Dental News - Interview: "There is definitely a benefit to having a more holistic approach to treating patients"

Nathalie Schüller, Dental Tribune International

Wed. 20. October 2021

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Dr Dominik Nischwitz is a dentist and naturopath, a world specialist in biological dentistry and ceramic implants, and the vice-president of the International Society of Metal Free Implantology. With his father, Dr Nischwitz cofounded DNA Health and Aesthetics Center for Biological Dentistry in Tubingen in Germany in 2015. Dr Nischwitz has exclusively used ceramic implants since 2013, placing more than 4,000 to date. A pioneer in the field of holistic dentistry, Dr Nischwitz regularly gives lectures around the world and has recently published his first book, It’s All in Your MOUTH (2020, Chelsea Green Publishing). He trains traditional dentists in biological dentistry and believes that all health starts in the mouth.

I learned about you when listening to an interview Dr Miguel Stanley did with you. A lot of what you both do is connected, so maybe the first question could be who came first, you or Dr Stanley?
He invited me in 2018 to teach him about biological dentistry so that he could start implementing it in his clinic.

You have been practising biological dentistry for 13 years and back up your arguments with evidence, but I am quite sure some people are not happy about your advice to avoid root canal therapy and to have all restorative metals removed from the mouth. There is definitely a benefit to having a more holistic approach to treating patients, including looking at the immune system and nutrition, so how popular are you nowadays?
It is getting better, but I definitely have had negative feedback. You will of course find negative things about me online as well, so haters are always there, but there are people like me saying that they can see the sense of my message. The problem comes more from those who are not open-minded, who feel attacked. Therefore, I have learned that the most important thing is to not criticise. I prefer to inform people about the new things I have learned to reach the next level of care, a progression towards constantly improving care.

Biological dentistry is the overlap of high-tech dentistry, functional medicine and health optimisation/biohacking. The goal is optimal health. My message is that everything starts in the mouth, and therefore the dentist has a major role in helping people if he or she keeps his or her knowledge up to date. I am trying to fill gaps in traditional dentistry knowledge from the overall functional medicine and health optimisation point of view.

Basically, the dentists that understand the message I am trying to share usually become fans and see results with their patients that they never expected. Instead of repairing teeth and taking care of pain, they reach what I would consider the next level, a more holistic approach. This results in healthier patients with better lives. You know that most patients do not want to go to the dentist. My patients are happy to see me because they learn so much about their overall health and their bodies. They might have to wait for months to see me. I only do surgeries and bigger cases, seeing one or two patients a day. It is a lot of work, but the rewarding part is that I can really help people with their overall health by starting in their mouths.

Dr Dominik Nischwitz’s checklist for dental amalgam removal. (Image: Dominik Nischwitz)

You talk about how metals present in the mouth affect the body, increasing inflammation and sometimes causing certain diseases. You have experienced this first-hand. Can one really heal from certain ailments, autoimmune disease for example, if one no longer has metals in the mouth?
Yes! One needs to understand the overall picture. Basically, the body’s immune system is our first defence and attack mode. Hashimoto’s disease is an autoimmune disease that results in the body seeing that there is something wrong in the body that it attacks. It knows what the natural body looks like. For example, in a person with amalgam fillings, mercury could attach to the thyroid. The body does not recognise it as normal, like it would not recognise a virus as normal and could therefore just attack the thyroid or any altered tissue that doesn’t look natural anymore. This is called the “Hapten effect”.

From the traditional approach, dentistry’s goal is to repair teeth, relieve pain and obtain good aesthetics. Some of the various restorative materials put in the mouth affect the microbiome, such as gold and mercury in amalgam. The body becomes epigenetically more unnatural, like the world around us, and the immune system has difficulty dealing with it. This is the reason why we say that health starts in the mouth. We need to take out all the stuff that has already been placed in the mouth and replace it with new biocompatible or at least neutral materials and simultaneously consider everything that goes and has gone into the mouth regarding nutrition, micronutrients and macronutrients, and potentially any deficiencies acquired over time.

The body heals itself from the inside and one can use all sorts of healing modalities, including going back to nature and doing grounding — contact with the earth’s surface electrons by walking barefoot outside and in doing so reducing pain, sleeping better, etc. — but if there are still a lot of foreign materials installed in the mouth that the body cannot tolerate or is allergic to, the body cannot heal. If one removes these things, the body has a chance to recover and it then needs to get back what it needs to heal: first and foremost food, particularly macronutrients (proteins, healthy fats and carbohydrates) and micronutrients (vitamins and minerals), all it needs on a cellular level. We basically bring the patient back to his or her innate natural state, restore everything in a way as healthy as possible and give the patient tricks, tools and tips to improve his or her lifestyle for the rest of his or her life. And of course, use high-tech dentistry to repair the function as well as the overall aesthetics. A healthy body is most likely more aesthetic anyway.

Can we then say that, if all that is not natural, not supposed to be in the mouth, is removed, we can get rid let’s say of an immunodeficiency disease, or is it not so easy?
I don’t think it would be that fast, but certainly, if one understands the concept that one’s immune system became intolerant or a bit too aggressive, then it is necessary to balance the inner environment again, take out all that should not be in the mouth, including an overabundance of bacteria.

Nischwitz is an advocate of biological dentistry that applies all basic principles of chemistry, physics and biochemistry. (Image: Dominik Nischwitz)

We shouldn’t tell a patient that this or that disease created by the constant inflammation will be gone, but healing, making the body as healthy as possible will in turn help the body find its balance again, and whether it’s Hashimoto’s disease, skin disease, irritable bowel syndrome or chronic fatigue, it’s all connected to the nervous and immune system. The mouth is part of the body, and the teeth are like an extension of the brain; like the eyes are. The whole jawbone and all the teeth are connected to the trigeminal nerve (the fifth brain nerve). Infections, toxins, cytokines, basically everything that is in the mouth and on or in the teeth will be transported through the blood system, through the lymph- and nervous system into the whole body within minutes. The trigeminus nerve can even transport infections and toxins into the brainstem, ganglia, hypothalamus and pituitary, through the so called retrograde axonal transport. It is therefore possible that you suffer from chronic fatigue because you are having an ongoing chronic inflammation in your jawbone as a reaction to the anaerobic bacteria from a chronically inflamed root canal treated tooth. If we address chronic inflammation, toxins and infections, the body and immune system will be able to find harmony and balance – the state of homeostasis – again. The mouth is the entrance to the body and plays a major role in establishing overall optimal health and that is the reason why one needs a skilled biological dentist to help one establish this.

My perspective of biological dentistry goes way beyond this. We do biohacking, functional medicine, of which nutrition is a big part, and we take care of everything that is in the patient’s mouth. Patients who come for treatment need to first send their information, a panoramic radiograph, their vitamin D₃ and LDL levels, and the completed medical questionnaire we have prepared. We then create a treatment plan, send video links, a cost estimate and a preparation plan (nutritional booklet, micronutrient to be taken, Bone Healing Protocol, etc.) before their visit.

So your approach takes care of more than the patient’s dental health and implements changes that are not going to be needed just for your treatment but lifelong. Are your patients committed to that extent, or do they take the necessary steps only for the duration of the treatment with you?
I would say that around 95% of people who come and see me are doing everything they can to optimise their health, so they are grateful for the help I give them to change their lifestyle for their health optimisation.

My Food Design Concept, a general guideline for them, is about what they should eat and not eat, but if they come see me, they are already prepared, they have taken the nutrients I recommended, and their nutrition is optimal. We treat them in the clinic for a week and I do their surgery, so they are mostly with me for a day, and explain everything. After the surgery, we will individualise their nutrition for the next six months. I would say that 90% are fully committed to their health. The dental aspect is not the primary concern. At the end, they tell me that 80% of their aliment—depression, chronic back pain, Hashimoto’s disease, etc.—has been resolved and on top of this they now have nice teeth.

Teeth are then no longer the focus; the focus is health, and yes, it is a different mindset. Those are people looking for changes to improve their health; some have had huge chronic problems for decades, some are in the field of health optimisation, like myself, and are looking for the edge. They might feel that something is missing or holding them back. They are biohackers, athletes or high performers who just need the edge. There are extreme-case scenarios, chronically sick people, athletes, etc., but all are really committed and take responsibility for their health and are very grateful for the tips we provide to change their lifestyle, and people tell me that I am inspiring them, and I am very happy that I can do this.

My motto is that I do my best every day and I practise what I preach. People often take things for granted, but I am curious and open-minded and know that there is much to learn. People who feel they know everything already will deny what one says if it is not common knowledge, not what we are used to, not what has been practised or believed, and then they will get angry and judgemental.

I recently watched a presentation by an Italian dentist, and he said something very interesting to me: he said that people who inspire one are the people who always ask themselves why, which to me means that they don’t take something established as the universal, unchangeable truth. I think that it is only when one thinks this way that things progress and change for the better. Don’t you think?
Exactly. During my studies, I might have been the only guy who questioned everything, even more so if it did not make sense to me. I think I am actually very sceptical and very curious as well. Therefore, if someone tells me I am doing something well, but he has an idea to make it even better, I listen and I try. If it does not work, I will discard it; if it does, I will now use it. Bruce Lee said: “Absorb what is useful, discard what is not and add what is uniquely your own”, this is what I have been doing for the last 19 years. I am continuing to learn things every day.

You talk about mouth breathing being a possible cause of caries. Why?
Mouth breathing changes the whole microbiome, which changes the immune system. Mouth breathing creates a dry mouth because there is less saliva, which is needed to help the tooth recover, to remineralise. Mouth breathing allows more plaque to accumulate, increasing the risk of caries.

The common understanding of the cause of caries is basically that the consumption of sugar feeds bacteria in the mouth and a carious lesion results. That is not the whole story. Lifestyle and nutritional deficiencies are major factors. The right amounts of proteins and vitamins in the body result in teeth that are hard as stones. One wouldn’t then even need toothpaste to clean them, but of course, this depends on lifestyle: if one eats too much sugar, one aggravates the problem because more deficiencies result, a hormonal imbalance develops and the mouth’s PH level changes. Acidity in orange juice and cola, for example, will also attack the enamel, making it weak.

Gluten intolerance is also a cause of tooth problems. People with coeliac disease (who cannot tolerate gluten at all) are very likely to have very soft teeth because the chronic inflammation in the gut, which starts in the mouth, will create problems in the body’s ability to absorb minerals, so it cannot really build bone and teeth because of the lack of nutrients, because of the inflammation. It is more complicated than this, having to do with insulin and bad saliva, and again it comes back to what one does on a daily basis.

If one was breastfed, had the perfect nutrition as a kid and never took any fluoride, one would most likely have hard teeth and no caries, even if one doesn’t clean that much. In today’s world, one needs to tell patients to clean, once or twice a day, depending on what they already have in their mouths, but in nature, one would probably just use a stick to clean.

“This is really a whole mindset shift I want to teach to many dentists [...]. I believe that, if they do biological dentistry, they will get better results and happier patients”

I actually was surprised that, in Germany, the health insurance system pays only for amalgam as a restorative material. With all we know and with the Minamata convention, how is it possible that we still use amalgam instead of composites to fill a tooth?
Most dentists just do what they have been taught and without question, so for them, it is totally normal to place amalgam and insurance pays for it. Many dentists do not use dental dams or special aspiration devices when they remove amalgam, but what they don’t know is that they are putting themselves at risk by not doing so. Dentists might drill out five fillings a day for ten years and therefore are actually at the greatest risk for heavy metal intoxication, if they don’t remove amalgam in the safest way possible. Dentistry is often listed as the number one unhealthy profession.

Safe amalgam removal. (Image: Dominik Nischwitz)

Remember as well that dentistry is often no fun and a stressful job and not many people are happy to go to the dentist, so they do not like the dentist. Then the dentist must discuss money, treatments are often not well reimbursed or are expensive, and patients do not regard money spent on taking care of themselves in this manner as an investment.

This is really a whole mindset shift I want to teach to many dentists, and this is what I am teaching dentists and their whole staff. I believe that, if they do biological dentistry, they will get better results and happier patients. The philosophy we are teaching is to have a no-stress environment and then help people to recover and heal overall, by taking care of their bodies and their mouths. The goal for the future should be that they will never get a tooth ache in the first place because we taught them how to optimize their lifestyle and nutrition, and that they can come in once or twice a year for cleaning and maybe for other health optimisation strategies, like hyperbaric oxygen chamber treatments and intravenous nutrition, and then maybe get an update of their nutrition plan every six months so that they stay on point.

So hyperbaric chamber treatment and intravenous nutrition are not only done in preparation for an upcoming surgery?
Yes. This is functional medicine or health optimisation. If one really wants to invest in one’s body, longevity and lifestyle, doing this at least once a month would be a great strategy. For somebody who has a high level of stress or an athlete, I would recommend it once a week. It is a vacation for the body to replenish. This is advanced stuff, things one can do as a bonus for health or to recover faster, but the most important thing, the 80% rule, is lifestyle and nutrition on a daily basis: going out in nature, breathing fresh air, going barefoot and grounding oneself, eating clean foods, taking care of one’s micro- and macronutrients, going out into the sunlight and maybe into fresh water, minimising Wi-Fi and EMF exposure (smart use of technology). All these strategies that one can do oneself are way more important, but if one wants the extra edge or if one has a stressful lifestyle or is already chronically sick, then these therapies really work to get one to the next level or just help one to deal with an extreme lifestyle.

You recommend taking 5,000–10,000 IU vitamin D₃ per day, but I read that, for the purpose of rebuilding bone, you recommend taking about 20,000 IU vitamin D₃ daily? What about Omega-3, what is the Bone Healing Protocol you referred to, and does it mean we always have to take supplements?
I named it the “Bone Healing Protocol” because back then it was only planned for my surgeries. It is basically a concert of all micronutrients that work together in synergy to help the body. It is based on high levels of vitamin D₃, which the body produces through exposure to the sun, and 20,000 IU is a short-term higher dose we use before and after surgery. The Bone Healing Protocol starts typically two to four weeks before the surgery and lasts for at least six to eight weeks afterwards. On a regular basis, I check my vitamin D₃ level and take 5,000–10,000 IU vitamin D₃ daily. I want to have the blood levels above the average, which is 60 ng/ml, so 60–100 ng/ml is really good.

But the Bone Healing Protocol it is not just about vitamin D₃: it is about fine-tuning the daily nutrition, which I call the “Food Design Concept”. The top priority in terms of nutrition is always to skip the bad stuff, which is what I call the “CORE FOUR SICKENERS”: gluten-containing grains, dairy products made from conventional cows’ milk (besides butter, sheep, goat and buffalo milk are possible alternatives), refined vegetable oils and sugar.

Food is nature’s pharmacy, and we should try to eat what nature gives us, what we can fish, hunt or grow, and focus on the nutrients it gives us. The most important nutrient is protein. It comes from the Greek word “proteios”, which means the first one or the most important one, and the building blocks of proteins are amino acids – especially the nine essential amino acids that we need to get from food.

Animal proteins from high quality meats, fish or eggs are always complete sources of these essential amino acids. We can also find proteins in plants, but it is not as “foolproof” as the animal version because plant proteins are mostly incomplete and need to be mixed and prepared differently. Most of the people I see have a protein deficiency and an even greater deficiency if they are vegan. I think that cleansing the body with a vegan diet for a few weeks is okay, but I do not think it is a good strategy from a medical point of view as over time there are just too many shortcomings in various nutrients (B12, creatine, carnosine, taurine, choline, etc.).

But why supplement if one lives a healthy lifestyle with the right diet and all the nutrients one needs? Why do you yourself supplement, being more aware than most and taking proper care of your nutrition?
I supplement for optimal health. In an ideal world, where there is no stress, no toxins, no Wi-Fi, no electromagnetic fields, and only organic food on great soil and one prepares one’s own food, it might be possible not to supplement, but in our society, to have optimal health, I think we need to supplement to have all the nutrients we need. I want to be in a nutrient surplus rather than a deficiency. Better safe than sorry.

One doesn’t need too much. Basically, the Bone Healing Protocol (BHP) supplies all the micronutrients together, including the right amount of vitamin D₃, vitamin K₂, magnesium, zinc and other minerals, because our bodies are depleted, and we need minerals for bones. I drink a lot of sea-salted water and eat a lot of sea salt, such as Celtic sea salt. I take an omega-3 supplement if I don’t eat fish because I want to have about 1 g/day of EPA, which is the anti-inflammatory omega-3 fatty acid. Enzymes are supplied in the Bone Healing Protocol as well.

Essential amino acids (EAA) are the building block of life. In my opinion this is the one supplement almost everybody can benefit from. You can get them in a drink without needing to digest food before – I call this better living through science. EAA are pre-digested, giving an instant boost of recovery building blocks to the body, without any energy needed to digest the food before. That is in itself, an easy strategy to optimise the nutrition – start “Thinking in nutrients”.

Nischwitz says that creating biological tissue with A-PRF is the simplest way of using natural regeneration. (Image: Dominik Nischwitz)

I had never heard of neuralgia-inducing cavitational osteonecrosis before reading your book. It sounded actually scary to think that one might have chronic inflammation, superficially closed wounds and infections without being aware of it. Even scarier was to learn that a person with no implants, crowns or restored teeth could still suffer from it because their third molars were removed. Are dentists generally aware of this problem?
The problem is that NICO (neuralgia inducing cavitational osteonecrosis) is still not being taught in medical schools, even though this problem has existed for ever. Dr Johann Lechner in his practice in Munich in Germany, focuses on holistic dentistry and has been researching these cavitations (layman’s term for NICO/FDOJ) his whole life. He coined the term FDOJ which stands for fatty degenerative osteonecrotic. Jawbone, and that is actually a perfect description of what we find in these jawbone areas. He is now 72 years old, and people have been fighting him his whole life. I think the change is almost here, but the older generation of academics generally deny the existence of the problem. I am not sure why. The next generation, maybe with the technology now available in dentistry, seems to be more open-minded and more open to new research. We do a lot of research now to prove the existence of the condition scientifically.

I am a dentist, who feels the deep need to helps people to get healthy or healthier. I am a doctor. The first rule is “do no harm” and the second is “he or she who heals is always correct”. Doctors need peer-reviewed papers, but this is not science, it is academics, meaning everybody has agreed on it and that is the opposite of science. Science is the study of nature, of things that have not been discovered yet and the reason why it is called science. There need to be people who are innovators and think outside the box, to find new solutions for new evolving problems. Research is important but always comes second. However, there is tons of research in various sciences about the whole body, and we need to be able to apply each of these findings to our teachings. Not just the peer reviewed dental papers but nutritional studies, micronutrients, herbs, physics, chemistry, biochemistry, microbiology – all the sciences. We are living in the age of information, and this the amount of research doubles every year.

I see now that biological dentistry is almost there and could become a major trend. It took my early doctor friends ten years to believe me, and they are now all fans. If one reaches a certain margin, I think 5%, then a new trend, movement or idea can grow. Biological dentistry has not yet reached 5%; there are still so few people all over the world doing this. But we definitely need more dentists to work like this.

What about the cost of treatment? Does it prevent many continuing with the plan you give them?
It is always a matter of priorities. If one does not think about health, one can do with one’s body whatever one wants and one is not worried about one’s teeth, as long as one can chew. But if one really has a health issue or wants to become “superhuman”, I would think that restoring the body as it was when one was born would be a good idea. Therefore, we use science and tools and knowledge from different fields, medicine, nutrition, etc. to build a programme that helps the patient reach his or her potential. I am not saying that I am doing everything correctly or perfectly; I am just trying to give my best every day and look for new solutions. Maybe a source of inspiration would be to say that I am the guy who will push it to the extreme to find new tools and new ways. This is what I like, building, creating and optimising things.

Biological dentistry, offering a more holistic approach to the body instead of treating areas separately, breaking down diseases that ail us into specialties, seems to make a lot of sense when we understand the interrelation of many health issues. Most alternative treatments however are poorly reimbursed by health insurance if at all. Do you think that it is possible to change our current healthcare system from being primarily reactive, only treating symptoms, to being proactive, addressing the causes of disease instead?
My idea is to inform the masses. I am the “public relations guy” for the mission “health starts in your mouth”. I tell people that biological dentistry is something they need to be aware of. Then the patient needs to go see his or her dentist and ask about it. A dentist will need to upgrade the way he or she treats. This is the first step to teaching more dentists. And if people hear about this, and we think about changing lifestyles on a bigger scale, I think that at some point the masses will follow to some extent, but I think it will take years for general insurance to recognise that prevention is the key. The best idea is probably for patients to take care of themselves and address their lifestyles, so that they don’t need to see a doctor in the first place, and invest in their health from the beginning.

Informing people is probably the best strategy. I give my best to spread the information and try to make the world a healthier place, day by day. I also think that with the Internet it is possible to do so on a bigger scale. My personal health magazine is my Instagram @drdome1 where you can find various interesting and applicable topics on a daily basis.