Biological dentistry is the naturopathic version of dentistry. In this episode I’m excited to introduce you to Dr. Toni Engram. She is what’s referred to as a biological dentist. She’s also an integrative health coach and the owner of Flourished Dental Boutique in Richardson, Texas.

For a lot of people, we think a dentist is only a dentist, but that’s not really the case anymore. While biological dentists still do fillings, crowns, and other standard procedures, how they do these things is very intentional.

Biological medicine has an appreciation for the biological terrain. It’s not just about one germ causing one illness – it’s about what our toxic bucket looks like. Have we filled it too much and is it overflowing, or are we supporting it? In biological dentistry, practitioners look carefully at what materials they’re using and whether those are helping or hurting. They look for infections in a patient’s mouth that might be hiding and could impact overall health.

When toxins or infections are involved, biological dentists use techniques that aim to be safer and more natural whenever possible. They don’t use fluoride anywhere in the office. When taking out old silver fillings that are half mercury, they follow specific protocols to protect patients and staff. Even the filling materials used are carefully sourced as responsibly as possible.

People can search online for a biological dentist in their area. Many patients switch to a biological dentist when their regular dentist retires, or when they realize that traditional dentistry doesn’t align with their values. It’s about finding a practitioner whose approach matches what you believe in. Some patients don’t want fluoride, don’t want unnecessary junk in their mouth, and want to ensure dental work is done safely without unnecessary X-rays.

What’s interesting is that Dr. Toni also has health coach certification, which isn’t common even among biological dentists. This gives her a broader perspective on health – she’s not just looking at the patient’s mouth but considering how their diet and overall health relate to what’s happening with their teeth.

Health coaching skills help her with one-on-one patient conversations and in communicating with the public through platforms like Instagram and YouTube. It gives her more fine-tuned skills around how to actually help patients to do the things that support them in getting healthier overall.

Dr. Toni’s Journey to Biological Dentistry

Dr. Toni’s personal illness changed her career path. She was diagnosed with Crohn’s disease after experiencing awful gut issues for about a year. This happened early in her career when she had a toddler at home and was working too hard, not taking enough time for herself. She was opening a practice from scratch while working full-time as a dentist in another office.

She got so sick that when she was finally diagnosed, she had to convince her doctor that something was wrong. She told him she was losing weight without trying and had bloody stools. The doctor seemed to be humoring her by doing a colonoscopy but was surprised to find Crohn’s disease. When she woke up after the procedure, he confirmed she had been right – something was actually wrong.

The tipping point came when the doctor looked her in the eye and said: “Here are your list of medications. You’re going to be on these forever, or until they stop working, then we’ll put you on stronger medications. Oh, by the way, there’s about a 40% chance you’ll need surgery at some point to remove all or part of your colon. Your diet has nothing to do with this.” 

Dr. Toni knew instinctively that this approach wasn’t right for her. While she initially got on the medications out of fear and went into remission quickly, she embarked on a journey to figure out how to actually fix the root cause of her condition. Through trial and error, she learned what worked for her. It took a second pregnancy for her to decide to get off the medications, working with a different doctor to develop a plan. That child is now 12 years old, and Dr. Toni hasn’t looked back.

While doctors would say she’s in remission, Dr. Toni believes she no longer has Crohn’s disease. The medical establishment can make it seem as if recovery is impossible, but much of this can be the mindset. If we believe it’s impossible and follow that path, that becomes our reality. But when we’re not willing to accept that and figure out another way, transformation happens.

In the process of healing herself, Dr. Toni transformed her dental practice to be more aligned with helping people who are also trying to stay away from toxins and eat clean to take care of their bodies.

She recognized similarities between Crohn’s disease as an inflammatory condition contributed to by dysbiosis (an imbalanced microbiome) and dental issues like tooth decay and gum disease, which are also about inflammation and an imbalance in the bacteria in the mouth. She realized that just as she was able to heal herself, her patients could get well too – otherwise, she’d be a hypocrite.

The Oral-Gut Microbiome Connection

Research is now showing that the microbiome in the mouth is related to the microbiome in the gut. These are not separate; they’re very much connected and influence our immune system. Dr. Toni often talks with her patients about microbiome health and how the microbiome in the mouth impacts overall health.

Her practice conducts saliva testing to look at the oral microbiome and uses that information to help guide treatment. This approach is cutting-edge and represents where dentistry should be heading. Otherwise, we’re just dealing with decay in the teeth – filling, removing, replacing – without solving what’s really happening under the surface.

Traditional dentistry has gotten really good at “tooth carpentry,” just as surgery has seen amazing advances on the medical side. But if we’re not addressing the root causes, we’re not really solving the fundamental issues. We might be doing amazing restorative dentistry, but without getting to those root causes, we’re missing the bigger picture.

The connection between the mouth and the rest of the body is becoming increasingly clear. The microbiome in the mouth directly impacts the microbiome in the gut, and both play crucial roles in our immune function. By conducting saliva tests to analyze the oral microbiome, Dr. Toni’s practice can develop more targeted and effective treatment plans that address underlying imbalances rather than just treating symptoms.

This whole-body approach to dental health represents a shift in how we think about dental care. Instead of viewing the mouth as separate from the rest of the body, biological dentistry recognizes the intimate connections between oral health and overall wellness. This perspective allows for more comprehensive and effective treatments that support the body’s natural healing processes.

The Fluoride Controversy

The thinking behind fluoride was to give everybody fluoride to prevent tooth decay, but evidence is emerging about issues with this approach. Recently, there was a lawsuit against the EPA where the judgment found that according to the government’s own scientific research, we don’t know what a safe level of fluoride is. Yet we’ve been adding it to water since the World War II era, in the 1950s.

One of the most studied issues with fluoride involves its impact on IQ levels in children. What used to be considered a conspiracy theory now has peer-reviewed evidence showing that fluoride actually does impact IQ significantly based on the levels that children are receiving. This could potentially mean a 10-point IQ drop, which for a child on the edge of needing academic help could mean the difference between functioning independently and needing substantial extra support.

Other concerns with fluoride include thyroid issues and pineal gland calcification. What’s interesting is that when looking at the data more carefully, countries and areas that did not choose to fluoridate their water saw the same decrease in tooth decay as those that did. This suggests that the benefits of fluoride may have been overestimated while the risks were underestimated.

While there are oral health benefits to fluoride, the risks make it incompatible with Dr. Toni’s values to use in her practice, and she tries to avoid it at home when possible. One major issue is that when fluoride is in the water supply, it’s impossible to control the dose. It ends up in sodas, in packaged foods manufactured with municipal water, and even in home-grown vegetables watered with a hose.

Dr. Toni points out that this is one area that Robert F. Kennedy Jr. has his eye on – water fluoridation. The lawsuit against the EPA highlighted that we don’t know what a safe level of fluoride is, yet we’ve been adding it to water for decades. This is particularly concerning for parents, as the potential 10-point IQ drop in children could significantly impact their futures.

The issue with fluoride in the water supply is that it’s impossible to control the dose. When it’s in municipal water, it’s everywhere – in beverages, in processed foods manufactured with that water, and even in home-grown vegetables watered from the tap. Dr. Toni hopes that in the coming years, fluoride will at least be removed from the water supply, allowing individuals to decide whether they want to use fluoride toothpaste.

She personally thinks fluoride is unnecessary, as it’s not a nutrient and not necessary for healthy teeth. There are other tools and ingredients that can be used to promote dental health without the potential risks of fluoride.

The Microbiome Is Key to Preventing Cavities Naturally

When considering dental health approaches, it’s important to prioritize methods with minimal potential harm. If we optimize the microbiome in the mouth and help people make diet changes, we’re choosing interventions that have no harm and only help overall health. It’s not about taking away something beneficial but choosing alternatives that are more helpful with less risk.

Dr. Toni created an online course called “The Cavity Cure” because even with longer-than-average appointments, there isn’t enough time to go through all the nutrition and oral hygiene information patients need. The course covers how to cure and prevent tooth decay from the outside in – choosing toothbrushes, floss, toothpaste, and other products. More importantly, it explains how to heal cavities from the inside out through diet, supporting gut health, and making teeth intrinsically strong and resistant to decay. The course also covers how to find a dentist and what to look for in dental procedures and materials.

This kind of comprehensive approach to dental health isn’t taught in schools. Typically, we just learn to brush our teeth and hopefully floss. When people still get cavities despite brushing better and flossing more, they assume they just have “bad teeth.” However, only about 1% of the population actually has a genetic condition causing truly bad teeth. For most people, even if there’s a genetic tendency towards certain issues, those genes can be turned off with the right tools and know-how.

Dr. Toni emphasizes that it’s a myth that people simply have “bad teeth.” She explains that for about 99% of the population, it’s not actually a genetic condition but rather issues that can be addressed with the right approach. Even if there are genetic tendencies toward certain dental problems, those genes can often be turned off with proper care and nutrition.

Even people who have been struggling with their teeth can turn things around. In Dr. Toni’s practice, they take patients through a 90-day accelerator program that makes the online course material hands-on, following a functional medicine model where they coach, test, tweak, and test again. Since starting this program about a year and a half ago, they’ve seen 100% success rates, which shows that even if patients aren’t perfect, consistent changes make a difference.

The 90-day accelerator program has shown remarkable results. Dr. Toni explains that even she was surprised by the 100% success rate, which demonstrates that even if people aren’t perfectly compliant with every recommendation, making consistent changes does produce significant improvements. Sometimes patients still need dental work, but combining that with strategic, focused care to change the pH of saliva and oral microbiome leads to objective improvements that can be measured and seen on paper.

For many people, dental issues can cause embarrassment about their mouth, smile, or breath, which impacts how they interact in their daily lives. When dentists can give someone their smile back and the freedom to speak and smile with confidence, that’s a huge improvement in quality of life. Dr. Toni notes that we can all think of people who hold back because they don’t want to show their teeth, so helping someone regain their smile and confidence is truly life-changing.

The Dangers of Mercury in Amalgam Fillings

Amalgam (silver) fillings contain 50% mercury. In dental school, Dr. Toni was told that mercury was chemically bound and couldn’t escape once mixed and placed in the tooth. However, research has shown that anytime heat or friction is applied to these fillings – through actions like chewing, brushing teeth, drinking hot coffee, or grinding teeth at night – small amounts of mercury are released as vapor.

Over time, this exposure can be significant. For some people with a larger “toxic bucket,” it might not cause problems, but for others, it might be too much. Removing this source of toxicity can help people reach the next level of healing.

The symptoms from having amalgam fillings can be vague and difficult to pinpoint. Like most chronic illnesses, it’s usually not just one thing that causes problems but a combination of factors. What biological dentists try to do, in collaboration with naturopathic and functional medicine practitioners, is peel back the layers of the onion for their patients so they can heal more efficiently and effectively.

When removing amalgam fillings, it’s crucial to do so safely. If a conventional dentist takes a high-speed drill to an amalgam filling, there will be a tremendous amount of mercury exposure. This is why dentists in the past, especially those placing amalgam fillings, had incredibly high mercury levels and high rates of neurological diseases due to their constant exposure.

The SMART protocol (Safe Mercury Amalgam Removal Technique) provides layers of protection during removal. This includes isolating the tooth, protecting the patient by covering them head to toe as much as possible, using special air filters, and giving binders ahead of time to collect anything that might slip through the equipment. At Dr. Toni’s practice, they also have a nurse come in to administer IV vitamins afterward to help the body clear any remaining mercury.

Many patients travel to see biological dentists who follow the SMART protocol, even driving four or five hours or flying from out of state. This is worth the effort because going to a local dentist who doesn’t follow proper protocols could make things worse through increased exposure. Dr. Toni’s practice sees many patients who travel from rural areas around Dallas, driving four or five hours, as well as people who fly in from out of state to spend a few days getting dental work done with proper protocols.

It’s important not to just jump straight to amalgam removal without preparation. Starting with diet changes, gut healing, restoring healthy stress hormone levels, and optimizing nutrient levels helps prepare the body to heal. Getting the immune system and microbiome in good shape before any dental work leads to better outcomes with less risk. Dr. Toni emphasizes the importance of collaboration with other healthcare providers to prepare patients before dental procedures, which makes the dentist’s job easier and helps patients handle the procedures better.

Finding the Right Dentist for You

When looking for a biological dentist, a good place to start is with the International Academy of Oral Medicine and Toxicology (IAOMT), the largest organization of biological dentists. Their directory shows if a dentist is SMART certified, accredited, and how many meetings they’ve attended, giving a sense of whether they’re just a member for marketing purposes or actually participating in continuing education.

Another approach is to ask for recommendations from naturopathic providers you already work with, as they likely have relationships with biological dentists in the area. This adds a layer of trust – if a practitioner you already trust recommends another healthcare provider, you’re more likely to feel confident in that recommendation.

Ultimately, trust your gut about who you feel comfortable with. If you’ve known your dentist for 20 years and they use fluoride but don’t push it on you, and you feel good about the relationship, that might still be your best fit. The important thing is that they respect your values and don’t push treatments you’re uncomfortable with.

You can always call dental offices to ask questions about their practices, such as how often they take X-rays or whether they use fluoride, to get a sense of their approach. These questions can help you determine if a dental practice aligns with your values and preferences before you even schedule an appointment.

Finding the right dentist is essential because dental work involves someone being “all up in your grill,” as Dr. Toni puts it. The relationship requires a high level of trust, so it’s worth taking the time to find someone you feel comfortable with and who respects your health values and decisions.

Practical Dental Care Tips

For everyday dental care, Dr. Toni believes you get what you pay for in a toothbrush. While a manual toothbrush made from sustainable materials is good, an electric toothbrush works better. A $7 spin brush will work better than a manual brush, but a $100 electric toothbrush will work better than the spin brush. The investment in a quality toothbrush is worth it for the improvement in dental health.

Flossing is an excellent tool, but for those with arthritis or large fingers that make flossing difficult, a water pick is a great alternative. While it technically doesn’t do quite as good a job as perfect flossing, it’s definitely better than not flossing at all. Dr. Toni takes a pragmatic approach, acknowledging that a water pick might not be quite as effective as perfect flossing technique, but it’s much better than skipping flossing altogether.

For toothpaste, you can keep it simple. If you’re not prone to cavities, choose something from the health food store, use a powder, or even just use water with a good toothbrush. If you are cavity-prone, look for ingredients like xylitol (a plant-based sweetener) and calcium hydroxyapatite (often abbreviated as HA). These two active ingredients can make toothpaste more effective than fluoride toothpaste, so you don’t need to rely on major commercial brands.

Avoid harsh, alcohol-based mouthwashes. Just because it stings doesn’t mean it’s working well. You want to support your oral microbiome, not take a blowtorch to it. The idea that a product needs to sting or burn to be effective is a misconception; gentler products that support rather than disrupt the microbiome are often more beneficial in the long run.

Ultimately, dental health is more about diet than anything else. Good healthy fats and optimal vitamin D levels are what make teeth intrinsically strong and more resistant to decay. This emphasis on nutrition highlights the inside-out approach to dental health that Dr. Toni advocates.

For most people, getting teeth cleaned every six months is appropriate, though some patients benefit from more frequent visits while others might be fine with annual cleanings. It depends on the health of the mouth. If possible, finding a biological dentist for these cleanings is ideal, as they’ll approach the cleaning with the same holistic perspective as other treatments.

Conclusion and Next Steps

Taking care of oral health is important not just for your smile and social interactions, but for your overall health as well. The biological approach to dentistry recognizes this connection and treats the mouth as an integral part of the whole body system. As Dr. Toni has shown through her own health journey and her dental practice, addressing the root causes of dental issues can lead to improvements in overall health and quality of life.

The connection between oral health and systemic health is becoming increasingly clear through research on the microbiome and inflammation. By taking a more holistic approach to dental care – considering diet, gut health, toxic exposures, and the oral microbiome – we can improve not just our teeth but our overall wellbeing.

Remember that even small, consistent changes to your oral health routine and diet can make a significant difference over time. You don’t have to make all changes at once – start with what feels manageable and build from there.

If you would like to learn more about how Dr. Toni can help you make sure to check out her clinic’s website here: Flourish Dental Boutique. You can also find her on Instagram @drtoniengram and Facebook @Dr. Toni Engram. 

If you want to learn more about her 90 Day Cavity Cure Program you can find it here. You can also find Dr. Toni’s favorite fluoride-free products here.

Dentists also play a crucial role in screening for oral cancers, including those related to HPV. High-risk HPV is associated with 70% of head and neck or oral cancers. Any good dentist should be performing oral cancer screenings at every checkup, looking for anything that doesn’t look quite right and performing appropriate biopsies when necessary. 

This is an area where mainstream dentistry also recognizes the importance of early detection and intervention.

To reiterate, you can think of biological dentistry as the naturopathic version of dentistry. For regular readers, you are sure to recognize many of the same principles in Dr. Toni’s work that we discuss here on this blog week to week. Good overall health is about self-C.A.R.E.™ — Clean eating, Adequate sleep, Stress recovery and Exercise – I encourage you to take control of your overall health with my book, Master Your Stress, Reset Your Health.

For those needing one-on-one support, I offer consultations via Zoom or phone from anywhere in the world. I’ve worked with patients from Australia, Hong Kong, India, Europe, Dubai, Canada, throughout the United States, and more. My team can help coordinate supplement shipping worldwide, and we can work within your budget to find the right starting point.

You don’t have to figure it out on your own. My team and I are here to help guide you step by step. 

Thanks again to Dr. Toni Engram for being here with us today, and thank you everyone for joining us on How Humans Heal. I’d love to hear from you – please like, comment, share, and subscribe, if you haven’t already. I look forward to having you join me for the next episode of How Humans Heal.

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