Working with a dentist

Dentists are one of the common medical specialists with whom Marshall Protocol (MP) patients will have to partner during the course of treatment. Like other parts of the body, teeth can easily be infected by bacteria. One of the benefits of visiting a dentist is that, unlike most other medical specialists, they have the tools to remove bacteria. Some patients find that they need to visit the dentist more frequently due to rapid tartar buildup.

Dentists treat dental symptoms, some of which are associated with periodontal disease. In an MP patient, sometimes a dental symptom, such as a tooth ache, is due to the immunopathological response, and a dental procedure can be delayed if not avoided.

For dental procedures requiring a local anesthetic, one without epinephrine (adrenaline) is essential.

Basic tips for visits

The following are tips for MP patients visiting a dentist:

  • Discuss your particular issues and needs with your dentist and hygienist.
  • Wear your NoIR glasses in the office to protect you from natural and artificial light.
  • If you are concerned about grit damaging your glasses, exchange them for an airline-style sleeping mask.
  • If you suspect that swallowing debris from drilling and other work makes you feel unwell, explain this and negotiate a way to minimize it.
  • If you suspect that the polishing paste used contains substances that irritate your gums, discuss this with the hygenist.
  • Request that any local anesthetic used be free of epinephrine.

Dental problem or immunopathological response?

Treatment with the MP may make a patient more aware of pre-existing dental problems. It is logical to expect a significant immunopathological response, in the areas most affected by disease including one's teeth. Before MP patients assume that dental symptoms indicate the need for a dental procedure, they should consider the possibility that the symptoms might be due to an immune system reaction. If dental symptoms wax and wane with antibiotic dosing, adjusting MP medications may resolve symptoms.

Many members have been convinced [they had] a dental/jaw infection only to find out it was immunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed. symptoms. I for one was one of those. I could not open my mouth more than an inch or so for the first year of the Protocol and I was certain the bone under my crowned molar with an old root canal was highly infected. I hung on and cannot believe it resolved. Though it did take months and months the pain is gone now in Phase III.

Vez, MarshallProtocol.com

Should I delay fixing dental problems?

A number of MP patients have had lingering dental pain subside during MP treatment, even after their dentists could find no apparent reasons for that pain. These latent infections from chronic forms of bacteria usually remain hidden, except for the symptoms experienced.

It is not surprising, then, that some MP patients have experienced pain and sensitivity, even in previously-treated teeth. If adjusting MP medications does not resolve discomfort, the problem should be discussed with the dentist.

Never have an implant in a previously infected tooth which has had a root canal as it will fail. Crown and bridge restoration is very effective if technically possible. Try to avoid metal in crowns and or bridge. There are new ceramics which are equal in terms of strength.

Also, any MP patient who has had root canals for an infected tooth or have teeth that have been sensitive and suspected to be possibly infected should not be surprised if it 'blows up', that is, becoming abcessed. Though painful and requiring extraction often, it is a reflection of improved immune response. The occult infection which has been likely affected one's health is now being isolated and eliminated by the immune system. Lower levels of infection in the gums and teeth will also resolve and luckily without abcess formation.

If one requires an implant, then wait until almost or fully recovered.

Greg Blaney, MD

Mercury fillings

Main article: Detoxification

There is limited, if any, evidence that chronic inflammatory disease is driven by the accumulation of heavy metals such as mercury.

Teeth stains and minocycline

The use of tetracyclines, especially the MP antibiotic minocycline, during tooth development (the second half of pregnancy, infancy, and childhood up to the age of eight years) may cause permanent discoloration of the teeth (yellow/gray/brown).

In older children and adults, temporary discoloration of teeth occurs infrequently1) and not in doses recommended by the MP.

Antibiotic prophylaxis

In 2007, the American Dental Association, together with the American Heart Association, announced changes in who they say should get antibiotics prior to dental procedures. Their guidelines now state that patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

The revised guidelines are aimed at patients who would have the greatest danger of a poor outcome if they developed a heart infection.

Therefore, preventive antibiotics prior to a dental procedure are advised for patients with:

  • artificial heart valves
  • a history of infective endocarditis
  • certain specific, serious congenital (present from birth) heart conditions, including:
    • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits;
    • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure;
    • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device;
  • a cardiac transplant that develops a problem in a heart valve

These recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances and should consult with their cardiologists.

The American Heart Association press release explains the rationale behind the recommendations. Among other reasons, they mention “allergic reactions” to antibiotics. This may be an example of the immunopathological response.

Choice of antibiotic

If a dentist wants an MP patient to take an antibiotic prior to a procedure, the MP patient should ask the dentist if the MP antibiotics that the patient is currently taking would suffice.

MP patients should not take prophylactic clindamycin unless they have taken it before with olmesartan and know how they might react to it.

Moxifloxacin (Avelox), a fluoroquinolone, is safe to take with olmesartan – and, at least according to one study, may be more effective than other antibiotics traditionally used by dentists.2) MP patients should read the information on other non-MP antibiotics before agreeing to take anything else. An MP patient could also ask the dentist if the work can be postponed until the patient has progressed further on the MP. This will give teeth a chance to heal and avoid the need to stop the MP in the early stages when the patient is still learning to manage the MP medication or stabilizing symptoms. Also, when one's bacterial load is lower, an antibiotic challenge will be less of a threat.

Sánchez AR, Rogers RS3, Sheridan PJ. Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity. Int J Dermatol. 2004 Oct;43(10):709-15. doi: 10.1111/j.1365-4632.2004.02108.x.
[PMID: 15485524] [DOI: 10.1111/j.1365-4632.2004.02108.x]
Diz Dios P, Tomás Carmona I, Limeres Posse J, Medina Henríquez J, Fernández Feijoo J, Alvarez Fernández M. Comparative efficacies of amoxicillin, clindamycin, and moxifloxacin in prevention of bacteremia following dental extractions. Antimicrob Agents Chemother. 2006 Sep;50(9):2996-3002. doi: 10.1128/AAC.01550-05.
[PMID: 16940094] [PMCID: 1563553] [DOI: 10.1128/AAC.01550-05]
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