Biological Dentistry: An Invitation to Think Differently

An invitation to explore the science of biological dentistry, discover a whole new way of caring for patients, and find your people along the way.

I want to invite my fellow dentists to consider something. What if there's a whole world of fascinating science that could change the way you practice dentistry, and you simply haven't been exposed to much of it yet? I'm talking about toxicology, immunology, biochemistry, airway development, material compatibility, microbiology, and the incredible relationships between what's happening in someone's mouth and what's happening throughout the rest of their body.

We learned about most of these subjects in dental school. We spent YEARS studying them. But how much of that knowledge are we actually applying when we're planning treatment for our patients?

How often do we consider the toxicology of a material instead of concentrating primarily on how strong it is or how long it's expected to last?
How often do we investigate WHY someone keeps fracturing beautiful restorations instead of simply making another one?
How often do we consider whether an infection in the mouth might be affecting the patient's immune system somewhere else?
How often have we questioned the status quo of the research?
How often have we considered the true root cause of our patient's oral health dysfunction?
How often have we questioned what we were taught in dental school?
And how often do we stop to ask whether the research we've been relying on actually answered the question we needed answered?

These are some of the things we explore in biological dentistry. And I'm telling you, there's some absolutely FASCINATING science out there!

I've been a dentist for more than 30 years, and I've spent approximately half of those practicing biological dentistry. One of the greatest joys of changing my approach was discovering how much MORE there was to learn about the profession I already loved. And I was a damned good dentist before I became biological. Becoming a biological dentist made me an even BETTER one. That's what I'd like to invite you to explore. My purpose in this article is to show any dentist looking at this path that biological dentistry is SCIENCE FORWARD. And if my scientific library can get your critical thinking juices flowing, then I have hope that we can bring more amazing dentists to the path.

We Learned the Science. Now Let's CONNECT It!

Think about everything we learned in dental school. Anatomy, physiology, microbiology, pathology, pharmacology, biochemistry, immunology, and all the wonderful things that make the human body work. Then we learned how to prepare teeth, place restorations, make crowns, treat gum disease, and replace missing teeth. All of that education matters.

But somewhere along the way, many of us became so focused on treating the dental problem in front of us that we stopped asking questions about what else might be happening in the person attached to those teeth. We also didn't realize there were things we DIDN'T learn in dental school.

We're treating a living human being whose immune system, nervous system, airway, blood circulation, lymphatic system, and metabolism all interact. That beautiful crown we just placed doesn't exist independently of the patient's chewing muscles, breathing patterns, nutrition, or overall health. The dental implant we placed isn't simply a piece of hardware. It's a permanent material sitting inside living bone, surrounded by immune cells, blood vessels, and connective tissue. And that dead tooth with a root canal? It may look perfectly fine on an X-ray, but the living tissue that once occupied its internal canals is gone, and researchers have found bacteria living inside some previously treated teeth.

So when I started down this path, I kept coming back to the same question. What else should we be looking at? My goal is to show you the science. I'm ultimately a science geek. I WANT you to see the science that is already in the literature. I WANT you to see that there ARE people asking the right questions. We just have to look. And we have to stop accepting someone else's word for it. We have to do our own research. I'm here to make your life easier. I'm such a research geek that I've done years of it. I'm here to share my excitement and info-dumping in a way that won't annoy you, in chunks that are manageable for learning. This article will give you a BRIEF TASTE of the science out there. But there are over 100 articles on our platform to feed your inner science geek, with over 2000 scientific references to show you that biological dentistry is SCIENCE FORWARD.

Toxicology: What Happens to Dental Materials INSIDE the Body?

We spend a tremendous amount of time learning about dental materials. We learn their physical properties, how to manipulate them, how strong they are, and how to use them successfully. But how much time do we spend learning about what happens when those materials interact with living tissues for 10, 20, or 30 years?

Let's talk about titanium implants. Researchers have documented that titanium implants can undergo corrosion and release ions and particles into surrounding tissues. A 2022 review examined 34 studies investigating titanium degradation. Researchers identified several factors that contribute to corrosion, including bacterial activity, acidic conditions, fluoride exposure, and the microscopic movement of implant components. [1]

Now, think about that for a minute. We're placing titanium into one of the most chemically active environments in the human body. The mouth is warm, wet, full of microorganisms and electrolytes, and exposed to changes in acidity all day long. And we're expecting that material to remain there for DECADES. Researchers have actually SHOWN that titanium particles can trigger inflammatory responses.

In a 2017 study, investigators exposed human macrophages to titanium-containing particles and measured the release of IL-1β, an inflammatory chemical involved in immune responses. The titanium particles activated an inflammatory pathway, and the response became stronger when bacterial inflammatory substances were also present. [2]. That's pretty interesting right? For something that we are told in conventional dentistry is very biocompatible, why is titanium a driver of inflammation?

And there's more.

A 2018 study examined jawbone samples from patients with titanium implants and fatty-degenerative changes in the surrounding bone. The researchers measured inflammatory chemicals, including RANTES/CCL5. In their selected diseased tissue samples, RANTES/CCL5 levels averaged approximately 30 TIMES HIGHER than in healthy comparison samples. [3]

Now, these were specifically selected areas of abnormal jawbone, so that doesn't mean every titanium implant produces the same result. But it sure does raise some fascinating questions about what can happen in the bone surrounding an implant, even when we're not seeing the kind of obvious infection or implant failure we usually look for. And this is what I mean when I talk about being science forward.

We're asking what the material is actually DOING inside the body. We're looking at cellular responses, inflammation, corrosion, and toxicology. And we're asking whether the usual measurements of implant success tell us everything we need to know.

What About Mercury?

Mercury is another subject biological dentists spend a LOT of time studying. We were told in dental school that we were all fine. That it wasn't that bad. That the only time it was released was when the filling was put in and when it was removed. They spent a lot of time calming our anxiety about mercury. Except they were misled themselves. Imagine finding out that the thing you have spent your career placing and removing is actually toxic and that you have contributed to it - with yourself, your team and your patients.

A 2017 review examined 15 studies from nine countries investigating mercury exposure in dental professionals. Researchers found that dental personnel in several countries had higher mercury levels than comparison groups. Some studies also reported neurological and other health complaints among exposed dental workers. [4]. So when biological dentists talk about protecting patients AND dental teams during amalgam removal, we're asking questions about actual occupational exposure.

That's why organizations such as the IAOMT developed education and protocols aimed at reducing mercury exposure during amalgam removal. That's one reason I'm such a strong advocate for SMART and PROTECT mercury removal protocols. We have an obligation to understand what we're exposing ourselves, our teams, and our patients to. That's toxicology. And it's part of practicing good dentistry.

Material Compatibility: We Aren't Cookie Cutters!

Another thing I love about biological dentistry is our interest in individual material compatibility. Think about how different our patients are. Some have allergies. Some have autoimmune conditions. Others have mast cell problems or complicated medical histories. Some people seem to tolerate almost anything, while others react to substances that don't bother the person sitting next to them.

Why would we assume that every dental material is appropriate for every person? We already know that materials can produce different cellular and immune responses.

A 2025 study compared titanium and zirconia implants in mice. The researchers examined immune cells in the surrounding tissues and found that zirconia produced less infiltration by certain inflammatory cells, particularly neutrophils. They also found differences in macrophage activity that favored tissue repair around zirconia. [5]. It shows that the material itself can influence how the immune system responds.

And researchers have observed differences in humans, too. A 2019 study deliberately allowed plaque to accumulate around titanium implants, zirconia implants, and natural teeth in 16 patients. They measured several inflammatory chemicals during the experiment. One of those chemicals, IL-1β, was higher around titanium implants than around zirconia implants. [6].

So when we're choosing an implant material, why would we limit the discussion to whether it's strong enough or whether the implant survives? I want to know how the surrounding tissues respond. And I want to know whether the patient's individual health history might influence that response.

I'm a fan of material compatibility testing when it's available, although we still need better research connecting different testing methods with actual long-term patient outcomes.

A 2022 review examined tests used to investigate titanium hypersensitivity. The researchers found that traditional allergy tests don't necessarily capture the inflammatory reactions caused by titanium particles. They also found problems with the reliability of available testing methods. [7]. That's an important distinction, because not every inflammatory reaction is a traditional allergy. And if we're only looking for an allergy, we may miss other ways the body responds to a material.

OraBiologics actively encourages material compatibility testing among our vetted providers whenever it's available, although we can't make it a requirement because access and regulations vary by state. The bigger point is that we should be thinking about the individual patient before selecting something that's intended to remain inside their body permanently.

Oral Galvanism: There's ELECTRICITY in the Mouth!

This is another fascinating subject that many dentists don't spend much time investigating. When different metals are present in an electrically conductive environment, they can produce electrical currents. And guess what? Saliva is an electrolyte! Researchers have been measuring electrical currents between dental restorations for decades.

But a 2023 study went a step further. The researchers wanted to know whether the electrical current itself could damage living cells, separately from the metal ions released during corrosion. They created a laboratory model of the lining of the mouth and exposed it to galvanic currents and metal ions from different dental alloys. And they found that the electrical current itself could contribute to cellular damage under the conditions they studied. [8]. Now THAT'S interesting.

We already know dental metals can interact electrochemically. But investigating what those electrical interactions actually do to living tissues is a much bigger conversation. And it's one biological dentists are having. Why is conventional dentistry NOT having this conversation? We keep putting more and more metal in people's mouths. We SHOULD be paying attention!

Oral Infections: What Happens Beyond the Tooth?

Researchers have found bacterial DNA from oral organisms inside blood clots removed from patients who suffered heart attacks and strokes. I'm talking about the actual clots blocking blood vessels. In 2013, researchers examined coronary blood clots removed from 101 heart attack patients. They found DNA from bacteria commonly involved in infected tooth roots in 78.2% of those clots. The amount of bacterial DNA in the clots was also 16 times higher than in blood samples from the same patients. [9]

Let's do some (what I call) "Mom Math". Imagine 100 patients having heart attacks caused by blocked coronary arteries. In this study, roughly 78 of those 100 clots contained DNA from bacteria commonly involved in infections inside tooth roots. That's an extraordinary finding.

And in 2019, another study examined clots removed from 75 stroke patients. Researchers found oral streptococcal DNA in 79% of those clots. [10]. Now, those findings don't establish that every bacterium came from a particular dead tooth or that the bacteria caused the clots. But they SHOW that bacterial material from organisms associated with the mouth can be found far beyond the mouth. And that raises some VERY important questions about chronic oral infections, inflammation, and the rest of the body that dentistry SHOULD be routinely asking!

Other researchers have examined dead teeth with persistent infections around their roots. In one 2010 study involving 106 diseased roots, researchers found bacteria in nearly every specimen. Biofilms were present in 77% of the roots, including 74% of the previously root-canal-treated roots. [11]. Those weren't randomly selected healthy teeth. They were teeth already known to have inflammation around their roots. But the findings help explain why bacterial communities can persist in the complicated anatomy of a tooth's internal canals. And why we need to think carefully about what may remain after treatment.

What Happens to Inflammation AFTER a Root Canal?

This is another area where I think dentists need to look more closely at what the research actually SHOWS. In 2022, researchers followed patients undergoing root canal retreatment or surgery around previously treated tooth roots. They measured 14 different inflammatory markers in the patients' BLOOD before treatment and again at three, six, and twelve months. [17]

And the results were interesting - but they were CHERRY PICKED for the presentation I heard at the IAOMT presentation in September 2026 in Columbus Ohio! The presentation focused on the fact that two of the inflammatory markers went down at the 6- and 12-month marks. Of course, I had to dig deeper, because science girl. At three months, SIX inflammatory markers had increased compared with their levels before treatment. At six months, two of those markers, IL-1β and IL-8, had increased even further, while several others were going down.

By twelve months, some markers had fallen below their original levels, while others were closer to where they'd started. Two markers involved in tissue remodeling, MMP-2 and MMP-9, had started increasing again. And when the researchers evaluated healing with CBCT at one year, only 25.9% of the treated cases were completely healed. Another 63% were still healing, and 11.1% had failed.

Another study published in 2024 followed 29 patients after root canal treatment. Two forms of CRP, which are used to evaluate inflammation, decreased in patients who'd started with higher levels. But five other inflammatory markers didn't show meaningful changes. [18]

So when somebody tells me that inflammatory markers went down after root canal treatment, I want to know what ALL of them are doing. I want to know why some are going up instead of down, because something is driving inflammation! And I want to know not just the short term, under a year thing. I want to know what happens at 2, 3, 5, and 10 years later. Because if the inflammatory markers don't stay down long term, then was the treatment truly a success?

These treatments are intended to last for decades. A few months of improving bloodwork doesn't establish what happens to someone's immune system over the entire life of that dead tooth. And we don't have the long-term measurements needed to answer that question. That's the kind of research I want somebody to DO!

I explored these findings and a LOT more in my September 2026 article, The Root Canal Question: What Are We Actually Saving?, written after attending the IAOMT meeting in Columbus. Because understanding what treatment accomplishes is important. But understanding what it might leave behind, and what happens to the human attached to that tooth over the next twenty years, is just as important.

This research has enormous implications for the way we investigate dental infections, especially when patients are dealing with complicated medical problems. There's a whole world of microbiology and immunology waiting for us to explore, if we only start asking the right questions.

Airway Dentistry: Sometimes We're Asking the WRONG Question

Let's talk about another subject that changed the way I look at dentistry. Airway development. A patient comes into your office with broken teeth, worn restorations, or repeated implant complications. You notice that they're clenching or grinding. So you make a nightguard. But WHY are they clenching?

Could they have sleep-disordered breathing?
Could their jaws be too narrow?
Could their tongue have inadequate room?
Could something be happening during sleep that's affecting the forces they're generating?

A 2023 study examined 914 adults with obstructive sleep apnea. The researchers found that almost HALF also had sleep bruxism. They also observed that most of the recorded rhythmic jaw-muscle activity occurred around sleep arousals. [12]. It sure does give us a reason to investigate the relationship between breathing and jaw-muscle activity. And that matters when we're planning restorations and implants.

A 2024 review examined 27 studies involving more than 12,000 implants. The researchers found that implants placed in patients with probable bruxism had approximately 2.2 times the odds of failure compared with implants placed in patients without bruxism. [13]. So maybe the patient who's repeatedly breaking beautiful dental work needs something more than another beautiful restoration. Maybe we need to investigate what's happening during sleep.

And now let's look at something else. Researchers have examined whether extracting premolars during orthodontic treatment reduces airway size. A 2025 review found little overall change in measured airway dimensions in the studies comparing extraction and non-extraction treatment. [14]. Okay.

But WAS THE AIRWAY ADEQUATE IN THE FIRST PLACE? Because if someone started with a narrow upper jaw and breathing problems, showing that the airway didn't get smaller doesn't tell us whether the underlying problem was addressed. It doesn't even ask the question of what the underlying problem is! The study completely missed the point. It failed to ask the question of why the airway was so small in the first place, and if it was too small, what could have been done to make it bigger. Instead, it just asked whether the airway gets smaller. This is an example in my mind of BAD science. They ask the wrong question in the first place.

Meanwhile, a 2025 review of 41 studies found that maxillary expansion in growing patients generally increased space in the nasal cavity and upper throat. Some studies also showed improvements in airflow and breathing measurements. [15]. So now we have two different sets of findings. One tells us that extraction treatment didn't substantially change certain airway measurements. The other tells us that expansion can increase airway space in appropriately selected growing patients. The other studies asked the RIGHT question. Knowing the airway was too small, what could be done to improve and increase the size of it?

What we REALLY need to know is whether the treatment addressed the needs of that particular patient. That's the sort of critical thinking that makes biological dentistry so interesting. A study can answer its original question correctly and still miss a much BIGGER question. And that's where I want us to keep looking deeper.

Good Science Should Make Us Ask MORE Questions

We don't have to agree with every conclusion in every paper we read. And we certainly shouldn't stop investigating something simply because the research hasn't answered every question yet. Sometimes the most interesting part of a study is what the researchers DIDN'T measure. And then there are the studies that tell you something "interesting" but leave out a lot of their research because it doesn't match the narrative they want, like with the cytokine research I mentioned above.

And that's what science is supposed to do! One study answers a question. Another study raises another question. Researchers develop better methods, examine more patients, and discover things we didn't understand before. The process keeps growing. There's an enormous amount of joy in that for someone who genuinely loves science. And biological dentistry gives us opportunities to connect information from different fields in ways that can change how we care for patients.

You Don't Have to Be Unhappy With Dentistry to Become Biological

Some dentists discover biological dentistry because we got really sick. Some of us discover it because we're frustrated. We're tired of fixing the same problems over and over again. They're tired of production pressure, insurance companies, and feeling like they barely have time to talk to their patients.

I get that in my bones! But you don't have to be unhappy with dentistry to become interested in biological dentistry. You might LOVE what you do. You might be an excellent restorative dentist with a successful practice and wonderful patients. And you may simply discover that there's more science to explore.

Your clinical skills and experience still matter. And everything you've learned along the way is still part of what makes you a good dentist. Biological dentistry gives you the opportunity to look at those skills through a much bigger lens. You're still treating teeth. But you're also thinking about the microbiology, toxicology, immunology, airway, nutrition, materials, and overall health of the human attached to those teeth. And that can make dentistry a LOT more interesting. I know it did for me.

Where Do You Begin?

If you're new to biological dentistry, I'd encourage you to start by exploring the education available through the two organizations that have played an enormous role in my professional development.

The International Academy of Biological Dentistry and Medicine (IABDM) offers education and certification in biological dentistry.

The International Academy of Oral Medicine and Toxicology (IAOMT) offers education covering mercury-safe removal, toxicology, material compatibility, oral galvanism, fluoride, oral infections, and other biological dentistry subjects.

Attend a meeting. Take a class. Learn how science-forward we are, because I want you to fall in love with science again! Get to know some biological dentists. Don't assume that because something wasn't emphasized in dental school, there isn't research worth investigating. Some of the most interesting studies we discuss in biological dentistry come from researchers in universities, hospitals, and medical institutions throughout the world.

The research is there. We need to be willing to find it, read it, and think critically about what it actually SHOWS. And you don't have to change your entire practice overnight. Learning takes time. I took on a subject a year when I shifted. Because it's like drinking from a fire hydrant with a straw! Becoming proficient with new clinical protocols takes time. And developing a genuinely biological approach involves more than putting the word "holistic" on your website. It's a commitment to understanding the science behind the choices we're making for our patients.