Professionally, I have always been an anachronism. Prior to World War II the general practitioner dominated the medical scene. Following World War II, however, the medical landscape changed dramatically. It was generally believed that advances in diagnosis and treatment had made medical care of an individual too complex to be handled by a single physician. To gain the respect of their peers and the admiration of society physicians were expected to select a narrow area of care and become expert in it.

The early specialties of pediatrics, internal medicine, and surgery quickly became too broad to be considered by most medical students. Anyone who was someone in medicine chose to sub-specialize in a field such gastroenterology, urology, or cardiology. Eventually, it was not enough to specialize in a particular body part, such as the eye. A truly fine ophthalmologist needed to become a retinal specialist, a corneal specialist, or a glaucoma specialist.

When I graduated from medical school I deliberately chose to become a generalist in an age of specialization. “Specializing” in Family Medicine did not change the fact that I was providing womb-to-tomb care. While many of my classmates believed it impossible to provide competent care for a total eye, I was choosing to provide comprehensive medical care for an entire person.

The ability to provide comprehensive medical care is not as difficult as some believe. It is simply a matter of acquiring a great breadth of knowledge rather than a great depth of knowledge. A medical sub-specialist knows a great deal more of the esoteric details of disease in very limited area. A medical generalist knows a great deal about the common maladies that plague most individuals.

He or she is content with knowing that a rare disease exists, how to recognize it and the appropriate sub-specialist to consult, should he or she ever encounter a person with the ailment. By concentrating on learning the skills required to effectively manage common problems, a generalist can personally deal with 85 to 90 percent of the challenges encountered and easily refer the remaining 10 to 15 percent to the appropriate sub-specialist.

Ironically, as I have gained an understanding of how disease develops, I have found that I am able to show many people how to reverse illnesses for which sub-specialists have no effective treatment. Having begun my medical career dealing with common health challenges I have come full circle and now spend most of my time consulting with people for whom modern medical sub-specialists can provide no answers.

As I went through my medical training I became equipped to handle a wide variety of health challenges. By the time I completed my training I was approaching rashes, infections, lacerations, heart attacks, fractures and pregnancies with confidence. No one was too young or too old to access my services. There was one aspect of health care, however, for which I was totally unprepared, for I had received no training in that area whatsoever.

There is, you see, one part of the body that has been the realm of specialists for so long that it is no longer considered a part of medicine. I did not hear a single lecture in medical school regarding the subject. I did not rotate through the specialty during my internship or residency. I have never heard a continuing medical education talk on the subject. When confronted, as I occasionally was, with an injury or disease of the teeth or gums I was hopelessly incompetent. I could only call a local dentist and ask for assistance.

Dentistry has been divorced from medicine for at least 300 years. Pierre Fauchard, who is considered the father of dentistry, founded the specialty around the turn of the eighteenth century. With the advent of dental drills, artificial teeth, and dental braces (all of which were introduced by Fauchard), care of the teeth rapidly became the province of dentists and was excluded from the scope of medical diagnosis and treatment.

The completeness of this division is evident in the existence of dental insurance as an entity separate from medical insurance. As third parties began to exert their control over the practice of medicine, I quickly learned that if I wanted to be paid for a visit by an individual complaining of ear pain due to an inflamed temporomandibular joint, I needed to code my diagnosis as an “earache” and not “TM Joint syndrome”. While the service I performed at the time of the visit was identical, if I said I had diagnosed and treated a problem with the TM joint, payment for the visit would be withheld on the basis that it was a dental problem and not covered by medical insurance. If I said that I had treated an earache, I would receive payment, since an earache is a medical problem covered by medical insurance.

While I continue to refer people who have cavities, are in need of dentures, or who need braces to dentists in the same manner in which I refer those in need of spinal alignment to a chiropractor or with a hernia to a surgeon, I no longer view care of the teeth and gums as outside of my spectrum of interest. The teeth and gums play a significant role in maintaining the body’s overall health. As such, protecting them is a legitimate concern of a wellness physician.

Physicians, as a whole, know very little about the mechanisms that cause aging and trigger the appearance of most chronic diseases. They know less about how to reverse inflammation, how to restore methylation ability, and how to stop free radical damage than a typical high school dropout knows about quantum physics. I suspect that the same limitations are true of dentists. Therefore neither physicians or dentists are adequately prepared to deal with the inflammation that is at the heart of most gum disease and loss of teeth.

My personal experience is illustrative of what can happen to teeth and gums and what can be done to protect them. I experienced excellent dental health during my childhood. My first cavity occurred while attending medical school. The dentist shook his head in disgust, placed a filling, and dismissed me with a gruff command: “Take better care of your teeth!”

I entered my internship with that single filling; by the time I completed my residency three years later there was scarcely a tooth in my mouth that did not carry at least one mercury amalgam. Perhaps it was the stress inherent in the training process, the long hours, eating meals on the run, or a lack of sleep that caused my teeth to deteriorate so badly. It was most likely a combination of all of those factors, coupled with a lack of understanding of how to properly care for my teeth.

I continued to develop cavities during my first two years of medical practice. A series of dentists dutifully identified the damage and placed fillings, occasionally commenting on my need to come in for frequent cleanings and to brush my teeth regularly.

During my second year of medical practice I moved to a new community. About six month’s later I once again found myself in need of a new dentist. After doing x-rays and repairing two cavities that had been revealed, he did something no other dentist had done. He taught me how to take care of my teeth.

He noted that nearly all of my cavities had occurred adjacent to the spaces between my teeth where brushing could not reach. He took out a container of dental floss; a marvel that I did not know existed. He withdrew an appropriate length and proceeded to demonstrate how I could effectively clean between my teeth. Plaque, he explained, needs more than 24 hours to form. Therefore, I could eliminate nearly all cavities by simply flossing once each day. I have not developed a new cavity since that day, nearly thirty years ago.

Unfortunately, amalgam fillings expand as they harden. This phenomenon caused hairline cracks to occur in my teeth. Over the years these invisible fractures have led to a number of broken teeth and the need for a number of protective crowns.

During one of my visits to obtain a crown for a broken tooth the dentist used a caliper to measure the depth of my gums and proclaimed that I would soon need surgery to trim back excess tissue. I had, however, recently learned of propolis, a bee product that is extremely effective at preventing plaque build-up and supporting gum health. My gum line receded without surgery, and the issue has never been raised again.

Looking back, I cannot help but wonder how different my dental history might have been had the first dentist taken a moment to tell me about the availability of dental floss rather than dismissing me with a harsh rebuke for letting that initial cavity develop. I am eternally grateful to the man who took less than three minutes of his time to explain how I could stop the process of plaque development and prevent tooth decay. He is personally responsible for the fact that I still have all my teeth today. Had it not been for his sage advice I would probably have lost them to decay or periodontal disease.

Periodontal disease is the term used to describe conditions that destroy the tissues that support the teeth, including the gingiva (gums), the periodontal ligaments, and the tooth sockets (alveolar bone). The mildest form of periodontal disease is gingivitis.

Gingivitis is a condition characterized by inflammation of the gums. (The suffix “itis” means “inflammation”; gingiva means “gum”.) When gingivitis is present the gums may be swollen, tender, have a bright, shiny red or reddish-purple appearance, or bleed easily. Unaddressed, the inflammation can spread and ultimately involve the bone surrounding the roots of the teeth. Uncontrolled periodontal disease is the leading cause of tooth loss in the world today.

Gingivitis is typically treated by professional tooth cleaning every six months, twice daily brushing with a toothpaste containing fluoride, and daily flossing. While these measures will reverse and control the condition in many cases, they are an incomplete answer to the challenge.

Plaque is believed to be the leading cause of gingivitis and more severe periodontal disease. Mechanical cleansing is helpful in preventing plaque buildup, but it is often insufficient. Plaque that is not removed hardens into a substance called tartar, that is firmly attached to the surface of the teeth.

Plaque is a biofilm. A biofilm is a colony of microorganisms that have attached themselves to a surface and surrounded themselves with a protective cover of slime made up predominately of sugars. Once surrounded, the bacteria, fungi, and other organisms are able to survive indefinitely. Organisms from the biofilm are able to invade the gum, causing an infection. (For more information on biofilms see the February, 2005 issue.)

Once established, biofilms protect the microorganisms from the body’s immune system and from chemical agents such as antiseptics or fluoride. If the biofilm becomes mineralized, as in the case of tartar, it cannot be destroyed by brushing or flossing.

Fortunately, there are agents that destroy the protective coating of biofilms and make the organisms they contain vulnerable to the body’s immune system. Although rarely recommended by dentists, products containing these agents are readily available. One of the most effective anti-plaque substances is propolis.

Propolis is a waxy substance used by bees to seal cracks in their hives. Although it was long believed that its sole function was to improve the structural stability of the hive it is now felt to be a significant deterrent to parasites and diseases in the hive. Propolis has been used medicinally to treat burns and sore throats, and instrument makers, including Stradivari, have used it to enhance the appearance of the wood grain.

A number of dental care products now contain propolis, in part because of its demonstrated ability to eradicate plaque, and also because propolis is one of the few substances that has been found to decrease the sensitivity of teeth to hot or cold foods.

Essential oils such as clove, thyme, tea tree, peppermint, spearmint, almond and others are also effective at breaking up dental plaque as is xylitol, a sugar alcohol. Xylitol is not only found in some dentifrices, but it is used as a sweetening agent in some brands of chewing gum to take advantage of its decay-preventing properties. It is also found in several candies for the same reason.

As important as mechanical cleansing and the use of topical agents to dissolve plaque are to the prevention of tooth decay and gingivitis there is an additional factor that is, again, rarely considered or recommended by dentists or physicians. It is well-documented that gingivitis is associated with an increased risk of heart disease.

The most popular theory in this regard is that the inflammation of the gums allows bacteria to enter the bloodstream and subsequently cause inflammation in the arteries of the heart leading to a heart attack or congestive heart failure. There is a more straightforward relationship, however. Coenzyme Q10 is a substance that supports cellular energy production. It is found in the greatest concentration in heart muscle, but it is also required for gum health. Low levels of coenzyme Q10 are found in people with gingivitis as well as those with heart disease. It is quite likely, therefore, that coenzyme Q10 deficiencies are the common thread that links heart disease and gingivitis.

Coenzyme Q10 supplementation can produce dramatic results. I have personally seen people who were scheduled for a total mouth extraction reverse their periodontal disease so completely and so quickly that they were able to retain their teeth. Thirty to sixty mg. twice daily is the usual amount required to produce improvement.

As with other medical challenges, basic interventions can significantly improve dental health. The need for dentures should not be viewed as a natural consequence of aging. Flossing daily, using a dentifrice containing propolis, xylitol, or an essential oil, and, if necessary, supplementing coenzyme Q10 can prevent nearly all dental, and periodontal disease. Making those simple measures a part of your daily routine will assure that you have healthy teeth and gums throughout your life.