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Biological Dental Hygiene: A Whole Body Approach to Oral Health

By Carol Wells, RDH

dental scalingThink of a visit with your usual dental hygienist, and you probably think: Yeah, I’ll get my teeth cleaned and a little lecture about flossing, and that’s it. Every appointment is just like another – though each patient’s dental needs are not.

Fortunately, there are growing numbers of hygienists who think outside this box. Free from its confines, we can take a “whole body systems” approach to oral and overall health.

We call this Biological Dental Hygiene.

As a biological dental hygienist, I’m concerned with how the mouth affects the body and how the body affects the mouth. Each patient’s treatment plan is unique, customized to their personal oral-systemic health situation and needs.

What Makes a Biological Hygiene Appointment Different

Conventional dentistry has a pretty set plan for how a hygiene appointment should go:

  • The patient is seated in the operatory.
  • Their medical history is reviewed and charted.
  • Necessary x-rays are taken.
  • Conditions of both hard and soft tissues in the mouth are charted.
  • The patient is screened for oral cancer.
  • The hygienist reviews the patient’s home care and suggests improvements.
  • The patient’s teeth are cleaned and polished, likely with a fluoridated prophy paste.
  • The teeth are flossed.
  • Fluoride is applied.
  • The patient returns to the front desk to book their next appointment.

Things go a bit differently at a Biological Hygiene appointment. For one, we start by talking with you outside of the operatory. We want to know

  • What your past dental experiences have been.
  • What your current oral and overall health is like.
  • What you would like your oral and overall health to be.

In other words, we want the big picture before we move on to the operatory.

Though each biological dental hygienist may work a little differently, I always start by taking your blood pressure and giving a blood glucose test. (There’s a strong relationship between diabetes and gum disease!) I also screen for head and neck cancer.

phase contrast microscopeIf any x-rays are needed, we take them – digitally, to minimize radiation exposure. (Some also provide homeopathics to counter the effects of radiation.) I also take intra-oral photos of your mouth and then look at a sample of your subgingival plaque with a phase contrast microscope, to get a glimpse of the health of your oral microbiome.

You get to see this in real time, too, observing pathogens – “bad bugs” that may be wreaking havoc with your health. When you do, it raises an obvious question: “How do I get rid of them?” You can see the infection for yourself.

We know that infection produces inflammation not just in the mouth but throughout your body. With the phase contrast microscope, you can see its cause – and have a better understanding of how your teeth, gums and the bone that supports their teeth are affected by these disease-related bacteria.

The biggest difference between this and a conventional dental visit, though, is the conversation we have with you. We’re not there to lecture you on flossing. Instead, together we explore a set of factors that play a big role in both oral and systemic health, identifying your challenges and creating a plan for conquering them.

These factors are summed up nicely in an acronym: HONEST AGE.


Let’s break down what these mean:

Hygiene: How does the way you brush your teeth impact the health of your teeth, gums, and body? Do you floss? Do your gums bleed when you brush or floss? How many times a day do you brush and floss? How effective are you?

Occlusion: How do your teeth fit together? Which teeth are affecting your bite relationship? How does this affect your mouth? Are there areas that are hard to reach?

Nutrition: Is your diet well balanced? What can you do to improve it?

Exercise: Are you getting enough physical activity? What can you do to get more of it into each day?

Stress: How do you handle stress? How would you rate your stress level on a scale of 1 to 10, where 10 is “maxed out” and 1 is “pretty mellow”? What can you do to lower that number?

Tobacco: Do you smoke or chew? How much is too much? Do you want to quit?

Age: Are you having any difficulties with mobility and dexterity as you age? Are there other, easier ways to do what you need to get done?

Genetics: Are you predisposed to certain illnesses? How do the ones that affect you affect your oral health?

Experience: Do negative dental experiences in your past keep you from seeing your dentist or hygienist regularly? Are you able to take care of yourself in the environment you live in?

Talking about these points in an open, honest, and nonjudgmental way empowers you to take charge of your oral and overall health. The info we uncover and share becomes the basis of a game plan for improving both.

After this strategizing, we’ll have you swish a disclosing solution in your mouth that will highlight any plaque on your teeth. (Dental plaque is invisible to the naked eye.) You’ll be able to see where you’ve been cleaning effectively, as well as areas you’ve been missing with brush and floss. I’ll take an intra-oral picture of this, as well, so we can compare it to results at your next visit. That way, we can track your progress.

And so you can progress, I’ll give you a mirror to look in as we review home care techniques. Most patients don’t realize how hard it can be to remove mature dental plaque. So I ask you to show me your brushing technique so I can advise on what you can do to get better at removing those soft deposits of bacteria. We may review flossing technique, as well.

interdental brushAnd I may suggest other tools you can incorporate into your home care routine to get better results – for instance, oral irrigators, interproximal/interdental (“proxy”) brushes, rubber tips, power brushes, sulcus brushes, and more.

Once we’re done with that, I’ll ask you to rinse with a fluoride-free, alcohol-free rinse in preparation for your cleaning. Before scaling – scraping the biofilm from your teeth – I’ll irrigate with ozonated water or use a subgingival laser (i.e., a laser that goes below your gumline) to reduce the bacterial load in the pockets (sulci) that flank each of your teeth. This lessens the bacterial cascade into the body that can happen during a deep cleaning.

I then scale the teeth to remove both hard and soft deposits (calculus and plaque, respectively). If I’m using an ultrasonic scaler, I’ll use ozonated water in it to further eliminate harmful bacteria. Afterwards, I’ll irrigate again with ozonated water and then polish your teeth with a fluoride-free, organic prophy paste, followed by a good flossing.

Your next appointment is then booked based not on some predetermined schedule but your actual needs.

Another biological dental hygienist may do these things in a different order or in a different way, but all of us take into account the whole body picture with respect to your oral health and opt for the least invasive nontoxic ways of providing the care you need.

whole health diagram

YOU Take an Active Role

Conventional dentistry trains patients to be relatively passive in their care. The dentist and hygienist are the ones who “do things.” The patient is the one “done to.”

We want to bring about an end to what I call “the Yes Syndrome” – where patients agree with whatever the hygienist or dentist says, just to get on with the cleaning so they can get out of the dental chair and on with the rest of their day’s business.

In the biological model, though, we expect you to be engaged in your own treatment plan, as well as your home care routine. We want you to be involved in your own oral and overall health.

After all, it’s YOUR mouth we’re working on.

Find a biological dental office near you

Images by Milenafoto & Clairemeaker, via Wikimedia Commons

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15 Responses to Biological Dental Hygiene: A Whole Body Approach to Oral Health

  1. Crista James October 14, 2017 at 7:04 pm #

    I am thrilled to read this information. I went to a dentist last year and he replaced my filings without taking any precautions. I have had health problems as a result. It is time for me to get my teeth cleaned and I don’t know who I can go to.

    How do I locate a biological dentist near me? I am located in Fort Collins, Colorado 80525.
    Thank you!

  2. Lori Saporito October 17, 2017 at 5:37 pm #

    Hi Carol,

    I’m a hygienist. Please tell me how you check the glucose. I always ask about their A1C but do not test in the office.


    • IABDM October 25, 2017 at 3:30 pm #

      There’s a chairside HgA1c test that can be used (kits available at CVS; 2 to a kit at $40 a box USD), but there’s also a test with no finger prick by Freestyle. It’s used on the arm to guesstimate the A1c.

    • Marlene Grove November 18, 2017 at 8:19 am #

      Thank you for this information as well!

  3. Michelle February 8, 2018 at 9:59 pm #

    Do you have courses for biological dental hygiene for hygienists?

    • IABDM February 15, 2018 at 3:08 pm #

      Our “Biological Dentistry 101” course is a great place to start, for both dentists and hygienists alike. We offer it as one of the pre-session seminars at our annual meeting each October (info on this year’s meeting:, and occasionally offer it at other times throughout the year. You can also contact our executive director, Dr. Dawn Ewing, to let her know of your interest:

      • T February 4, 2019 at 8:21 pm #

        Does “Biological Dentistry 101” (in the shop) go over how to collect samples, prepare slides and identify microbes?

        • IABDM February 5, 2019 at 8:11 pm #

          For more on the course specifics, you can contact Dr. Dawn Ewing directly:

  4. RP February 27, 2018 at 3:35 am #

    Hi, an issue I have been trying to find help with is how to best treat infection in the mouth, especially considering chemical sensitivities…For mouth bacteria you mentioned ozonated water, and I also have read of holistic dentists doing ozone therapy for oral infections, but if there is no such practitioner in my area, would an ND who does ozone therapy be able to treat a gum infection?
    I appreciate any help,
    and thank you for this article!

    • IABDM February 27, 2018 at 3:07 pm #

      There are no FDA requirements for Ozone. Ask the ND to make you some ozonated ice cubes. Melt one each day and swish. Additionally, ozonated oils can be purchased online. The ozone in a dental office is usually applied with a custom made traym with the ozone pumped into the tray around the gums on a regular basis. An ND will not have the ability to do the same.

  5. Li Li March 17, 2018 at 6:10 am #

    Hi, I don’t think there is a holistic dentist in my area. I have peridontal disease. How can I treat my peridontal disease. You mentioned about Ozonated water and I will try to get it online. Is there anything else I need to do to get rid of peridontal disease. I also have sensitive teeth. I would appreciate if you could reply directly to my email.

    • IABDM April 24, 2018 at 1:20 pm #

      You don’t mention where you’re located. Have you tried searching our directory to find the closest biological dentist near you? If not, here’s the place to start:

      When periodontal disease is in the early stages, improved nutrition and home hygiene can do a world of good. We encourage you to explore the blogs of our member dentists such as Dr. Bill Glaros ( and Dr. Mike Rehme (, as well as the resources section of our site for helpful info on these matters.

      When gum disease is more advanced, regular deep cleanings by a dental professional are needed. If you can’t find a biological or holistic dentist in your area, look for a dentist or periodontist who is fluoride-free (or will at least respect your choice to avoid fluoride).

  6. Michelle Thooft April 9, 2019 at 10:08 am #

    Thank you for this information! I am getting metal fillings removed, and my holistic doc has tested my saliva to see which materials the dentist can use/cannot use for me. But I’m still concerned about the filling removal and I want to be sure my dentist is taking care of everything. I am also concerned/curious about the “deep cleaning” — how do I know if it’s being done correctly? Are there future side effects/complications from the cleaning? Do you have any resources I can read? The dentist I am going to see is listed as a biological dentist. Thank you!

    • IABDM April 12, 2019 at 12:53 pm #

      Carol writes:

      For the removal of the mercury fillings, the first thing to look at is that the dentist is either PROTECT Certified (IABDM) or SMART Certified (IAOMT) in the safe removal of mercury

      As far as the deep cleaning goes, if it is necessary to use some type of pre-cleaning antimicrobial, the best options are ozonated water or laser treatment. This will mitigate harmful bacteria entering the blood stream. Does the dentist have phase contrast microscope? This test can be done chairside and will show you how effective the gum treatment that you are having done is. Is the dentist performing the deep cleaning? Usually it is the dental hygienist who has been trained extensively who performs deep cleaning, which is called Periodontal Treatment. There is a video on YouTube by Dr David Kennedy called “Bad Bugs,” which offers good information on treating periodontal disease.

      With not having examined the level of infection you present with, it is hard to discuss what, if any, complication might arise after treatment. Usually, with the proper type of home care, you will be able to prevent this type of extensive treatment in the future.

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