Non-Toxic Approaches To Childrens Dentistry

Written by practitioner by Dr Steven Koos, D.D.S., M.D. – 1. I am very interested in your new Eco-Friendly DentistryTM practice. Can you tell me what makes it different from other dentists?
Since this is a new concept and we actually coined the term, it is probably best to define what Eco-Friendly DentistryTM actually is first. Eco-Friendly Dentistry is a newly evolving practice of dentistry, which encompasses a simultaneous devotion to sustainability, prevention, precaution, and a minimally invasive patient-centric, as well as global-centric treatment philosophy. Eco-Friendly Dentistry, through green design and operations, protects the immediate health of patients and team members, protects the health of the surrounding community, and protects the health of the global community and natural resources.

ORA Dental Studio and ORA Oral Surgery & Implant Studio has proudly become the first and only green group dental practice in the nation. Our team at ORA truly embodies Eco-Friendly Dentistry and we have distinguished ourselves as leaders in the dental community through our steadfast commitment to the environment. We are significantly different from other dentists by not only building offices from the ground up as sustainable, green LEED projects, but also by employing green business practices and most importantly by comprehensively practicing green healthcare. As a landmark achievement unique to ORA, we are the first dental facility in the country to generate zero bio-hazardous waste.

2. I know my readers are concerned with some of the ingredients in toothpaste, like sodium laurel sulfate, silica, chalk and fluoride to name a few. What do you recommend as a non-toxic toothpaste for children?
This is an important concern and our recommendations for children are not really any different than what we recommend to adults. Growing evidence supports the idea that what goes in your mouth stays in your body, even after you brush and swish. Your mouth and gums absorb ingredients, and act as an entry point into your system. As a result, your choice of oral products is as important as the food you eat, what you put on your skin, and all the other products you choose for a healthy home environment. Small changes made to our daily habits can really add up. Two very good products out there that avoid toxic ingredients are:

– Tom’s of Maine Natural ToothpastesTM, Adult and Children Formulations – these products do not contain triclosan; saccharin; artificial sweeteners, preservatives, colors, or flavors; or animal ingredients. They are tested without the use of animals. They have a refreshing natural flavor from real wintergreen and peppermint oils, not artificial sweeteners like saccharin. Some preparations are fluoride free and others contain only naturally sourced fluoride and zinc citrate, a naturally occurring mineral, which interferes with the calcification of plaque into tartar.

– The Natural Dentist ToothpastesTM, Adult and Children Formulations – these products do not contain any artificial dyes or flavors. Mainstream products use artificial additives such as Blue #1, Yellow #5 and other FD&C colorants. The Natural Dentist uses vegetable juices such as red cabbage, purple carrot, beet, tomato and annatto. The company does not contribute to the manufacture of artificial ingredients, therefore, they are not introduced into the ground water or water treatment systems when consumers use their products. Their toothpastes are made without Sodium Lauryl Sulfate (SLS is a foaming detergent that can irritate your mouth and has been linked to canker sores) Instead they use a natural coconut based oil as an effective surfactant. Their products are sold without a cardboard box – an important “green” step that reduces excess packaging. While eliminating a box may seem small, consider that one billion tubes of toothpaste in boxes are sold each year, contributing more than 28 million pounds of packaging to the waste stream. The environmental effect is more than the trees that are saved by eliminating the cardboard box — it’s also the energy to manufacture, print and transport the excess packaging.

Your readers’ quest for dental products that have natural, non-toxic ingredients should not end with toothpaste. They should also consider safe, eco-friendly choices for dental floss, toothbrushes and mouth rinse to complete a healthy at-home, eco-friendly dental wellness regimen.

3. We are concerned about mercury in old fillings. What are your recommendations about this issue?
This indeed has been a serious topic of concern for many years now for the public, the ADA, the WHO and the FDA, and would normally require quite a lengthy response.

At ORA, one of our paramount practice tenets is upholding the precautionary principle, which we feel all health professionals and organizations should abide by. The precautionary principle is officially defined as “a moral principle, which states that if an action or policy might cause severe or irreversible harm to the public or to the environment, in the absence of a scientific consensus that harm would not ensue, the burden of proof falls on those who would advocate taking the action. The principle implies that there is a responsibility to intervene and protect the public from exposure to harm where scientific investigation discovers a plausible risk in the course of having screened for other suspected causes. The protections that mitigate suspected risks can be relaxed only if further scientific findings emerge that more robustly support an alternative explanation.”

So for us, the answer is quite simple. ORA Dental Studio has proudly partnered with the WHO (World Health Organization) to advance its Mercury Free Health Care Program. Mercury is one of the world’s most ubiquitous heavy metal neurotoxicants and ORA is leading the way as a designated mercury-free practice that also implements the safe removal of mercury containing fillings. But the concern for mercury use in healthcare shouldn’t stop with amalgam fillings. ORA Oral Surgery & Implant Studio utilizes only mercury-free thermometers, and sphygmomanometers. In addition, in the few locations where we use fluorescent lighting, we purchase only low-mercury fluorescent bulbs that meet the Toxic Characteristic Leaching Procedure (TCLP) standard set by the EPA and we also properly recycle these bulbs at designated recycling centers.

4. Are your sealants, plastics used in mouth guards and retainers, and tooth-colored fillings BPA and phthalate free?
Traditionally, mercury fillings are replaced by tooth colored resin fillings, which contain BPA. This made absolutely no sense to us. BPA, known as Bisphenol A, is an organic compound used as a building block for several important plastics, plastic additives and in composite dental resins. It has been found to be hazardous to humans due to its estrogenic and possible carcinogenic potential. For the safety of our patients, ORA Dental Studio has diligently sought out a BPA-free dental composite resin, which we use exclusively.

Upholding the Precautionary Principle within our practice, ORA Dental Studio is the first dental practice to exclusively utilize a BPA-free dental composite resin. In addition, none of the Invisalign aligners or Vivera retainers that we use contain bisphenol A or any phthalate plasticizers.

5. How else do you limit your patient’s exposure to toxins while visiting your office?
Besides reducing our environmental footprint, having a true healing facility is what my vision was and what we at ORA strive to deliver. We have implemented countless protocols and details to limit our patient’s and our team member’s exposure to toxins. Some of these protocols and innovations include:

– Being a PVC-free, DEHP-free, and latex-free practice
– Having all of our furniture and cushioning BFR-free (Brominated Flame Retardant)
– Non- VOC (volatile organic compounds) paints and textiles preventing off-gassing
– Non-urea-formaldehyde containing, chlorine-free composite wood and agrifibers from recycled content
– Finishes, textiles and veneers made from sustainable, non-toxic, recycled post-industrial and post-consumer waste
– Mercury free, BPA-free treatment
– Digital dental radiography and digital CT scanner – which means over 80% less radiation dose for the patient compared to conventional plain film. Also, no toxic chemical developers and fixatives as well as no lead-foil content to film, nor the carbon-footprint in the manufacturing, packaging and transport of these materials
– Lead-free patient x-ray aprons
– Eco-rock drywallTM, Modular ArtsTM sculptural paneling, 3-FormTM eco-resin doors, all of which are not subject to hazardous polymerization
– EarthwiseTM Energy Star HVAC system with no CFC coolants
– Digital patient charting and registration (paper-free) office
– Non-chemical sterilization, utilizing steam and dry heat, thereby avoiding any noxious chemicals within office and in surrounding environment
– GreenMaidTM green cleaning services
– The ability to process our bio-hazardous waste with a revolutionary state-of-the-art system that renders it non-toxic, non-contaminating and safe for disposal with regular garbage – thereby avoiding harmful incineration, which releases these toxins into the atmosphere.

6. What are the most important things parents can do to help keep their children’s teeth healthy?
Starting at a young age, more frequent (at least bi-annually, if not quarterly) preventative check-ups and professional cleanings. Good healthcare habits and preventative care is built on trusting relationships with the doctor and team, education within the office and at home, and also by example. This means that good dental habits are modeled and learned as our children watch our behavior as parents, coupled with more frequent visits as a family to the dentist. Early detection of decalcification/demineralization is the key, thereby preventing the end stage of bacterial demineralization of tooth structure – namely tooth decay. Diagnostic tools like the DIAGNOdentTM by Kavo, which is a laser detection tool measuring the mineralization loss in teeth, allow clinicians to detect cavity formation at its earliest stages and allow them then to intervene either before the cavity forms with re-mineralization procedures, or it allows them to be minimally invasive with cavity repair. In addition, Ozone therapy is a revolutionary treatment approach that is just on the horizon within dentistry and ORA Dental Studio is one of the first practices in the nation to begin its safe implementation in treating decay in a completely non-invasive way, utilizing the CMU3 device from LIME TechnologiesTM.

So reinforcing thorough home care, healthy eating habits, using safe dental products and quarterly visits to the dentist are all part of the recipe to empower our children to maintaining healthy teeth for their lifetime.

7. How can parents encourage more dentists to take on these non-toxic and green principles? What can parents do right now about BPA in sealants and fillings as well as mercury in fillings?
The medical field has already embraced the fact that the health of the environment and our own health are inextricably linked. And a grand reformation is underway, albeit slow, within the medical industry towards sustainability. The dental industry should follow suit and at ORA we are trying to pave the way for this to happen. The motto we have is “What’s good for the environment is good for the patient” and as such, we have both built and are operating green facilities and comprehensively practicing green healthcare. As doctors, aligned with the Hippocratic Oath, we have an obligation to ensure that we do no harm – not only to the patient but also to the environment. In addition, patients and consumers are beginning to realize that one way that they can contribute to a healthy community and environment is to support green businesses and healthcare facilities. Every dollar spent, in essence, is a vote for or against the environment.

Patients need to encourage their dentists to take on more non-toxic and green practices by voicing their concerns and by starting dialogue with their healthcare providers. Another great resource to start with is the “Green My Dentist” program extended by the EDA (Eco Dentistry Association, to help guide patients and their dentists towards better, safer patient health as well as planetary health.

Parents can also choose to have their families treated only by practitioners who practice mercury-free dentistry and who utilize non-BPA containing resins. There is only one BPA-free resin available on the market at the moment, so have your dentist do their homework and specify that this is what you prefer that they utilize. mission is the education and advocacy of natural medicine and a holistic lifestyle.


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By Dr. Steven Koos , D.D.S., M.D. –


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