New Dentists Column Dr Bowers

Embracing the Whole Patient, Honoring the Evidence

Oct 5, 2026 by Stephanie Bowers, DDS, MS
“Non-toxic.” “Clean.” “Natural.” “Holistic”. These buzzwords have become increasingly common in conversations about health and wellness over the past several years, and now in dentistry too. Medicine is learning to treat the patient as a whole person. The mouth is finally being recognized as part of the body, with growing evidence linking oral health and overall health. The focus is shifting to identifying the root source of illness and working on prevention, instead of just prescribing medications and treating symptoms. Dentists should be ecstatic; we have been working toward this for years. But embracing this cultural shift does not require us to throw everything we already know about dentistry out the window.

Patients are coming with more information than ever before. They have questions about fluoride, hydroxyapatite, ozone therapy, salivary testing, red-light therapy, “non-toxic” dental materials, and countless other new products and treatments. The problem isn’t that every new emerging therapy or product is ineffective. Some of these innovations may significantly change the way we practice. The problem is that plausibility, testimonials, laboratory findings, and early studies can easily get translated into clinical claims, that the evidence simply does not justify yet.

Social media has accelerated this shift dramatically. A podcast or an influencer makes a bold and emotional statement like “your toothpaste contains a neurotoxin” or “your root canal is giving you cancer” and suddenly patients are coming in with rampant caries or asking for their perfectly healthy teeth with root canals to be extracted. The term “toxic” is often being used incorrectly. In toxicology, essentially anything can become toxic at a sufficient dose. The dose, route, duration, and level of exposure matter.

Perhaps the most important example: Fluoride. The 2024 National Toxicology Program review found an association between fluoride exposure above 1.5 mg/L and lower IQ in children. That's more than double the recommended level of 0.7 mg/L in community water1. At the doses we use in practice, there is strong evidence showing no negative effect on cognitive development and no significant harm2,3. Mild dental fluorosis can result from swallowing too much as teeth are forming, which is why we teach children to use only a “pea-sized” amount of toothpaste. Many Hydroxyapatite toothpastes have come to the market with claims to be better than fluoride, or a “safer” alternative. Available research has relatively short follow up periods, heterogeneity in particle size, and high risk of bias due to product manufacturer funding. While there is promising initial data on remineralization and hypersensitivity, Hydroxyapatite is not a proven replacement for fluoride, especially in high caries risk patients4,5,6.  There is also no credible scientific evidence that a properly performed root canal causes cancer or systemic disease. There is, however, a plethora of evidence that chronic oral inflammation is linked to systemic disease, such as untreated periodontal disease, caries or a chronic apical abscess.

Another example is Ozone therapy. Ozone is O3. This molecule is unstable and will release one oxygen that acts as an antioxidant and can damage the cell wall of microbes. It can be used in gas, water, gel and oil forms. But it is not selective, so it can also damage our body’s cells that are necessary for healing. While the gas form is the most potent, there is a significant risk for lung damage if it is inhaled. Some clinicians claim that its’ use in extraction sites or in treatment of periodontal disease yields “better” results or quicker healing. Much of the available evidence is in vitro (in a lab) and the results in patients are inconsistent7,8,9. Although a meta-analysis showed a statistically significant decrease periodontal pockets when using ozone, versus traditional non-surgical instrumentation, this difference was only about 0.25 mm7. 

Just because there have been some studies completed on a new method or product, that alone is not good enough to make a recommendation. We have to examine study design, sample size, comparators, duration, outcome measures, funding and conflict of interest. How we say things to patients matter as much as what we say. Use calibrated language like “promising”, “an add-on, not a replacement”, and “may help”. Steer clear of absolutes like “proven”, “no risk”, and “cures”. Our patients trust us to distinguish what is promising from what is proven, and most importantly, to be honest when we do not yet know the difference. Patient autonomy matters, but informed autonomy requires complete information. Our job is to avoid presenting these options as miracle workers or as replacements for proven care when the research just isn't there yet. Being open-minded and being evidence-based aren't opposites. Combining these mindsets is how we better care for our patients.

 Resources:

  1. National Toxicology Program. NTP Monograph on the State of the Science Concerning Fluoride Exposure and Neurodevelopment and Cognition: A Systematic Review. National Institute of Environmental Health Sciences; August 2024. NTP Monograph 08. doi:10.22427/NTP-MGRAPH-8
  2. Taylor KW, Eftim SE, Sibrizzi CA, et al. Fluoride exposure and children's IQ scores: a systematic review and meta-analysis. JAMA Pediatr. Published online January 6, 2025. doi:10.1001/jamapediatrics.2024.5542
  3. Warren JR, Rumore G, Sicinski K, Herd P, Engelman M. Municipal water fluoridation, adolescent IQ, and cognition across the life course: evidence from the Wisconsin Longitudinal Study. Proc Natl Acad Sci U S A. Published online April 13, 2026. doi:10.1073/pnas.2536005123
  4. Limeback H, Enax J, Meyer F. Clinical evidence of biomimetic hydroxyapatite in oral care products for reducing dentin hypersensitivity: an updated systematic review and meta-analysis. Biomimetics (Basel). 2023;8(1):23. doi:10.3390/biomimetics8010023
  5. Hu ML, Zheng G, Zhang YD, et al. Clinical efficacy of nano-hydroxyapatite in dentin hypersensitivity: a systematic review and meta-analysis. J Dent. 2019;82:11-21. doi:10.1016/j.jdent.2018.12.014
  6. Wierichs, Richard Johannes et al. “Efficacy of nano-hydroxyapatite on caries prevention-a systematic review and meta-analysis.” Clinical oral investigations vol. 26,4 (2022): 3373-3381. doi:10.1007/s00784-022-04390-4
  7. Pardo A, Signoriello A, Brancato G, et al. Effectiveness of ozone therapy in non-surgical periodontal treatment: a meta-analysis of topical applications. J Clin Med. 2025;14(14):5124. doi:10.3390/jcm14145124
  8. Moraschini V, Kischinhevsky ICC, Calasans-Maia MD, et al. Ineffectiveness of ozone therapy in nonsurgical periodontal treatment: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Investig. Published online May 12, 2020. doi:10.1007/s00784-020-03289-2
  9. D'Ambrosio F, Caggiano M, Acerra A, Pisano M, Giordano F. Is ozone a valid adjuvant therapy for periodontitis and peri-implantitis? A systematic review. J Pers Med. 2023;13(4):646. doi:10.3390/jpm13040646