Beruflich Dokumente
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The Communicator
tal air vacuum system, mercury vapor ionizer, masks for doctor
& assistant, an air-exchanger in the HVAC system that replaces
all the air in the building 1 1/2 times per hour, and a mercury
separator to remove mercury from the waste water.
The Communicator
Member Profile:
HDA Interviews Jim Kennedy, DDS
The Holistic Dental Association represents members who
support diverse modalities of complementary alternative dentistry.
Dr. Jim Kennedy focuses on the treatment of TMJ dysfunction,
facial pain, sleep apnea, and orthodontics. When I mentioned his
name to a well-established dental laboratory head technician, he
said of Jim, “He’s a genius!”
The Communicator
One of the hallmarks of PTSD is flashbacks. These are re- as well as anger, feeling out of control, and betrayed.
plays of sensory memories of traumatic events, often intense
and frequently accompanied by great, inexplicable fear. Instead Oral-Motor Issues and Deficits
of understanding that a memory of an event has been triggered, Children, who have been sexually abused orally, may
it feels like it is happening right now in the present. develop an intolerance to touch around the face, neck, and
As Babette Rothschild puts it in The Body Remembers, mouth. That intolerance may cause or exacerbate oral-motor
“Typically … individuals with PTS and PTSD are missing issues, and the person may develop involuntary muscle move-
the explicit information necessary to make sense of their dis- ment and facial weakness which manifests as difficulties
tressing somatic symptoms …. with chewing, swallowing, and speech.. For these children
“A flashback can be triggered through … something seen, - and these children grown into adults - dental visits can be
heard, tasted, or smelled that serves as the reminder and sets emotionally agonizing (Yehuda, 2006).
the flashback in motion. It can just as easily be a sensation aris- Carmen Santos, a psychologist who has studied the con-
ing from inside the body. Sensory messages from muscles and nection between adult female survivors of sexual abuse and
connective tissue that remember a particular position, action, dental anxiety, describes the psychic overlap between experi-
or intention can be the source of a trigger…. Even an internal encing sexual abuse and dental anxiety:
state aroused during a traumatic event, for example, accelerated “Varying forms of abuse, such as those that inflict pain or
heart rate, can be a trigger… The accelerated heart rate and in- cause lack of control and powerlessness, may have a dramatic
creased respiration can be implicit reminders of the accelerated impact on the individual’s ability to manage routine activities
heart rate and increased respiration that accompanied the ter- involving physical discomfort, and may cause dental phobia.
ror or their trauma (Rothschild, 2000, 44-45). The symptoms that result consist of fear, anxiety, nausea,
When a person gets triggered, flashbacks tend to come in- dissociation, flashbacks and feelings of shame. The shame can
stantaneously with no time to realize what is happening. The be about being anxious, about poor oral health, or about hav-
experience is often compared to falling down a rabbit hole: one ing someone find out about the abuse.
minute you’re in the here and now, the next thing you know Many aspects of dental treatment symbolically represent
you’re in a state of fear - or nonexistent, nowhere. sexual abuse for many survivors. The following conditions may
trigger a repetition of earlier trauma: being alone with a per-
What This Means for You son more powerful than oneself, being placed in a horizontal
Professionally position, having someone nearby and touching you, having ob-
The problem for you as a professional trying to work in jects placed in one’s mouth, being unable to talk or swallow,
the mouth of someone who experiences PTS or PTSD is that and experiencing or anticipating pain. Many dental experiences
your work in the mouth may trigger memories, sensations, and may remind the patient of their abuse experience in that they
emotions from old sexual abuses - and consequently fear and restrain movement, produce gagging sensations (impressions),
possibly a strong need not to cooperate with you, even get away and the feeling of suffocation(rubber dams).”
from you. It is very important to understand that your patient
is a person who has become intensely afraid - not someone who Body Memories
is trying to make your job harder by being difficult. In the more than 100 years during which responses to
overwhelming experiences have been systematically explored,
The Mouth as an Erogenous Zone it has been noted that the psychological effects of trauma are
The mouth, lips, and tongue are very sensitive to touch and expressed as changes in the biological stress response. Excessive
taste and are a highly erogenous zone. Adults using children for stimulation of the central nervous system during the trauma
their own sexual gratification often choose this site for abuse. produces enduring neuronal changes. The abnormal startle re-
The strong sucking response of infants is even taken advantage sponse characteristic of PTSD is an example of such neuronal
of by adult and teenage males who seek sexual gratification change (van der Kolk, Ch 12).
from someone they think will not tell or even remember. Apparently the cells retain a ‘memory’ of how a traumatic
Sexual abuse in or involving the mouth can produce a con- experience felt physically and emotionally.
fusing combination of pleasurable and painful feelings. For Psychotherapists and body workers, such as massage thera-
people who have been sexually abused, the mouth can become pists and acupuncturists, have long known that the body re-
charged with fear and negative energy. Since being touched tains traumatic memories that can be released and healed
around and in the mouth can feel very good, children who have through mind-body work, unblocking of energy, and physical
been abused often experience a conflicted set of feelings for manipulation. And, with the increasing popularity of yoga in
these events: pleasure, guilt and shame at having been aroused, this country, many people are now experiencing the tremen-
10 The Communicator
information to you and ask questions even if she is unable to you can make her time in your chair easier for her, and staying
speak because her mouth is numb or full of dental equipment. within your comfort area with the material are probably going
7. Do not take the stance that this patient is just being dif- to be the most satisfying for both of you.
ficult or trying to do something to you. What you are engaged 12. You have to prove your trustworthiness to the patient.
in with a previously traumatized patient is a struggle to stay in Make reassuring eye contact, smile sincerely, be relaxed and
the present and not see you as another abuser. confident, do not criticize the patient, who is doing the best
8. If the patient is uncomfortable and trying to change po- she or he can manage at the time.
sition, allow it. Never push the patient back into the chair or
force her or his face into a particular position for your own Conclusions
purposes. It will work much better if you explain what position Recognizing when traumatic sexual experiences have made
you need for the work you are doing and ask for cooperation. patients fearful of dentists and dental procedures and becom-
9. Do not try to negate the patient’s fear by ignoring it or ing more adept in your approach to these patients will reward
trying to engage in small talk. you with better compliance. Patients will come to value you
10. Provide good distractions like music, animal or nature as a safe person in their lives and stop dreading or postponing
videos, your spoken explanations of what you’re doing while regular check ups and necessary dental work. You may even be
you are doing it. able to assist in their healing by becoming perceived as a trust-
11. Be respectful of the person’s struggle. Even if you rec- worthy authority figure rather than another violator.
ognize the abuse the patient has suffered, do not try to get
her or him to talk about it – for many reasons, including that REFERENCES
it is inappropriate to the situation, that you are not trained in For references, please contact the author:
how to do this, and that memories of and feelings about much Dr. Joan Rothchild Hardin
childhood sexual abuse are often repressed. If the patient re- 393 West Broadway #4
members being abused and trusts you enough to bring up the New York, NY 10012
subject, listening respectfully, thanking her for telling you so Tel (212) 966-9433
Fax (212) 431-9196
12 The Communicator
bone growing as a functional unit, not just from the stimulus of united by fibrous joints called sutures or fuse into the open lat-
the condyle, but including the body of the mandible, the condyle ticework of spongy bone. The spaces between the trabeculae fill
and the coronoid, angular and alveolar processes. Experimental with red marrow. The original connective tissue that surrounds
support for the functional matrix theory of mandibular growth the growing bone becomes periosteum.
was provided by the results of condylectomy which showed that Dr. Moss conjectured that the principle of the functional
growth of the rest of the mandible was unaffected. Moss empha- matrix would be applicable not only to sutures and intramem-
sized that the condylar growth occurs as an adaptive response to branously formed bones but also to endochondrally formed
the functional behavior of the oral cavity and orofacial muscula- bones–the vertebrae, the long bones, and most of the bones in
ture and that some parts of the mandible only reach optimal size the body.
with the full development and functional activity of their associ- Endochondral ossification is the replacement of cartilage by
ated muscles (Craniofacial Development, Growth And Evolution, bone. Again the mesenchymal cells proliferate and differentiate
Murray C. Meikle). and the chondroblasts lay down an extracellular matrix of colla-
Melvin Moss based his functional cranial hypothesis on his gen and chondroitin sulfate proteoglycans. Early in the embryo,
study and measuring of the craniological collections in the Amer- a cartilage model or template of the future bone is laid down and
ican Museum of Natural History and on the anatomical literature covered by a membrane called the perichondrium. Blood vessels
of the time, namely. On Growth and Form by D’Arcy Wentworth penetrate the perichondrium and stimulate cells in the internal
Thompson and The Development Of The Vertebrae Skull by Gavin layer to enlarge and become osteoblasts and form a periosteal
de Beer. He built on the theories that went before. In the lab, bony collar. Cartilage cells hypertrophy and burst. This changes
reports his wife and colleague, Dr. Letty Moss-Salentijn, he used the pH, making it more alkaline and causing calcification and
the approach, “If you want to test whether a structure is respon- deposition of minerals. When the cartilage cells die, they leave
sible for a specific parameter of growth, remove the structure and large cavities and blood vessels migrate in and a marrow cavity is
see what happens to that parameter.” (Moss-Salentjn, L. Melvin formed.
Moss and the functional matrix. J Dent Res. 76.(12)1997). Other Dr. Moss viewed cartilage as just one of many connective tis-
labs tested and verified Melvin Moss’ thesis, first with intramem- sues in the body whose differentiation was established because of
branous bone, the major classification of bone that forms the site-specific biomechanical conditions.
skull. Bone forms in 2 ways either by intramembranous ossifica- For example, growth in the articular cartilage of the condyle
tion or endochondral ossification. represented evidence of a compensatory secondary growth re-
The first stage in the development of bone is the migration sponse to the primary growth of the mandible down due to the
of mesenchymal cells (embryonic connective tissue cells) into the function of mastication.
area of bone formation, at about the 6th or 7th week of embry- As far as the role of the cranial cartilage, in the basicranial
onic development. These cells increase in size and number and synchondroses, Dr. Moss believed that they were similarly con-
differentiate. Some cells become chondroblasts, which form car- trolled by the functional matrix and not under genetic control.
tilage, and bone, and some cells become osteoblasts. He devised an experiment, using a drug that would affect the
Whether bone or cartilage is the more primitive tissue is functional matrix but not the skeletal tissue, and demonstrated
still undecided, but the distinction has long existed. Aristotle, that if the growth of the brainstem was reduced, the spheno-oc-
who lived 384-322 BC, separated fish into chondrichthyes and cipetal synchondroses was affected and would not grow indepen-
osteicthyes. The skeleton of the most primitive living fish–the dently.
lampreys–is cartilaginous. But in extinct jawless craniates, the Bone is constantly remodeled. In the adult, there is a balance
exoskeleton consists of a type of acellular bone with dentine tu- between the amount of bone resorbed and the amount formed.
bercles. This maintains mineral homeostasis, acid/alkaline balance, adap-
Cartilage and bone form from the same mesenchymal stem tation to mechanical loading, and the structural integrity of the
cell and their differentiation may well be determined, as Melvin organism. It has been estimated that there is a complete turnover
Moss taught, by their functional imperative. of the human skeleton every 10 years.
Bones formed by intramembranous ossification are the flat Dr. Melvin Moss’ theory of the functional matrix revo-
bones of the skull, most parts of the mandible, and parts of the lutionized our view of bone and made us aware that bone is
clavicle. Osteoblasts cluster in the fibrous membrane and become a dynamic and mobile tissue whose form is dependent on use
a center of ossification. The cells secrete a matrix composed of and the influences of surrounding tissues and other loads. This
collagen, proteins, and glycoproteins, in which calcium salts and new paradigm has changed the way we practice orthodontics
other minerals are deposited. A network of trabeculae or bony and supports the principles of cranial osteopathy. The func-
spicules with vascular spaces radiates outward from the initial tional matrix theory is a holistic approach to the biomechanics
site of ossification until it meets other trabeculae, which become of bone.
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Friend or Foe? Time Magazine and Prevention Magazine informed the public of
the “danger in the water supply”, in summer 2006, and advised their read-
ers to raise questions about the necessity of fluoride with their dentists.
Fluoridation of community water is one of the top 10 public The ADA continues to support fluoridation and provide point-
health achievements of the 20th century. Yet, there is enormous con- ers to help dentists respond to patient inquiries and refute the dan-
troversy about fluoride. Do the benefits outweigh the risks? The gers of fluoride. A quote from the ADA:
major benefit is reduced caries. 1.6 fewer cavities is the most optimis-
tic statistic, and this is provided by the ADA. Many people believe “Magazine Article May Confuse Readers
that the toxicity of fluoride is not worth the decrease in cavities. About Water Fluoridation Safety
Profluoride legislation has been defeated or tabled in Oregon, A cover story in the August issue of Prevention magazine,
Arkansas, Nebraska, Hawaii, California, Colorado, Iowa, Missouri, ‘The Danger in Your Water,’ contains what we believe is misin-
NY, Ohio, Utah, Washington. formation about the safety of community water fluoridation. The
Other established organizations have issued warnings. article appears to misconstrue the findings of the recent National
The FDA placed a warning on toothpaste with fluoride: “if Research Council report. It also highlights a research analysis by a
more than used for brushing is accidentally swallowed, get medical then-Harvard doctoral student that suggests a possible association
help or contact a poison control center.” between fluoride in water and osteosarcoma (a rare form of bone
The CDC issued guidelines stating that in communities with cancer). The ‘association’ found in this one, limited study, falls far
non-fluoridated water the only children who should get fluoride below any scientific standard needed to establish a cause-and-ef-
pills are those at high risk for decay, due to familial tendencies. fect relationship.”
In March, 2006, a panel of dentists, toxicologists, and research-
ers, assembled by the National Research Council, under the umbrel- ALTERNATIVES TO FLUORIDE
la of the National Academy of Sciences, determined that the current
level of fluoride, 4ppm, in community water, is too high, and that Practitioners concerned about the possible risks associated with fluo-
fluoride, rather than preventing decay, might initiate decay, as too ride use may wish to try some of the following:
much fluoride causes mottling and softening and more susceptibility MI Paste: GC America Inc: www.gcamerica.com
to decay(fluorosis). Even more alarming, the committee reported
Cavistat: arginine bicarbonate/calcium carbonate-containing denti-
that fluoride may have systemic effects-- such as lowering of IQ–as
frice. Contact: Ortek Therapeutics Inc. israel.kleinberg@sunysb.edu
much as 8 points–and that over a lifetime the ingestion of fluoride
could weaken bones and increase fractures. Magnesium
Also in the spring of 2006, a Harvard doctoral study suggested Milk of Magnesia
an association between fluoride in water and osetosarcoma.
16 The Communicator
A History of Fluoride that fluoride at 1 part per million (ppm) in water is enough to mini-
mize tooth decay without causing discoloration–or dental fluorosis,
as it’s now called.
As Presented in Prevention Magazine by Timothy Gower 1945: Federal scientists choose four pairs of cities for a 13- to 15-year
As researched by Joel Griffiths in “Covert Action Quarterly” study of fluoridation: Grand Rapids and Muskegon, MI; Newburgh
#42 and reported by Dylana Accolla, LicAcup and Kingston, NY; Evanston and Oak Park, IL; and Brantford and
1850: Fluoride emissions from iron and copper industries are poi- Sarnia, Ontario. Grand Rapids becomes the first city in the world to
soning livestock, crops, and people. have fluoridated water.
1900: Lawsuits and heavy regulations threaten to put an end to 1951: Muskegon, the comparison city for Grand Rapids, begins fluori-
these industries in Germany and England. The invention of the tall dating its own water supply. Communities across the country join in,
smokestack saves those industries by dispersing fluorides and other well in advance of any published results of the four-cities studies.
toxins into the upper air, so less of it directly effects living creatures 1955: Procter & Gamble introduces Crest, the first fluoride tooth-
below. paste endorsed by the American Dental Association.
1909: Colorado Springs dentist Frederic K. McKay asks the US den- 1962: Results from the Grand Rapids study are published. The find-
tal community to help him find an explanation for the “Colorado ings are called into question because the control was dropped 6 years
brown stain,” a discoloring of teeth common to the Pikes Peak area. into the study.
1927: A dentist in Bauxite, AR, reports extensive staining of resi- 1964: The movie Dr. Strangelove or: How I Stopped Worrying and
dents’ teeth. The town gets its water from a deep well near the site Learned to Love the Bomb is released. In it, an insane general, Jack D.
of an aluminum mine; fluoride is a waste by-product of aluminum Ripper, attributes fluoridation to a communist plot.
mining.
1977: A federal report finds evidence that Americans’ consumption
1931: The Public Health Service, under the leadership of Andrew of fluoride from food and water has increased significantly. At these
W. Mellon, US Treasury Secretary and a founder and major stock- levels, the report states, bone damage is a risk.
holder of the Aluminum Company of America (Alcoa), sends a
dentist named Trendley Dean to several remote Western towns 1990: As part of its “Healthy People 2000” plan, the CDC sets a goal
where drinking water contains high concentrations of natural fluo- of getting fluoridated water to 75% of Americans. Then, as now,
ride from deep in the earth’s crust to determine the effect of fluoride roughly two-thirds have treated water.
in the drinking water. He learns that fluoride discolors the teeth but 1993: A government review board, the National Research Council,
the people in the towns have fewer cavities. issues a report indicating that the variety of fluoride sources in the
1933: The world’s first major air pollution disaster, in the Meuse Val- United States could make limiting fluoride exposure necessary, and
ley, Belgium, involves fluoride poisoning. Several thousand people “reduction of fluoride concentrations in drinking water would be
become violently ill and die. easier to administer, monitor, and evaluate” than alternative cut-
backs.
1937: Danish fluoride researcher Kaj E. Roholm, MD, Copenhagen’s
deputy health commissioner, publishes a 364-page report titled Flu- 1997: The FDA requires toothpaste manufacturers to place a poi-
orine Intoxication. In it, he details the bone disease, skin lesions, and son control label on tubes and boxes reading: If more than used for
mortality that result from long-term exposure to fluoride. He also brushing is accidentally swallowed, get medical help or contact a
questions its ability to protect teeth. Poison Control Center right away.
1939: Researcher Gerald J. Cox at the Mellon Institute in Pittsburgh 2001: The CDC issues new guidelines saying that fluoride supple-
releases results from a rat study (showing healthier teeth) to support ments should only be given to children in nonfluoridated commu-
his recommendation that water be fluoridated. Cox gets help from nities who are also at high risk of cavities.
Edward L. Bernays, a nephew of Sigmund Freud who pioneered the 2006: The NRC releases a report suggesting that the current upper
application of Freud’s psychological theories to advertising and gov- limit for fluoride in water could cause tooth damage, bone fractures,
ernment propaganda. “If you can influence the [group’s] leaders, ei- and neurological problems and may be connected to certain can-
ther with or without their conscious cooperation,” wrote Bernays in cers. It recommends the EPA lower the safe exposure limit.
his 1928 book Propaganda, “you automatically influence the group Addenda: The US Public Health Services has endorsed silicofluo-
which they sway.” The main targets of Bernays advertising blitz are ride, a chemical by-product of various industries, to be added to wa-
doctors and dentists. Under Bernays’ media tactics, a quick shift in ter as a cheaper substitute for naturally occurring sodium fluoride.
peoples’ perception of fluoride begins to take place. Research since 1975 has shown that it is much more toxic than so-
1942: A National Institutes of Health study of 7,000 children shows dium fluoride.
18 The Communicator
• Dopamine
Clinical Pearls • Gamma amino butyric acid
• Histamine
Jewels for Safe Removal of Defective • L-Tryptophan
Amalgam Restorations • Norepinephrine
3. Evaluate the presence and load of Heavy Metals in the body
By Dr. Harold Ravins by fecal testing, using Doctors Data Laboratories.
4. Have the patient give you a complete list of all supplements
Before removal of amalgam: he/she presently takes.
1. Check the levels of: 5. Check biocompatibility of all materials used.
• Glutathione
• Magnesium During removal of amalgam:
• Vitamin C 1. Use rubber dam, high power suction, mercury ionizer, ster-
• Selenium ile O2 mask on the nose
• Vitamin E 2. Use a new carbide #1156 bur for all teeth
• Lipoic acid 3. Inform the patient that the basic removal will take under 35
• Acetyl cysteine seconds per amalgam.
(Note a deficiency or excess) 4. Remove corrosive debris with slow round bur
2. To determine if the blood/brain barrier is intact, check the 5. Rinse cavity with antioxidant
levels of the following neurotransmitters: 6. Replace the amalgam with Fuji 9, for the first phase of re-
• Acetylcholine chloride storing tooth.
• Adrenaline 7. Restore the tooth permanently with a tested nonreactive
• Beta Endorphin material-- filling, inlay, onlay, or crown.
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20 The Communicator