"Holistic Dentistry" in Arizona
Debra K. Davenport
Acting Auditor General of Arizona
Concerns have been raised by the public and legislators regarding the provision of holistic dentistry in Arizona. Holistic dentistry, which is not a specialty recognized by the American Dental Association, espouses treating the teeth and mouth to enhance overall health. (The eight ADA-recognized specialty areas are endodontics, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, prosthodontics, dental public health, and oral and maxillofacial pathology.) Issues relating to holistic dentistry are not new in Arizona, and have been previously debated in the Legislature in 1995 and 1996. Most recently the issue was brought to the forefront when the Board received several complaints against one holistic dentist and voted to hold a formal hearing to determine whether action should be taken against his license.
Holistic Dentistry Philosophy and Practices
Holistic dentistry, also known by names such as alternative or biological dentistry, advocates using restoration materials other than amalgam and focusing on the unrecognized impact that dental toxins and hidden dental infections can have on overall health. (Amalgam generally consists of a mix of silver, mercury, tin, and copper. It is typically the least expensive filling material, is long lasting, and can be placed in a single visit. However, some consumers and dentists believe amalgam fillings can contribute to noncurable systemic illnesses, such as Alzheimer's disease. A common practice among dentists who embrace the holistic dentistry philosophy is removal of amalgam fillings because of concerns about mercury toxicity. However, the American Dental Association's Principles of Ethics and Code of Professional Conduct does not support this procedure in situations where the fillings are still serviceable and the patient does not initiate their removal. Some holistic dentists also perform more invasive procedures, such as removing teeth that have had root canals.
The eight ADA-recognized specialty areas are endodontics, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, prosthodontics, dental public health, and oral and maxillofacial pathology. Others also perform cavitational surgery. (This is surgery to remove what are thought to be residual areas of dead bone tissue in the jaw bones around the former site of a tooth. It involves cutting into the soft tissue to reach the bone and then curretting, or cleaning out, the bone surrounding the area. Sites for possible cavitational surgery are not detectable through x-rays, and cannot be treated with antibiotics.) There is no prohibition against dentists performing or choosing not to perform these activities so long as they do not misrepresent the procedures or cause patient harm.
Attempts Have Been Made to Obtain Recognition
There have been efforts to have holistic dentistry recognized in the State. In 1995, a Sunrise review hearing was held to discuss establishing a separate board to regulate holistic dentists. Proponents argued that the existing dental board is biased against holistic dentists because of their nontraditional practices and procedures. A bill was never introduced, however, because the number of dentists who considered themselves holistic appeared to be so few that a separate regulatory board could not have been supported through licensing fees. One supporter indicated that there were approximately 20 holistic dentists practicing in the State. After the failed attempt to establish a separate board, legislation was introduced in 1996 to require one Board of Dental Examiners member to be a holistic dentist. This effort was also unsuccessful. More recently, holistic proponents have sought administrative rules specifically defining dentistry and assuring that holistic dentistry may be practiced in Arizona. However, dentistry in Arizona is defined in statute, and the Board does not have the authority to further define dentistry in rule. These recent efforts are related to a formal hearing against one holistic dentist.
Formal Hearing Addressed Complaints against One Holistic Dentist
When the Board initiated a formal hearing against one holistic dentist, allegations arose that this dentist had been singled out because of his holistic philosophy; however, the formal complaints against this dentist do not support the allegations. During a 16-day formal hearing, an independent administrative law judge heard 9 complaints against this dentist. Based on the evidence, the judge recommended that the Board revoke the dentist's license. The conclusions of law supporting the recommendation did not pertain to holistic dentistry but rather to misconduct as defined by Dental Board statutes. Specifically, the judge concluded that the dentist had endangered patients' health, safety, and welfare through behaviors such as:
- Basing treatment on inadequate x-rays and insufficient and unreliable clinical data;
- Failing to maintain adequate treatment records for each of the 9 patients involved;
- Failing to perform periodontal evaluations, despite evidence of periodontal concerns;
- Abandoning patients in the midst of treatment; and,
- Failing to adequately address complications stemming from procedures.
In February 1999, the Board considered the judge's recommendation and rejected it in favor of ordering censure, 5 years' probation, 48 hours of continuing education, and 5 years of quarterly audits of diagnosis, treatment, and planning skills, as well as recordkeeping.
The allegation in this case that the Board singles out holistic dentists appears to be unfounded. In fact, based on a review of complaint records, few dentists appear to be practicing holistic dentistry. Further, in those instances where complaints have been made about these dentists, most appear typically to relate to the quality of dental work rather than to practices considered "holistic."
The above passage was excerpted from Performance Audit: Arizona Board of Dental Examiners, Report No. 99-15, August 1999. The practitioner who was disciplined was Terry J. Lee, D.D.S., of Phoenix, Arizona. The administrative law judge's report is posted to Dental Watch.
This page was posted on July 1, 2002.