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Biological Dentistry – promotes keeping you and your loved ones safe from harmful toxins and radiations, design to prevent common dental problems like tooth decay, tooth disease and tooth loss by utilizing non toxic materials and conservative techniques.
Today, we can do better dentistry, in a less toxic, more individualized, more environmentally friendly way than ever. Biological Dentistry is a thought process, an attitude, and a guide for making choices in dental practice.
Oral Medicine, Dental Toxicology – An Introduction to Biological Dentistry
Oral medicine can be conceived in several ways. One way would be dentistry for people with medical illnesses, such as palliative treatment for mucositis in people undergoing cancer chemotherapy, or preoperative screening for heart surgery or joint replacement, to rule out infections that could threaten the outcome of the procedures. Another way to conceive of oral medicine would be to concentrate on the connection between oral conditions and the health of the rest of the body. The effects of periodontal infections on markers of systemic inflammation and cardiovascular health are the best known examples.
A third way to conceive of oral medicine is to consider the effects of dental materials and dental procedures themselves on the overall health of the body. For those of us who perform our healing functions by implanting foreign or synthetic materials in people’s bodies, the constant challenge is to understand the toxicology, the immunology, the microbiology of our work, and to minimize its impact on the biological terrain of our patients.
“Do no harm,” goes the injunction. But how can we ever be certain that a negative biological response to our work, something unforeseen, will not occur, whether in the whole population or in a single individual patient? We can only be vigilant for new information we can use to refine our techniques, and sensitive to new discoveries that call into question previously accepted views. Until we can replace body parts, like teeth, with all “self” materials, the concept of biocompatibility will always represent an approximation, and a work in progress.
We are the 4%
In a 2001 readers’ survey, the Clinical Research Associates Newsletter asked an interesting question: “What is your most deciding factor in choosing a dental filling material?” The answers were not unexpected: durability, 47%; patients’ preference, 22%; esthetics, 12%; ease of use, 10%; biocompatibility, 4%.
Why is biocompatibility such a low priority? We dentists are clearly most concerned that our work is comfortable, good looking and long lasting. The majority of dentists appear to believe that the biocompatibility of dental materials and procedures is a settled issue. It turns out, though, that our customary materials and procedures range from very benign to frankly toxic. Some of our all-time favorites, mercury and fluoride, have a therapeutic ratio of about one to one — their toxic effects can be detected when they are used “properly.”
By making distinctions – some obvious, and some subtle – among the available materials and procedures, we can reduce the impact on our patients’ biological responses. Our sense of duty to the well being of our patients should make biocompatibility a high value. The fact that there are now so many ways to make the dentistry work gives us the opportunity to do so.
A more biocompatible approach is the hallmark of “biological dentistry.” In using that term, we are not attempting to stake out a new specialty for dentistry, but to describe an attitude that can apply to all facets of dental practice, and to health care in general: to always seek the safest, least toxic way to accomplish the mission of treatment, to do it while treading as lightly as possible on the patient’s biological terrain.
The International Academy of Oral Medicine and Toxicology (IAOMT) is an organization for that group of dentists, physicians, and allied researchers who consider biocompatibility to be their first concern, and who demand scientific evidence as their key criterion. Members of this group have, since 1984, examined, chronicled and supported research into the distinctions that can make dental practice more biologically acceptable. The “biological dentistry” attitude can inform and intersect with all topics of conversation in health care, where the health of the mouth is an integral part of the health of the whole person. Here are some of the topics we talk about:
A general principle of biocompatible dentistry would state that everything we implant, or leave, in and around a tooth represents a systemic exposure, whose impact must be accounted for. As we pursue the main agenda of dentistry, restoring function and eliminating disease, we have two very broad challenges. The first is choosing among the synthetic materials for restorative and esthetic functions, and the second is reducing the presence of pathogens. As we shall see, there is a lot of evidence that professionally recognized restorative materials vary widely in their biological response, both in toxicology and in individual reactions. [See the related article, “A practical guide to compatibility testing for dental materials.”] Equally, some recognized procedures in dentistry, especially in endodontics, periodontics and oral surgery, can actually allow the maintenance of populations of pathogens in internal spaces where they don’t belong.
Aren’t all recognized dental materials biocompatible? The medical device industry has come a very long way in testing for biocompatibility, beyond the traditional cytotoxicity, carcinogenicity and sensitization tests. The current guide for safety assessment is the International Organization for Standardization (ISO) 10993 standard, and its American version, the FDA’s “Blue Book Memorandum G95-1.” The ISO standard is a seventeen part guide for thorough, customized evaluation, including tests for systemic toxicity, chronic and sub-chronic toxicity, characterization and toxicity of breakdown products and leachables.
However, both the ISO and the FDA processes have a “Grandfather Clause.” According to the FDA’s section 510(k), a manufacturer need only demonstrate that a new device or material is “substantially equivalent” to one that was legally in interstate commerce prior to May 28, 1976. Everything we use in dentistry today, from amalgam to endosseous implants and seventh generation bonding agents, has been passed through to market under that rule. Few dental materials have been subjected to anything like the kind of scrutiny mandated by the new standards.
There are, to be sure, more specific guidelines and safety checks, but the Grandfather Clause lets the big fish – dental amalgam – get away. It’s a biocompatibility nightmare. The scientific evidence has established beyond any doubt two propositions: that amalgam releases mercury in significant quantities, creating measurable exposures in people with fillings, and that chronic exposure to mercury, in the quantity released by amalgam, causes physiological harm.
Amalgam–derived mercury distributes throughout the body. It crosses the blood-brain barrier, passes through the placenta and goes into breast milk, resulting in measurable exposure to infants, who are more susceptible to the negative effects than adults. No one has disputed this. Dentists and dental staff members themselves have been shown to be affected adversely by their occupational mercury exposure. Toxicologists have not been able to detect a minimum level of exposure at which there is no adverse physiological effect.
Very few of the experimental studies on effects of mercury have used amalgam as the mercury source., so we are left to infer that amalgam is toxic because it is a source of mercury exposure. The inference is compelling! Imagine applying to a regulatory agency now, under ISO 10993, for permission to market a new implantable material that is 50% mercury, and leaches micrograms per day! And why, in this day and age, when you can no longer buy mercurochrome, and a broken thermometer in the school nurse’s office results in a mass evacuation and a hazmat emergency, should we go on exposing people to mercury when there are so many other methods of restoring teeth? From a practical standpoint, amalgam is totally unnecessary anymore. From the biocompatibility standpoint, it is totally insupportable.
The leaders of “organized” dentistry persist in maintaining the old party line. They say amalgam is a stable material. Mercury is released in an amount too small to harm anyone. The only adverse effects are very rare allergic reactions. No scientifically valid evidence exists to demonstrate negative effects. Reports of negative effects are “junk science.” Mercury exposure from amalgam has never been proved to cause any recognized human disease.
None of these statements can be supported scientifically, and, in fact, the great preponderance of worldwide scientific evidence squarely contradicts the notion of amalgam safety. It’s all a pure red herring. No one claims that lead, for example, causes a recognized disease other than lead poisoning, but we know enough to avoid it.
It’s all in the scientific literature, although this information is rarely mentioned in dental journals, except in the form of editorial rebuttals. The evidence is instead published in many of the world’s leading medical journals, where it has remained hidden from the independent dentist and the public alike, and we are proud to present this large body of work to the dentists who read this website. Is it junk science? Read on and make up your own mind.
Wastewater authorities around the world are on to us. Dental offices have been collectively identified as the major source of mercury pollution in wastewater, and they’re not buying the excuse that amalgam is stable and doesn’t break down. Regulatory action is in place in many jurisdictions requiring dental offices to install mercury separators on their waste water lines. We’ll examine the environmental impact of dental mercury. It’s considered a hazardous material before it’s used, and a hazardous waste after it’s removed, but not when stored in people’s mouths!?
Safe Removal of Amalgam Fillings
Dentists who engage in elective replacement of amalgam fillings have been criticized by their peers for unnecessarily exposing their patients to additional mercury, during the process of grinding the old fillings out. Yet the “mercury-free” dentists are the ones who are most critically aware of the problem. We present scientifically verified procedures for minimizing exposure to the patient and the dental office personnel, which everyone should learn and follow for their own protection.
Methods to promote excretion of mercury that has been stored in the body, both nutritional and medical, will be discussed as well.
In addition to using dental materials that are less overtly toxic, we can raise the biocompatibility quotient of our practice by recognizing the fact that individuals vary in their biochemical and immunological responses. We present a discussion of biochemical individuality, and sound methods of immunological testing to help determine the least reactive materials to use with each individual patient. The more a patient suffers from allergies, environmental sensitivity, or autoimmune diseases, the more important this service becomes.
What can we say about fluoride? Mainstream dental science has concluded that the effect of water fluoridation on children’s teeth, that we’ve long been led to believe, does not exist. The articles are bizarre, in that they start off with the assertion that fluoridation of public water supplies is among the most important public health measures ever devised, and go on to say that it doesn’t work! What are we to make of the statistics that show not only that non-fluoridated communities have experienced the same reduction in tooth decay as fluoridated ones, but that the non-fluoridated continent of Europe has, too? Something is going on with tooth decay in the developed world, but it’s not fluoride. Meanwhile, evidence of the harmful effects of of fluoride accumulation in the human body continues to mount. Any honest appraisal of the risks and benefits of water fluoridation must end with the conclusion that it must be stopped.
Pathogenic microbes, and the link between oral pathogens and systemic disease, have captured our imagination. At times it almost seems as if a tooth, with its root canal system and leaky gums, is a device for injecting pathogens into internal spaces where they don’t belong. Are the methods we typically use to disinfect diseased gums and root canals really the best at getting rid of them?
There is controversy once again in the public’s consciousness over root canal treatment. The origin lies in the question of remnant populations of microbes in the dentinal tubules – whether or not endodontic techniques adequately disinfect them, or keep them disinfected; and how those bacteria and fungal organisms turn anaerobic and produce highly toxic waste products that diffuse out of the tooth, through the cementum and into circulation. We will revisit the dentinal tubule and the periodontal pocket with the question of which techniques are the most anti-infective.
Tooth Extraction and Jawbone Osteonecrosis
What is a “simple extraction?” Does pulling a tooth always lead to adequate healing? Or is there more to it?
Recent work in the field of facial pain syndromes and Neuralgia Inducing Cavitational Osteonecrosis (NICO) has led to the realization that the jawbones are a frequent site of Ischemic Osteonecrosis, also known as aseptic necrosis, the same as is found in the femoral head. As a result, many extraction sites that appear to have healed have actually not healed completely, and can trigger pain in other parts of the face, head and distant parts of the body. Even though most of these sites actually present with no symptoms at all, pathological examination reveals a combination of dead bone and slowly growing anaerobic pathogens, with a soup of highly toxic waste products, where we would otherwise think there has been good healing.
The incidence is alarmingly high. Researchers in the field have implicated such diverse factors as oral surgery techniques and clotting factors, both endogenous and microbial, in its pathogenesis. This is a newly emerging disease entity, although the phenomenon of “bone caries” was known and written about in the days of G. V. Black, over one hundred years ago. Diagnostic criteria and treatment methods are in the early stages of development, as are methods for preventing routine extractions from becoming osteonecrotic lesions. But it’s already clear that this is going to be a big issue in the future, and may ultimately force us to totally re-evaluate our understanding of the relationship between the tooth and the bone.
Twenty First Century Dentistry
In the old days, when the only restorative materials were amalgam or gold, and the only esthetic material was denture teeth, our profession was hard put to fulfill its mission and be biologically discriminating at the same time. Today, we can do better dentistry, in a less toxic, more individualized, more environmentally friendly way than ever. This website is planned to be both a technique manual and a guide for making choices in dental practice. We have as many choices of attitude before us as we do techniques and materials. When you choose to put biocompatibility first, you can look forward to practicing effective dentistry while knowing that you are providing your patients with the safest experience for their overall health.Back to Holistic Bio-Compatible Dentistry
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(Sunny Isles, FL)
The dentist fit me in last minute when my normal dentist was unavailable I tried them on the recommendation of a friend after I broke a veneer and had 3...
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ML GG (Aventura, FL)
The receptionist goes above and be on for the customers. Excellent service the doctor treats you with all his attention feels like I’m right at home and explain everything detailed....
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Thank you Dr. Gorbatov for the great experience, your gentle touch and quality work you have done on my teeth. I have been very pleased with your professional, yet personable...
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I have lived and worked all over North America. One of the greatest challenges of relocating is finding the best dental practice. "Center For Dental Excellence" was recommended to me...
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Dr. Gorbatov is an excellent dentist. I went to several other dentist and they all wanted to do a root canal, but Dr. Gorbatov was able to save my tooth....
Arthur Rubinovich (Sunny Isles, FL)
First time here the staff and Dr were so informative and professional thank you for making my experience run so smooth ?
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Well I’ve been going to Dr. Gorbatov since 1996.... Yes ! I’m a loyal. With all the dental issues I’ve had, he’s been able to resolve them and been keeping...
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I was very fortunate to find Dr. Gorbatov right when I had a major issue with an old crown that fell off and led to a major infection just a...
Octavian Miron (Aventura, FL)
Jessica at the front has helped me tremendously and the Dr has made the large amount of work that I have had done painless
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Thank you doctor for my beautiful smile!
V V (Hollywood, FL)
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I feel I have the best care possible under Dr. Gorbatov and his team. His work is top quality and because of him I know my teeth and the health...
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When I first found this office I was terrified of the dentist and I had constant anxiety when seeing dentists. Now I look forward to cleanings and my anxiety is...
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I have been having a lot of issues with my teeth for quiet some time, including broken molars and bad procedures at other dental facilities. I came to Dr. Gorbatov...
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Dr. Gorbatov is an excellent dentist whose main priority is making sure his patients are comfortable and get the best dentistry he can offer. He provides an attentive service, and...
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Very professional nice staff great service.
Very happy with quick service, suggestions & prices. Will be a repeat customer
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I would like say that this office is at the TOP of my list. The staff is awesome, it is very clean and you made at home as soon as...
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Ruslan Gahramanov (Sunny Isles Beach, FL)
I have been going to Dr Gorbatov at A Center For Dental Excellence for many years now and their use of "Excellence" isn't just a marketing ploy and they definitely...
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I have been with the dentist for a few years now and love the care I receive. You are taken care of from the front desk person, through your visit!...
Juan Rodriguez (Greenacres, FL)
Fast service and the best staff! I highly recommend this Dentist. I've been going to this Dentist for 2 years and I travel far now just to come here. They...
Christine (Orlando, FL)
I switched my dentist because i was dissatisfied with their service and decided to go to Dr.Gorbotov's office for my wisdom tooth extraction. I never thought I would see the...
Oleg Solovey (Sunny Isles, FL)
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Iliana Gonzalez (Royal Palm Beach, FL)
Very good cleaning
Riley Purdy (West Palm Beach, FL)
Incredible how I was just taking my mother to her dentist appointment to me ending up becoming a patient, Jessica greeted me with such warmth and compassion and immediately noticed...
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This is the Best Dental Office I ever was. Great personality, gentle touch and perfectionism in all aspects of cosmetic dentistry. Thank you Dr. Gorbatov for creating Smile I always...
Yuriy Gorobets (Hallandale Beach, FL)
For me, dental work always came with the presumption of pain and discomfort. That's why it was always very difficult to get any recommended work done, because all I'd have...
Iry T. (Hallandale Beach, FL)
What a great experience at the dentist!! I wish I had found these guys years ago, maybe I wouldn't be so afraid of the dentist. Thought I needed a root...
Craig Balsam (Wellington, FL)
S u p e r b ...Immaculate dentistry! I was impressed with a GREAT attention to details! His work is truly an ART and priceless! Everyone in the office is...
Gordana Skracic (Aventura, FL)
Very high professionalism, excellent atmosphere and responsiveness of employees have made this business one of the best. A well-functioning team led by one of the best professionals of the US...
Lili Ivanova (Sunny Isles Beach, FL)
I want to say that I never write reviews. However I have to say that this dentist center is amazing! From the moment you enter you feel like family. Everyone...
Lisa Jerkins (Wellington, FL)
I are retired dentist and visit dr Gorbatov,s office like a patien for dental works. We graduate the same school New York university and l can tell you the dr...
Shmuil Aronovich (Hallandale Beach, FL)
Everyone in the office is super amazingly fantastic! They're informative and understanding. Dr. Gorbatov has done great work on my teeth! The dental hygienist has been a charm, makes every...
John Kern (Hollywood, FL)
The dentist is very friendly and gentle during procedures.
Sofie M (Sunny Isles Beach, FL)
I’ve been coming here for almost 10 years now and can surely say that the customer service provided is one of the best in town. Make sure to be nice...
Hype Kay (Royal Palm Beach, FL)
From the minute I walked in the dr Gorbatov office till the and of my treatment I was pleasantly surprised with professionalism and care of Dr and his staff. I...
Anna (Hollywood, FL)
No teeth fell out mid cleaning. 10/10
Erik Purdy (West Palm Beach, FL)
I had a procedure done by Dr. Gorbatov, it was amazing, I didn't feel anything, he has very gentle hands and techniques and I didn't even feel the shot! I...
Jessica Y Montero (West Palm Beach, FL)
Entire office & staff is very accommodating and attentive to all your needs. The dentist was very nice and professional and really took the time to explain to me everything...