Dr. Mark Burhenne’s journey to functional dentistry started in a hotel room. He and his wife were headed to drop off their oldest daughter at college. Instead of getting a good night’s sleep, Burhenne’s daughters were kept awake by constant snoring. Their parents were woken up repeatedly with pillows to the face.
Burhenne and his wife were suffering from sleep apnea, a common disorder in which breathing stops and starts throughout sleep. Burhenne sought treatment and learned sleep apnea is often overlooked by physicians. It also associated with other health issues, including teeth grinding and cavities.
As a practicing dentist, Burhenne saw an opportunity to use his experience to help patients. “Dentists can screen for and recognize sleep apnea decades before a physician can,” Burhenne says. From that point forward, he pledged to move his practice beyond simply treating patients’ symptoms to addressing the root causes of disease. Through his website, Ask the Dentist, Burhenne educates patients about functional dentistry—an approach to dental care that focuses on prevention, and recognizes the mouth as a reflection of overall health.
We sat down with Burhenne to learn more about functional dentistry and why it is essential to overall healthcare.
Question 1: What are some of the problems with traditional dentistry that functional dentistry aims to solve?
There’s nothing wrong with conventional dentistry. When you come out of dental school, you have an excellent clinical background for being a good provider. You’re able to fix problems and address chief complaints. If we get into a car accident, hit the steering wheel, and knock out all of our teeth, who is going to fix that? We need good clinicians, and we’re lucky to have them.
Functional dentistry is an overlay for traditional dentistry that represents the bigger picture. Most dentists see a cavity as just a hole. It’s something to fix and look like a hero in front of their patients, or an opportunity to make a living. But seeing a cavity as just a hole is failing to acknowledge tooth decay as the number one disease in the world. And not all cavities are the same—what if it’s a small lesion that we can remineralize instead of drilling and filling? How do we address the root cause of the decay to prevent it from happening again? A cavity should be viewed as a physiological process influenced by the state of the oral microbiome.
If you see a cavity or gum disease as simply a localized infection, you’re ignoring the oral-systemic connection. You’re practicing with blinders on. Functional dentistry is a philosophy and a practice that solves more problems than conventional dentistry does, because it sees and addresses the big picture, and in doing so, it changes how you treat that patient. It can even lead to better treatment outcomes.
Question 2: How do science and research fit into functional dentistry?
Physicians split from dentistry a long time ago. They essentially kicked us out of the club. One of the reasons for that was the persistent criticism that dentistry is not evidence-based. There is ignorance on both sides—physicians think the mouth is this little black box and they work around it, while dentists work in a vacuum in that little black box. But I do think it’s true that dentistry isn’t as evidence-based as it should be. When I was getting my dental education, we still thought of anything that happened in the mouth as an infection that needed to be disinfected and removed. It’s a very simplistic approach that doesn’t lead to good outcomes.
Now we know the oral microbiome is key to understanding the oral-systemic connection. For example, growing research has shown the connection between bacterial colonies in the mouth and major chronic inflammatory diseases of the body, including Alzheimer’s, diabetes, and metabolic syndrome. Dentists are highly specialized oral clinicians—they aren’t trained to review scientific studies. That’s why collaboration between medicine, dentistry, and research is important, and will ultimately bring the most benefit to patients.