Management of Dental and Oral Problems
NATIONAL JOURNAL OF HOMOEOPATHY 1997 May / Jun VOL 5 NO 3.
Dr Minocher N Sahukar

Mouth and Teeth are the intimate parts of human beings. Besides, they are sensitive indicators of general health status. Willam Osler called the mouth a "Mirror" since the early evidence of sub-clinical disease processes are sometimes mirrored in the oral tissues. Apart from this strategic importance of the mouth, the observation of characteristic changes in color, dryness, taste etc are considered leading signs to be included in the Homoeopathic drug picture. A dental surgeon too has to be vigilant observer even if he is not directly called upon to manage every oral lesion. Early detection of neoplasm, anemia, deficiencies, metabolic disorders prove helpful in guiding the patient to appropriate consultants. 

Dentistry as a part of healthcare delivery is based on broad biological concepts and on understanding of the patient as a psycho-biological entity. However, in modern times it is increasingly becoming highly mechanical and its newer branches are solely dependent on technological innovations. [Cosmetic Dentistry has projected itself through human appeal to self-image and is popularly identified with cosmetology and beauticians.] 

Then, where lies the scope of Homoeopathy in the Dental field Indeed some 40 years ago when I started practice I had to be simply content with the limited armamentarium to attend to dental and oral complaints. Even then I was sometimes called a tooth-carpenter! 

Today, we have gadgets, besides the ubiquitous computer, like an electric pad placed on the face, called TENS - Transcutaneous Electric Stimulation to control pain by sending signals which reach pain centers before the originating pain signals do, thereby closing the 'gate' to the transmission of pain sensations. And now comes Relaxodant system in the form of goggles! It is claimed to induce relaxation and overcome dental anxiety as also to provide mild analgesic response similar to hypnosis! 

Technology has made in roads into surgical procedures and medical diagnosis, but the Man behind the illness is increasingly left in the lurch if not relegated to the case number in the consultant's record book! Where is the time, they say, to dwell on the individual behind the disorder when he can be readily dismissed with the help of rapidly discharging gadgets. Today a dentist can drill, fill and bill in a jiffy, and both the patient and dentist are happy. This is not to say that a qualified practitioner is not aware of his responsibility as an important part of the comprehensive health service. But all are concerned with immediate problems of pain, mastication, speech, aesthetics etc and their quick solutions, never mind the price. 

Most of us know the scope of Homoeopathy in any surgical field [pre and post-operative] such as dentistry or its role in the management of the oral manifestations of systemic disorders.
[The latter aspect has been expertly dealt in the text book of ORAL MEDICINE by Lester W Burkett, the late Professor and Dean of the School of Dental Medicine, University of Pennsylvania, USA. He has covered hundreds of oral lesions having constitutional or psychological origin such as nutritional, metabolic and degenerative diseases in their early oral manifestations] 

Indeed, mouth is a mirror of the body's health status, in addition to the fact that the oral signs and symptoms for the data in totality, if characteristic, from the Homoeopathic view point.
Human body functions as a WHOLE wherein oral tissues are intimately linked through circulatory and nervous channels to all other parts of the whole organism. 

Oral cavity being the first segment of the digestive tract is closely related to the respiratory system and to functions such as deglutition, speech and taste. It is a corridor for the tonsils, throat, oesophagus, lungs and is constantly exposed to food, air and other irritants alike. It is this special position and function that places the mouth in an important place in the evaluation of the local as well as the systemic condition in health and disease.

Changes in the oral mucosa are good indicators of nutritional, metabolic, circulatory and other systemic disorders. The benefit of the general immunity mechanism is also extended to the oral tissues.
On the other hand, oral conditions such as the unhygienic state, oral lesions or sepsis may put a heavy burden on the system. Take the case of septic foci at the gingira sulcus [pocket] and at the apices of non-vital teeth which may lie dangerously undetected when painless. The least damage that sepsis anywhere, be it tonsils, sinuses etc can do is to keep the individual in a chronically rundown state with sub-clinical affections of urinary and gastrointestinal system. Even the joints, skin, eyes, lymph-glands are affected. There may be even an exacerbation of existing metabolic disorder such as diabetes. Thus the dangers of oral sepsis, pain and consequent poor mastication and nutrition, if unattended cannot be exaggerated. 

With the above introductory words let us consider Homoeopathic management of oral lesions, dental sensitivity, atypical pains, neuralgias, disturbances of oral functions, abnormal habits etc the most common factor which pleads for an immediate remedy is PAIN. Kent's Repertory [KR] has laboriously covered 33 pages on the Mouth and 14 pages to index Dental pain alone whereas our modern dental electronic anesthesia [TENS] and the powerful analgesics can do the job of pain control in minutes. 

Fortunately, for the patient, a dentist has an additional duty to remove local irritating causes of toothaches viz the food debris, the carious teeth, the inflamed pump, accumulated plaque and tartar, irritating jagged margins of teeth etc he has to 'desensitize' the eroded and exposed surfaces due the loss of enamel [erosion]. Such conservative local measures do take care of the major problems of pain and inflammation. Here Dr S Hahnemann's advice, first to remove the local 'obstacles to cure' is put into practice, since that alone solves many of the immediate problems which the patients has presented with. 

Then, there are common infections localized in the gingiva, the dental pulp or the root apex and a dentist has easy access to the modern "new generation" antibiotics and anti-inflammatory agents. So, why should a modern dentist get interested in Homoeopathy, the God-sent therapy, which essentially deals with the "host" and his natural immunity, when techno-dentist can readily train his skills toward the invasive bacteria or the inflammatory reaction and the end product of disturbed economy? The answer to this lies with the right orientation of the philosophy of healing which Homoeopathy expounds. 

Where does Homoeopathic therapeutics triumph over the 'instant relief' techniques? Limited though the scope, we can be helpful in difficult oral and dental problems especially of recurrent or chronic nature. These have their origin at the level of the "Host" - the individual personality and constitution with secondary manifestations in the oral tissues such as mucus membranes, gingivae, periodontium [tissues surrounding the teeth] and the tooth structure homoeopathy fortifies the defense mechanism and enhances the vital dynamics. 

As to the structural defects, congenital or otherwise, there is one serious problem of rampant or premature caries [KR pg 431] ie rapidly progressing decay or crumbling and deficient, discolored Enamel. These are aggravated during certain milestones of life such as childhood and puberty, or during epochal periods like menarch, pregnancy, breast feeding. The remedies that are called for are: Calcarea salts, Fluorides, Silicea, Kreosote, Staphysagria, Thuja, and nosodes like Medorrhinum, Syphilimum [dwarfed teeth]. Here are certain constitutional defects in need of correction [if not due to fluoride deficientcy in drinking water or nutritional problems in endemic areas]. 

A common dental problem is "Sensitivity". The teeth "feel on edge" [KR pg 431] and intolerant to air, thermal changes, to certain foods etc the common local factor is "erosion" ie the loss of enamel and cementum at the neck line area of the tooth. Nowadays sensitivity can be relieved by a topical application of Strontium and other proprietary pastes, but the constitutional approach is curative if we remember, that a sensitive 'personality' becomes reactive to physical environment and dental sensitivity is only one such symptom. It is observed that people with multiple erosions are found to be intelligent, disciplined but highly strong and sensitive individuals. 

It is common to find oral problems getting aggravated during the stressful period of life such as menses, pregnancy etc and during psychological crisis. "Bad Breath" is one such symptom which could origin elsewhere in the system [See the case described]. Biochemical changes in the saliva, like perspiration, can produce odors and these can be affected by emotions and systemic problems and may origin from respiratory and gastro intestinal tracts. Similarly, it is recognized that erosion [as against attrition wear] and even dental caries are due to changes in the chemistry of the tooth structure and of saliva. The biochemistry of any secretion [saliva] or discharge perspiration depend on the state of physiological systems of the organism. These are influenced by internal and psychological factors. This explains why local solutions are only palliative and not curative or preventive. The exaggerated propaganda regarding tooth pastes as the sure remedy for bad breath, and lotions for bad sweats have to be taken with a pinch of salt. 

A case of Bad Breath comes to mind. One of my earliest cases in the dental field treated with Homoeopathy was a case of a young Khoja girl which proved encouraging in my early Homoeopathic venture. This thin, tall girl came for a carious tooth and strong stench from the mouth. There was no evidence in her mouth such as unhygienic state, periodontal pockets, gingivitis, tonsils or throat infection etc. Her general condition was good except she was thin. On inquiry about her bandaged feet her father spoke about her recurrent painful cracks between toes and sometimes the dorsum with moist sticky offensive discharge. The girl looked shy timid and dull as she spoke slowly. Her father agreed to Homoeopathic treatment since there was no oral lesion to account for halitosis, except the history of occasional swollen gums during the puberty period. She had tendency to constipation and irregular menses and run down during periods. Few doses of Graphitis was given. I do not remember the dosage schedule, she came for a few weeks till her overall condition improved. The only local treatment was Calendula lotion for the mouth and feet, and repeated dry dressings were advised. 

Another atypical sensitivity or toothache that may come up in a properly filled tooth which has hitherto remained symptom free. An expertly filled Amalgam [containing Mercury, Silver etc] may sensitize the tooth immediately or even months after the treatment, even though Amalgam is an excellent filling material. Could Mercury element be responsible? Dr Diana messop of Jersey, Channel Islands thinks so. In fact in an article published in the journal of Holistic Health Science, 1996: "Disease caused by Mixed Metals." The writer gives a long list of adverse effects of Mercury and other metals in close contact with tissues such as when used in dentistry. The article explains the constitutional susceptibility and pathogenesis of metallic vibrations. Very few dentists will admit the systemic effects, from multiple Amalgam fillings, are an obstacle to Homoeopathic constitutional therapy. Dr Kent does not mention toothache from Mercury and suggests its antidotes. Another problem that may shoot up from other metallic restorations [gold, copper, crom-cobalt alloys in crown and bridge work] in close vicinity or in direct contact with the Amalgam filling. A 'battery effect' with low grade current may discharge chronically, and this too may be damaging. This fact is now recognized and corrected locally. 

There are cases of toothache arising in normal looking "sound" teeth [KR pg 438]. These pains are indefinite or vague and sometimes quite neuralgic type, and may be "distracting" the mind. Here we have some "angry" remedies like Aconite, Chamomilla, Coffea, Mat-carb, Nux-vom, Sulphur etc. These pains may come seasonally, winter being the most profitable period for the dentists. 

A case of bizarre toothaches with "burning mouth" syndrome makes interesting study. Miss RMV [age 22], had the pain "jumping" from one tooth to another on pressing. Over the years she got her teeth attended in public hospitals with 3 extractions, multiple fillings [some for neck like cavities] and Root Canal Treatment [RCT] on 4 teeth. Presently, the pain was shifting from upper left anterior [all non-vital due to RCT and apicectomy] to the premolars on the same side. She desired them to be extracted! [This may indicate suicidal or self-destructive urge] A mild but more troublesome was the burning sensation [glossodynia] which really worried her. Could it be cancer? This vague sensation would start as a "current" and shift from lower lip to the tongue and the lower anterior teeth. Here tongue was dry and anemic with sour taste [Nat-m, Sul]. Her strange story was the 'burning' started soon after an extraction of upper premolar six months ago. There was the first profuse bleeding on an attempt at drilling of this tooth, which was later extracted. The vague burning [Mez] soon followed. Pungent food was intolerable and the teeth were sensitive to hot drinks and sometimes to the touch even with her tongue [Mez]. Both hot and cold weather affected her and she preferred warm baths. Rains and cold drinks caused coryza and throat trouble. She was averse to leafy vegetables, cold milk, fried food and tea. She has a strong aversion for tobacco [Ign, Sul, Nat-mur] and liked sweets. She also gave a long list of food items which did not agree with her. She has an allergic rash [burning] once on travelling by train. She had severe bleeding after head injury. Her menses were delayed and scanty.

This unusual history led to inquiry into her personality make up. She was to have an arranged marriage next year which caused much anxiety since she had an instinctive distrust for the 'bad' uncle who was the match-maker. She had the fear of bleeding, illness, cancer and insanity. She sometimes felt sad, hopeless and had suicidal thoughts. She was easily offended by reprimand and angered at the talk of marriage, with anxiety, trembling, clammy hands and sweaty forehead. She would sleep with a pillow on her chest, become restless or wake up with palpitations from frightening dreams. Sometimes her dreams bordered on the vivid, fanciful, religious, and eve prophetic, which she said were verifiable later on. "Some power protects me" she felt. She had changing moods and would become sulky and could not confide. Much of her story emerged after repeated sittings. She would get tension headache with 'heat' extending to face, jaw and eyes. Sometimes she could not tolerate covering her feet and at other times needed covering.

She was sent to her physician for her anemic condition. Meanwhile, over a year [1994-95] she was initially given Staphysagria [multiple caries, amalgam fillings], but Mezerium and Sulphur partially relieved the burning problem. Whenever she spoke about the vivid dreams and sadness Natrum-mur helped her considerably. She returned on Jan 1997 and cheerfully said she was married to a boy of her choice [dream boy!] She came just for check-up. She complained of sinustitis with current-like pain during cold weather. A few doses of Kali-bich followed by Nat-m10 M relieved her. 

This was a clear neurotic case with psycho-somatic problems causing "burning mouth" and atypical toothaches of dramatic description. Such people become easy victims of multiple extraction and needless surgery.
Sometimes there are tricky problems of indefinite toothache requiring close examination of the neighboring tissues and organs such as the ear, sinuses, temproro-mandibular joint [TMJ], eyes etc. These are the "referred" pain arising from remote causes, for example glaucoma, early cranial neoplasm, unerupted tooth etc. Sometimes we have cases of toothache in a "Sound tooth" [KR pg 438] or with a good filling. 

A case if Sanguinaria comes to mind. A sensitive but stern looking young lady about 35 yr complained of chronic recurrent one sided bilious headache. This was recently followed by vague pains in the maxillary region and a premolar tooth. There was no tenderness on percussion, and on examination and X-ray the filled tooth appeared normal. The pains were vague and sometimes 'smarting'. Headache increased as the day advanced, it was congestive and bilious because there was concomitant nausea and vomiting of bile which relieved. The complaint also came up just before menses and lessened with the flow. The characteristic symptom was that sleep and eating gave relief. In fact, she could never remain on an empty stomach during headache and nausea and must eat to relieve. Analgesics did not help and caused upsets. She would like to uncover her feet and was fond of spicy food which did not agree. Sanguinaria relieved her toothache but she suddenly discontinued further treatment along the constitutional lines for her chronic headache. 

At the opposite end of the 'referred' toothaches, we have toothache extending to remote areas not directly connected by the nerve distribution such as the arms, fingers, throat, chest etc. [KR pg 440] Also, there are reflex pains ie pains jumping from one segment to another segment or tooth. The most common referred pain is toothache extending to the ear. Kent's Repertory lists Mang, Sepia and Nat-mur as the most common remedies, of which I have seen the benefit of Sepia on more than one occasion. 

"Sore Mouth" is a difficult condition faced by the dentist. We have to differentiate the "Recurrent Gingivo-Stomatitis' which is viral in origin [herps simplex], from "Recurrent Aphthous Stomatitis" which has often psycho-somatic basis, of unknown etiology and is difficult to treat. In the Herpetic lesion there may be a history of previous viral infection during young age and later new lesions crop up every 2-10 months spontaneously or from a trauma. 

We had an interesting case of recurrent Aphthous soreness in a young 25 years old girl. For the past one year small burning ulcers were coming up every month on the mucosa of lips, cheeks or sometimes on the tip of the tongue. The vesicles were rarely seen. She also had burning in the throat, with concomitant salivation. The mouth could not tolerate cold drinks [Ars], although sometimes hot drinks were also intolerable. Her mouth was offensive in the morning and talking was painful. Her complaints would come up whenever the general resistance was lowered especially during Coryza, menses and stressful times. The ulcerative pain would last for 7 days. The menses were of short period but copious. Her low back was the weakest part and always needed a support. She was thin although ate well. She had a tendency to catch cold especially from cold air, and was also intolerant to stuffy places. She admitted that whenever there was mental pressure, such as interviews, tests or repressed indignation her mouth would feel sore and made her taciturn. For years she had recurrent pimples and oily face. She resorted to a vigorous treatment [oral and local] from a beautician which completely cured the skin. Could suppressed eruption contribute to her recurrent Aphthae? 

As a person she was independent, sensitive [offended] and upright, not willing to take personal matters although I was a family friend. We knew her bright career and background, hence it was easy to see the psycho somatic basis for her recurrent malady. She had a bright academic career and being a linguist with a fair knowledge of European languages she was planning to go abroad. This brought about a conflict between the demands of family ties and her own need for freedom. There was a pressure for her aged, doting parents which restrained her from pursuing her career abroad. 

When asked about her reaction to her predicament she admitted indignation [silent] and could not weep in other's presence. She was anxious about her future and family. As a child she feared robbers and lightening flash. Her perfectionist trait made her exacting with self and others. She had mood swings. On the basis of her personality, Nat-mur was given at long intervals which helped her to prevent the recurrent Aphthae. During acute stages, especially with coryza and menses, Arsenic-alb relieved her with occasional doses of Sulphur intermittently. 

In dentistry, which largely consists of technical and surgical procedures, one sometimes meet challenging problems which need wider perspective and holistic philosophy. A patient is a whole 'person' with some local problem. The constitutional approach of Homoeopathy seems most rational but demands patience and ingenuity. Even a busy practitioner can ill afford to neglect the root causes of so called dental complaints. He may successfully manage through repair and palliation most of the oral conditions but the 'systemic' approach makes the practitioner more responsible in his contribution to the general health care of the nation.