of gingivitis, the ozone can get deep into the gum pockets and eliminate the periodontitis bacteria there. Bleeding gums and bad breath can also be greatly improved.

During operations in the oral cavity, the wound can be effectively disinfected with ozone, which improves wound healing and results in fewer postoperative complications.

Adjusting the bite to the correct height and position

The bite height indicates how the upper jaw and lower jaw align with each other vertically. Incorrect vertical adjustment of the jaws can lead to various problems. For example, this results in compression and improper loading on the jaw joints, compression of blood vessels to the brain and tension in the chewing and facial muscles.

The alignment of the horizontal bite position is also important and should be taken into account.

Particularly in patients with few teeth and in complex restorations, the jaw relation should be restored as ideally as possible. For this purpose, we use the exact evaluation of the three-dimensional DVT image (digital volume tomography) in combination with the digital intraoral scan.

A digital volume tomography provides clear reference points of the patient’s skull, allowing the correct skull axes and planes to be determined. From this, the ideal position of the jaws in relation to each other and the correct position of the temporomandibular joints can be precisely determined.

Additional intraoral scans of the upper jaw, lower jaw and bite of the teeth in relation to each other can provide data on the patients indiviual teeth and gum situation.

The information obtained of the skull from the DVT image and information of the teeth and gums from the intraoral scans are digitally merged to produce a complete and consistant image. This clear and repeatable information flows into the treatment planning. Thus, the ideal position of the ceramic implants and the exact shape of the tooth crowns can be individually and precisely determined.

In the case of complex functional disorders of the masticatory system, we use dentokinetics and the MAGO splint therapy. Please see the TMD/TMJD article for more information.

The holistic approach to dentistry should always consider bite position and bite height. The correct alignment of the jaws to one another is of great importance for health and quality of life.

Biological impressions

In order to make a tooth restoration, an impression of the teeth is made first. The type of impression and the material used determine how compatible it is.

Impressions are usually made with silicone or polyether, which provide a good result but have disadvantages in terms of biocompatibility. Polyether in particular shows toxicity according to various studies and should be avoided.

Hydrocolloid, which is obtained from algae, offers the best compatibility and has the most precise impression properties at the same time. Therefore, from a biological point of view, hydrocolloid is clearly preferable to silicone and polyether.

Another modern and harmless solution is the digital intraoral scan. With a small camera, many photos are taken in a rapid sequence and combined to form a complete, three-dimensional representation of the mouth (teeth and soft tissue). This intraoral scan can completely replace impressions made with impression materials.

The use of hydrocolloid for impressions or intraoral scanners of the latest generation, are clearly preferable in terms of biology. Depending on the situation, we choose one of the two methods in our practice.

Biological bleaching

If a patient finds their teeth too yellow or dark, they can be whitened quickly and easily with a natural bleaching.

Normally, a high-percentage hydrogen peroxide gel is used for teeth whitening. This gel also contains acids such as phosphoric acid or acetic acid, which not only has a bleaching but also a caustic effect. This can lead to oversensitive teeth and irritated gums.

In our dental office we use a mild method based on plasma medicine and ozone with no side effects.

Before biological bleaching the teeth are carefully cleaned, plaque and tartar are removed.

Since the oral cavity is flooded with oxygen molecules during the procedure, the pathological bacteria are eliminated at the same time.

Long lasting prophylaxis in biological dentistry

Many patients wonder why problems in the oral cavity remain and nothing improves. Year after year, more and more caries form and inflammation of the gums only subsides for a short time.

The reason for the progressive, destructive processes in the oral cavity is due to the oral bacterial flora. If the flora contains a large amount of pathogenic bacteria, e.g. bacteria that cause caries, periodontitis or bad breath, the corresponding symptoms will occur.

In order to prevent this progressive destruction in the oral cavity, the oral bacterial flora should be improved.

In our practice we have a holistic prophylaxis concept, which effectively addresses the flora in the mouth. Optimization of the bacterial composition results in fewer dental problems (e.g. caries, periodontitis, bad breath) and consequently a great improvement in quality of life.

Biological Dentistry Switzerland

In our practices in Winterthur and St. Gallen, we offer all treatments of biological dentistry at the highest level.

Since our dental offices are located directly at the train station, we are easily accessible from all over Switzerland.

For our patients who travel a long way within Switzerland, various treatments can also be carried out in one appointment. It is possible to perform large restorations with ceramic implants or have an amalgam removal with ceramic inlays in one session.

Our team consists of specialists who focus on their field of biological dentistry, so that an optimal result can be achieved:

Dr. Artur Hein: Biological dentistry

Dr. Josephine Phillips: Oral surgery and ceramic implants

Dr. Markus Spalek: CMD, prosthetics and complicated corrections of the bite

Tom Riedel: Metal-free dental technology

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