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The Terrain Theory

Let’s take a blog moment to recognize an important, yet complex area of healthcare: Terrain Theory.

(Excerpt from Rhondalyn Smith Brustoski, ND*, Doctorate of Naturopathy, Nature Cure Health and Wellness, LLC)

“Functional medicine practitioners are no stranger to the terrain theory over the germ theory. Biological dentists, like most alternative health experts, advocate for the terrain theory. Gum disease and tooth decay are not infectious diseases. They are caused by the environment inside the mouth that makes a person susceptible to cavities and gum deterioration, and this is often linked to toxicity.
Many biological dentists believe that bacteria don’t directly cause cavities. However, bacteria can cause toxicity that leads to deficiency, which, in turn, causes the mouth to become unable to protect itself against oral degeneration. Bacteria are aggravated by toxicity, and they also give off toxins. When this occurs, these bacteria release cytokines that trigger the immune system, causing the body to start attacking the mouth.

Periodontal disease, therefore, is an autoimmune disorder. Gum disease and cavities occur when the body and mouth aren’t functioning properly. They are caused by an acid imbalance, autoimmune problems, and a lack of certain vitamins and minerals. And they are caused by toxicity. (73, 74, 75)
This is why these dentists believe in treating the individual, not the teeth. For example, while they might not condone root canals in general, in exceptional cases, a root canal may be the best answer for certain people. Because the environment of every mouth differs, the rare individual might not experience any toxic effects from root canals.

The terrain theory is also why even people who have high oral levels of Streptococcus mutans — which has long been considered by traditional dentistry to be the primary bacteria to causes cavities — don’t necessarily have any tooth decay. Every bacteria, every virus, and every disease affects people differently and therefore needs to be treated differently. (66, 67)
Dentistry has long been concerned with not only clean teeth and a healthy mouth, but also aesthetic and cosmetic aspects. Unfortunately, however, it has often involved somewhat invasive and potentially harmful techniques to achieve desired results. Now, with biological dentistry, dentists can still aim to improve their patients’ teeth and smile, but along with a bigger-picture objective of overall health. Using non-toxic methods and with a focus on the mouth’s connection to the rest of the body, biological dentists can safely treat the patient as a whole.”

Brustoski is right on a few things where she connects terrain theory to the dental issues patients face. However, it has been difficult to support terrain theory as the etiology for oral diseases. Epidemiologists have not reached consensus on the theory, partly because of philosophical differences in the research community (In other words, “there’s 5 hypotheses for every 3” professionals in the clinical and research fields), and partly because the continuum of terrain-based care can be challenging for the patient and provider to completely and successfully co-diagnose and co-treat. There are also many variables in terrain studies that can confound or contradict the achievements and conclusions in other realms of ongoing dental research. There’s lots of supporting evidence in several realms, but it has been difficult to achieve consensus about the overarching oral-systemic approach. Dentla health is indeed, multifactorial!

Root canal care can be fraught with challenges for certain patients. Autoimmune diseases can be recognized in the continuum of periodontal disease. But there is truly an infectious disease at work; I see it every day.

As a clinical provider, I have to be very careful to follow the research evidence that is peer-reviewed and corroborated. Up to this point in practice, I have approached patients with a hybrid of infection control- and terrain-minded care.  The approach I take to diagnosing and treating periodontal disease is “BBB” : bugs, bite, and body. orthopedic,  genetic, systemic, lifestyle and oral biofilm controls are required to make a patients quality of dental health as optimal as possible. Tooth decay is similarly complex. It is inundated with causative factors.

There is no one factor that we can pinpoint as a trigger factor in the dental realm. Some factors are heavily weighted in our care plans for patients decay, such as lifestyle and nutrition. But it takes careful interview, assessment, and decisions to make conclusions to what extent terrain theory impacts each of us.

Give us a call to get a comprehensive assessment of your dental health as it relates to overall wellness. Reach us at 206.362.5400 or