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Dr. Terry Wahls is an Institute for Functional Medicine Certified Practitioner and a board-certified internal medicine physician. She also conducts clinical trials testing the efficacy of diet and lifestyle in the setting of multiple sclerosis. In 2018 she was awarded the Institute for Functional Medicine’s Linus Pauling Award for her... Read More
Dr. Stuart Nunnally is a graduate of the University of Texas Health Science Center Dental School in San Antonio (1980). He maintains an integrative biological dental practice in Marble Falls, Texas where he and his partners have treated patients from all fifty states and forty-seven countries. Dr. Nunnally is chairman... Read More
Dr. Lane Freeman returned to her childhood dental practice in 2002 and has helped develop it into a leading center for integrative, biological dental care. Dr. Freeman has a passion for educating her patients on the relationship between their oral health and overall systemic health. Dr. Freeman and Dr. Nunnally... Read More
- Learn about the significant role dental restorative materials can play in increasing the risk of neuroimmune problems
- Understand the potential risks associated with root canals and wisdom teeth removal in worsening autoimmune problems
- Gather insights on the best approaches for reducing periodontal disease and tips on how to find a holistic dentist
- This video is part of the Multiple Sclerosis and Neuroimmune Summit
Related Topics
Autoimmune Disease, Autoimmunity, Chronic Illness, Dental Health, Gut, Gut Health, Inflammation, Multiple SclerosisTerry Wahls, MD
Welcome. I am so glad that you agreed to be part of this summit. Welcome, Stuart. Welcome, Lane. What I would like to have you do is explain to the audience who you are briefly and why you are an expert.
Dr. Stuart Nunnally
We have a holistic dental practice in Central Texas, about 50 miles West of Austin. It developed 20 years ago, even though at 22 I have been in practice for way longer than that, 42. But I got sick myself about 20 years ago. I was treated in Montreal by the old grandfather of holistic dentistry. His name was Hal Huggins and really, as a result of that, we completely revamped our practice years ago. And so now primarily the patients that we see have either autoimmune disease or any degenerative disease cancer. So that is the vast majority of the patients that we see. Most are referred by physicians like you, Dr. Wahls, who know of the dental connection to systemic health.
Dr. Lane Freeman
And I’m Dr. Lane Freeman, and I’m practicing with Dr. Nunnally. I have been blessed to be here with him the whole time that we have transformed this practice into one that is more integrative and biological, that seeks to help patients look at how the mouth affects the whole body systemically. And so I think he gave a great overview of what our group looks like.
Terry Wahls, MD
Many of us know we see dentists regularly. And what is the difference between my conventional dentist that I have seen for my dental cleaning every six months and you guys?
Dr. Stuart Nunnally
Well, I think there are a number of things, so I will mention a couple and then I will have Lane follow me. But certainly, one thing is we placed very strict attention to the materials that we use so that we are not going to compromise the immune system. Most of our patients already have immuno challenges, and so we do not want to introduce something into their mouth that they are going to have exposure to 24 seven. We certainly consider that an important issue. We also consider materials like fluoride as a tremendous challenge to patients. And so we encourage patients, of course, not to use those things that would compromise their immune system.
Terry Wahls, MD
How do you explain that the compounds that conventional dentists are using are toxic that you would not use?
Dr. Lane Freeman
The big one. The big material that we would not ever use, but also that we have protocols to remove safely would be mercury fillings. So those many times are referred to as amalgams or silver fillings, but they are technically mercury fillings every one of those silver fillings if you open your mouth and look in there, would contain 50% mercury at minimum, and then there would be varying amounts of copper and tin and silver and zinc in there. And so that mercury, though, is 24 seven being released from those fillings, no matter how small or large, no matter how new or old they are. So that would be the big one. We are also looking at things like nickel and we want to also pay close attention to metals, even like titanium, which can sometimes be considered a more friendly metal. But we really want to be careful with anything that has a metal component, but those are probably the top three.
Dr. Stuart Nunnally
There are other toxicities too that we really look for, and that can come in the form of a root canal, which we know now has a toxicity of its own. And there is a jawbone lesion known as jawbone osteonecrosis. It is known in the world primarily as a cavitation. And those two have toxins that typically can be a challenge to the immune system.
Terry Wahls, MD
So you mentioned fluoride before we got into the mercury question. We all know that fluoride is important to prevent cavities. It is added to our water, and it’s added to our toothpaste. But it sounds like you are not a fan of fluoride. So what is the story there?
Dr. Stuart Nunnally
No, we are not a fan of fluoride at all because it competes for one and outcompetes binding sites for iodine, particularly in the thyroid. And so now we have displaced iodine with fluoride and we have thyroid hormones that do not function properly. So that is a huge thing. And of course, iodine is in every cell in the body. So there is not a place where fluoride does not outcompete its fellow halogens. And we are much opposed to it because of the systemic issues. And to tell you the truth, there is very little data on fluoride being beneficial in terms of preventing tooth decay, except for that is applied topically, but in terms of receiving it systemically, as we do in our water supply and in various other ways that we receive or to even, quite frankly, in these fluoride traces, deliver huge amounts of fluoride. We think that is not wise at all just because of its systemic impact.
Terry Wahls, MD
And now you mentioned titanium. You are so pleased with titanium. And I’m thinking about the people I know who have dental implants with titanium. What are your thoughts about that?
Dr. Lane Freeman
Well, with titanium as with any of these other metals, we do find that titanium can leach into in the instance of an implant into the bone. And so releasing that metal up, we could just keep it contained would be one thing. But since we find that it can be leached into the bone, that would be where our concern would come from. We would prefer if an implant is appropriate for a patient, it’s not always appropriate, but if it is appropriate for a patient, we would prefer to use a zirconia implant which would be metal free and all ceramic.
But in some cases, an implant just isn’t appropriate no matter what the material is because it is still something foreign that is being implanted into the bone. And really, just to circle back on what you asked about, what is the difference with a conventional dentist? There are some great conventional dentists that really care about their patients that they may not be looking at what they are putting in the mouth or what is already there, how it is affecting the patient’s whole system. And that would be really what sets us apart and how we’re looking at that dental needs.
Dr. Stuart Nunnally
Since we are dealing primarily with this here, we would not entertain the idea of having an implant placed on someone who has a blatant autoimmune disease in their aspirations or otherwise. We just think it is too much of a challenge, even zirconia. We would prefer not to place into someone’s bone something that does not have their own DNA on it. So we do not recommend implants for our patients who have degenerative diseases.
Terry Wahls, MD
In an M.S. patient, if I lose a tooth, you would not tell me to pop any implant.
Dr. Stuart Nunnally
That is correct. There are many other ways to replace missing teeth and we love to see patients improve. And once they are on their A-game, they can experiment if they wish with one implant, and see how they do. If they seem to do well, then maybe that is the reason for them to go forward with future implants. But we would say go very slow in that game and do not try to challenge the body with something that is foreign,
Terry Wahls, MD
That makes a lot of sense. So I’m curious, what kind of restorative materials do you guys use then if someone has a cavity that needs to be addressed?
Dr. Lane Freeman
We would use various materials We have access to Biocompatibility reports, which would be a serum blood test that would be sent to a lab that could tell us that they would be tested against a patient’s own blood, would be tested against thousands and thousands of dental materials, but specifically for filling materials, we have found there are a couple that have been just universally biocompatible, so appropriate for almost every patient we come across. If we have a question about it, then we just go ahead and send in a biocompatibility test. So it would be a composite resin would be the choice for filling a cavity. If a tooth is broken or has too large of a filling that we might be looking at non-metal ceramic restorations like a crown or inlay or onlay, things like that.
Terry Wahls, MD
And these crowns or inlays on those, those are ceramic kinds of things that are made specifically for my tooth.
Dr. Lane Freeman
Correct. They would be custom-made many times. We can make them here in our office. We have an in-house lab that is familiar with the materials that we like to use for our patients. And once again, we can always refer to that Biocompatibility test. If a patient has chosen to do that. That is completely for that patient only and can be done here at the same time. So that would be okay for those teeth.
Terry Wahls, MD
So if I have the misfortune of having my teeth filled and my tooth breaks and now my conventional dentist would say, well, after you broke your tooth, we ought to do a root canal. And that may be happening to some of the folks who are listening. How would you handle that kind of scenario in your practice?
Dr. Stuart Nunnally
Well, you have to know that in the first 20 years of my practice, I probably did 100 root canals a year. And I did not know about any data that suggested that root canals had toxicity associated with them or that they could contribute to systemic disease. Unfortunately, I have never read the works of Weston Price and others who demonstrated conclusively that root canals do have toxicity associated with them. They are laden with bacteria and viruses and fungi, and no matter how well a root canal is cleaned out and you cannot render the tooth sterile, you do render it without a blood supply. So now you have this non-sterile or bacteria-filled dead tooth sitting in an incubator of 98.6 and no way for your immune system to get to it and clean it up. Because in the process of doing a root canal, you sever the blood supply to it. So we now know and there is great data to support this now that root canal-treated teeth pose a systemic health risk. This is one of these great challenges for us as dentists. We have to have these discussions with patients and inform them and say, listen, this is the risk of having the tooth from either a root canal or removed. Let us talk about what that looks like in the future. And then you can participate and might help you make the decision.
Terry Wahls, MD
So if someone has had a root canal in the past and now I have two or three root canals in the past, I now have MS and a neuroimmune condition. How would I sort out if my root canals are part of the problem now and I don’t have any pain in my teeth, I’m eating steaks and that part seems to be going, okay, so how would I think through whether the root canals are part of the problem.
Dr. Lane Freeman
So many times root canal-treated teeth and any infected tooth can be asymptomatic. They can be completely unaware that you have an infection sitting in your mouth. The chronic infection can be completely without pain, but unfortunately, it does not mean that is an absence of infection. So one of the two big things to look at would be the research that Dr. Nunnally is referring to concerning the toxicity that we know is present in every single root canal tooth, no matter how perfectly it was done. But then also we utilize a cone beam imaging, 3D imaging so that we can look at these teeth more than just in two dimensions. Many times we will find a tooth that’s completely asymptomatic, looks perfect in a two-dimensional X-ray, and will have a huge infection like an abscess, which would be the layman’s term for that on that tooth that is visible with that three-dimensional X-ray.
So as far as determining if it’s a factor in any type of autoimmune issue the conversation becomes this: the single root cannot treat a tooth or multiple root canal-treated teeth are in some way a drain on the immune system. The immune system is daily responding to that root canal-treated tooth as an area of chronic infection. And so it becomes a definite contributing factor to the immune system, not functioning as well as it could. And that would be the conversation that I think we have with a lot of our autoimmune patients is this may not be the one thing, but it is definitely an important thing to look at.
Dr. Stuart Nunnally
And, you know, I think of a particular interest area when we talk about autoimmune issues, so often the leaky gut comes out and we know that certainly, that can induce although immune issues. Well, now in the literature you will see the term leaky teeth. And this was actually coined 100 years ago by Western Price, he realized that disease teeth leaked toxins he could not identify them 100 years ago.
Now they are identified. And now we have these elevated levels of LPS being leaked from gram-negative bacteria and root canal-treated teeth just like we do from the gut. And so those have a tremendous impact not only on our immune system but on our cognitive function. And it is an area we should be taking precautions with.
Terry Wahls, MD
I’m thinking if I am an M.S. patient and I have root canals, it is probably worthwhile finding a biological dentist who could do a cone beam examination of my teeth and then have a conversation about whatever they find and what I might do in response to those findings.
Dr. Stuart Nunnally
I think so. I would and the discussion should be this. I do not think it should just be, I want to take every root canal-treated tooth out that you have. You need to have an intelligent, informed discussion with the dentist. And the dentist says, listen, this is the trade-off. Let us say you have six root canal-treated teeth. If he does not say, if I take your six root canal-treated teeth out, number one, you may not have an improvement in your systemic health issues. That is possible. Number two, he should say, and listen, I’m going to pose a whole new set of problems. You may not be able to chew as well as you can now. So the discussion needs to be had in a way that unfortunately does not, so here is what happens in traditional dentistry now. If you come in with a broken tooth or a toothache, and the dentist just lets do a root canal on a crown. There is no discussion of any potential side effects as a result of that. What I think a well-meaning holistic business would do is say here’s the issue, we know you have this systemic illness I do not want to contribute to it. Let us talk about those things that we can do that will lighten the load for you. And let us talk about the consequences of that going forward.
Terry Wahls, MD
I think that sounds reasonable and if I have one or two or however many I have, I can get evaluated. I understand. Are there cavitations now? And if there are, that is one conversation. If there are no cavitations, then is it reasonable to just say periodically go look. And as long as there are no cavitations, I’m feeling well, I’m chewing well and my neuroimmune problem is fairly well controlled. I’m doing well. We could just watch. Would that be an okay approach? What do you think?
Dr. Lane Freeman
It would be? It will definitely be because the patient needs to be in control of making these decisions. They just need to be informed decisions. And many times we find patients saying, I would have never heard this before or I just started doing all this research. I do want to make a quick distinction on what we look for on the calm being an abscess versus a cavitation. So an abscess would be a lack of density, maybe around the end of a root where the infection inside of a root canal treated tooth would destroy the bone and cause what we would see as a little dark bubble that would be an abscess. A cavitation would form in an area where a tooth has been removed previously and perhaps was not cleaned out properly, or for some reason, the bone did not heal. Some commonly this happens when wisdom teeth are removed because typically those teeth are not infected. When they are removed, surgeons get in there, do a good job of actually just taking the tooth topper without going back in and cleaning out the socket. It can happen with any tooth that is removed. If it is not cleaned properly, then the area begins. The body begins to heal everything on the outside but the inside of the bone there doesn’t heal properly. That would be what, but it’s another. It’s a very similar setup to a root canal treated to an abscess and that you have dead tissue and you have a lack of blood flow. So it’s the same kind of setup, but it is a different area we will be looking at on both of those on a cone beam. You need a cone beam to see specific evidence.
Terry Wahls, MD
In the clue for that problem. Might that be symptoms or might they have like again the MS in your patient might but,
Dr. Stuart Nunnally
The majority of the cavitated lesions or cavitation are not changing.
Terry Wahls, MD
Are not painful.
Dr. Stuart Nunnally
Yeah. There is a subset of them that are and those typically manifest estrogen around. But those that do not often go completely undetected.
Terry Wahls, MD
So we could have MS and neuroimmune patients who had their wisdom teeth out, chewing fine, having no awareness that there are any mouth problems. And they may have tried Trigeminal neuralgia. Of course, I’m one of those folks or they may not have tried Trigeminal neuralgia. So, it might be worthwhile for them to go see a holistic dentist to say, I had wisdom teeth out, you know, take a look at my jaw, see if there is any mischief in there. I do not have any root canals, but my wisdom teeth were removed. Is that what I’m hearing correctly?
Dr. Stuart Nunnally
Positively. And whether the vast majority of these do not present in a painful way at all. Rarely ever do we find even what we think of as infected tissue in there and in the way that we find an abscess like pus. But we do find a concentration of very potent anaerobes in there that do produce a very potent line of toxins, all of which now are being identified. And they certainly pose a problem in terms of challenging a patient’s systemic ills.
Terry Wahls, MD
Now I’m going to move into another area that I hope you guys can address. If you have demineralization because of aging or demineralization because you’re relying on a cavity, is there anything that I can do with vitamin K2 or diet that could help me remineralize my teeth or heal a cavity?
Dr. Lane Freeman
I think we get this question a lot actually as we are looking at demineralization or if we identify a cavity in someone that feels like they are doing everything right from a diet standpoint and from a supplement standpoint, they still have these areas. Then definitely there are materials now with toothpaste and rinses and tooth powders that have agents like substances like hydroxyapatite in them that can act to help remineralize an area. One conversation I have to have sometimes the patient will have a deeper cavity that’s passed the enamel into the second layer of a tooth. That is like dentin. It is a little harder to get the two to remineralize at that point, but if we can catch it in that outer layer of two structures in the enamel, things like that can actually remineralize and heal a cavity or an area that’s becoming weak on a tooth.
Certainly, a clean diet with low and complex carbohydrates is important, not just brushing the teeth, but flushing out bad bacteria from under the gum line with things like a water pick. Things like that are also very important as far as homecare goes, but there are definitely agents that can be used to help with that remineralization.
Terry Wahls, MD
So please repeat that again hydroxy what now?
Dr. Lane Freeman
Hydroxyapatite. It’s hydroxy. And then Apatite.
Dr. Stuart Nunnally
And you will find that now in this remineralized toothpaste. Just as Lane said, as long as you are in the enamel, you do have the potential of remineralized the tooth. Even the slab of my mouth is full of minerals and it can help bring them along because of so much of this. A heart-healthy diet is a tooth-healthy diet. And if you emphasize those things that we know are healthy for our system until they do well for our teeth.
Terry Wahls, MD
Now, what about oil pulling? This is another thing that I have heard people mention as a useful dental care strategy. What are your thoughts on that?
Dr. Stuart Nunnally
I think it is fine. I don’t know that it does what people would say that it does. I think it is fine. You do certainly abstract some bacteria from the mouth because they have cell walls that tend to conglomerate with the oil that you’re using. When you spit, you get rid of those. The two problems are as one, no matter where you do it, someone always tends to come up to you wanting to visit with you while you are in the middle of the oil pulling or you clog your sink up, you need a hole to spit outside or any trash can.
Dr. Lane Freeman
That is a good adjunctive treatment. It’s just not a substitute for anything else.
Terry Wahls, MD
I like that oil pulling and then rinsing my mouth with water. It does feel super refreshing. I had to point out my son, he might spit down the sinks. No, you will clog the plumbing. Because for the listeners, what happens is the bacteria will then live in the pipes for your plumbing and will narrow. And suddenly you have a very expensive plumbing bill. And what about sources for vitamin K2? Do you have opinions about that?
Dr. Stuart Nunnally
Not so much. We typically supplement with K2. And we think, of course, we love to see our patients’ vitamin D levels up, especially when we’re doing surgery in the bone. We want to see their D levels up and we want to see them using D and in combination with K2. We typically supplement.
Terry Wahls, MD
This has been amazing. This is really wonderful. I could talk to you guys all day long. Why don’t we distill it down? What is the one thing that you would like to have people begin doing right now as it’s their next step for more holistic dental care?
Dr. Lane Freeman
The things that you can do at home immediately to reduce bacteria in your gum tissue, speaking from a periodontal disease perspective is to use a water pipe with a dilute solution of hydrogen peroxide. We will give our website here in a minute. And there is a lot of information on our hygiene tab regarding that and types of toothpaste and things like that. And then I think the other thing I would say is asking questions. When you go to the dentist, what is in my mouth, having a dentist that will answer your questions and look at things for you from a broader perspective and from a systemic health standpoint, is big. It’s huge. If you would say-
Dr. Stuart Nunnally
I think that too, Terry, if your listeners are looking for a holistic dentist, they can go to this website, iaomt.org. That’s the International Academy of Oral Medicine Toxicology. They’re almost 1500 dentists now around the world who have at least been exposed to holistic dentistry. And many of those now are what are called smart certified. They are certified in that technique for removing mercury fillings safely. This would be a great place for people to launch.
Terry Wahls, MD
Perfect. And where is your website? So they could come check you guys out?
Dr. Lane Freeman
Our website is Healthysmilesforlife.com. No abbreviations, just healthy smiles for life dot com.
Terry Wahls, MD
That is wonderful. Thank you so much. This has been terrific.
Dr. Stuart Nunnally
Thank you.
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