Dentistry and bees seem unlikely bedfellows. My continuing professional developmental journey has a tangential angle benefitting from new changes to our recertification guidelines. Personal development is now aligned to workplace professional growth without needing to complete a target of verifiable learning. During this period of COVID, finding meaningful education has been a struggle. Apicultural education has usurped dentistry for this period. This account describes that same experience, and I hope you enjoy reading it.
Brightwater in Tasman, New Zealand, also colloquially known as “Britwater” because of the large proportion of U.K. immigrants living there, is a sleepy backwater on the Nelson to Murchison main road, about 30 minutes west of Nelson. It is the home to two of my three hives forming my first apiary. Another resides with colleagues and friends in Mapua, 30 minutes north of Brightwater, again a sleepy, residential coastal village famous for its quirky shops, cafés and eateries as well as a thriving art scene. It is now late November, and for all three hives and the tens of thousands of worker and drone bees, the business of preparing for the up-and-coming honey flow in mid-December is afoot. Combe building, pollen and nectar gathering abound as the three queens prodigiously lay large numbers of eggs. The growth of larva and pupa, and ultimately hordes of new bees, will emerge to complement the hives burgeoning activities, adding more workers for the cause. As a beekeeper, you have the privilege to see nature go about its business. Like foragers (for I am also one), beekeepers look seasonally at the weather and listen to the “songs” from the hive. This, in turn, guides us to action, promoting the best possible outcomes for all, bees and humans alike, as we all benefit. Where did this journey begin for me, and how have I changed as a consequence?
I can’t honestly remember my first encounter with a honeybee, wasps, yes, but not the humble nectar gatherer. However, I have powerful memories of my next-door neighbour on Limewood Close, Woking, Surrey, UK, where I lived in the ’70s. He was one Johnny Hamer, who would have been termed a “peculiar” character in the day. Johnny was a well-educated man, crafty in practical terms and an outsider to the road community. His garage had a vintage Morgan sports car under a dusty old tarp, often in bits, but occasionally he roared up and down the street in it. When it worked, I was fascinated. The garage, too, housed demijohns for various potions and brews, and the heady scent of fermentation and experimentation pervaded. His three children, Sally, Michael and Richard, were friends to me and my sister Melanie. His wife Ann, a beautiful woman, often with a pained expression, was crucial in my future life when my mother passed away. I can vividly remember a swarm from his hive gathering on our fir tree, a rare garden feature. It was smuggled in from Austria by my parents when it was a sapling. I can recall this suited, spaceman type figure, with smoker in hand, coming to retrieve it. I watched him from the “safety” of my bedroom window, gazing in awe and wonderment at the surreal sceptical.
Returning to Johnny Hamer, a dear friend of mine, Dave Annette, asked whether I knew of anyone who was a beekeeper. I mentioned Johnny to him, and he affirmed he knew of him from Guildford Agricultural College. Neither of us was aware that he also had an apiculture college on Blackhorse Lane, Brookwood, Woking, Surrey. I visited it and met Johnny many years after that swarm event in my back garden. It was good to reconnect to childhood memories. I hope you have had similar experiences. They are to cherish. My memory of that event was watching another swarm marching up a ramp to a new hive. They were Italian honeybees, normally docile but even more so on this occasion.
Dave, a busy technical expert in his field, needed a diversion and point of focus to create more well-being in his life. This became an obsession and has since turned into a calling and a business, teaching and helping bees. Dave, with his partner Rachel, has set up an evolving enterprise called honeybeehappy.co.uk. I recommend that anyone locally pay a visit to their website for courses and events they regularly hold. After seeing Dave and Rachel in 2019, the symbolic seed began to grow. I had found that life in New Zealand hadn’t led me into the traditional natural interests, those of hunting and shooting, fishing and tramping. I had exposure to them from friends and acquaintances, but none had got under my skin in a meaningful way. Until, in a darker moment, during COVID lockdown 1, I read a thread on social media alluding to the fact that a level 3 course, laid on locally in Apiculture, was being held free of charge. Having no plans for the upcoming year, I decided to give it a go-to quote, the New Zealand vernacular.
One of my heroes is Paul Stamets, a mycologist extraordinaire from the Pacific North West of America. He is an unlikely muse for my transition from fungi foraging to apiculture and bees. Set apart, they appear very different, but the divide narrows in the context of nature and the symbiotic association of both. His passion and enthusiasm for mushrooms have inspired many people to evolve their interests in bees and shrooms. He has done both quite unexpectedly. I suggest you read Merlin Sheldrake’s “Entangled Life” book on fungi, and the connection will become vividly apparent. I’ve been a dental hygienist by trade for over thirty years now. Being with both kingdoms has brought a fresh and somewhat revolutionary perspective to my practice knowing what I know and have seen with oral ecology and their environment, immunity and balance. Stamets noticed this on his professional lifelong learning journey too. He observed honey bees where he lives and works, moving sawdust and leaves apart to expose mycelium, a vast fungal underground network. At which point they accessed and tapped into the nutrients for health and repair. These bees brought to Paul’s attention that it may have a purpose in apicultural disease control, particularly deformed wing virus. Having this prevented their ability to gather nectar and pollen, curtailing their life spans and the colony. Mushroom mycelia and bees symbiotically and therapeutically uniting, amazing. This discovery was recently published in Nature magazine, and further investigations and perhaps natural treatments to help reduce colony collapses in the future may appear.
The class began with a dozen or so wannabee apiculturists, mainly women and very much in my midlife age group. Our motivations were similar, curiosity, environmental, possibly entrepreneurial and the like. Some of the class had experience, and most, like myself, had just a passing glance and were, in effect, complete novices. I didn’t feel out of my depth consequently, but the feeling of being back in the “classroom” after so long was daunting. The thought, however, that much of the future learning would be out in the apiary was eagerly anticipated. I was aware that additional costs would be part of the subsidised course, specifically safety gear and the all-important nucleus hive or “nuc”. This was the moment, upon receipt of it, that things got “real”. The nuc was a five frame family of bees, brood, nectar, pollen, maybe honey and the queen. The course providers facilitated the provision of the said nuc and got together a dozen plus nucs for this class, let alone the four or so other courses they ran. Indeed, a considerable undertaking. The first hurdle, and perhaps the riskiest for all concerned, was their delivery to us, the uninitiated. I will begin the most significant learning journey of the course.
It was late October, and the weather had been exceptionally unseasonal. This posed a big problem for the course leaders from the onset, the date of receipt had been pushed back a few weeks as a result. We were asked to gather dried bracken before putting it into the 5-litre feeders in our personally constructed hives. A few frames with foundation were also a prerequisite. Empty hives were placed on either side of the metal road near the apiary, and instructions were given. The nucs would be placed beside and then added to the hives. The drama started after not enough bracken had been found, and the sugar water in the nuc boxes split after debussing from the truck. The sugar water being essential energy for bees became a distraction after removing them precariously by the rank and file, without proper advice. Suffice to say, the bees soon targeted the copious amounts of liquid fuel spread around. The air around us became a huge cloud of lusty bees after a fast food takeaway. The chaos was cut short abruptly with loud instruction from Scott, the alpha course commander who told us to scatter and go away for a few hours whilst the orgy settled down, and nature took its course. Tails between our legs, after a telling off, we hastily departed to return later. The scene was different, and we found our nuc boxes. I was the only one to be told my queen had died whilst in transit from the truck to my hive on transfer. I was distraught and felt guilty I had in some way caused its demise through my incompetence. My bee house returned to my house, put in its designated place, awaiting a substitute queen.
The subtext here is essential to clearly define how important healthy queens are to a vital colony. After she leaves her cell sixteen days after laying, where she is tended to and fed copious amounts of Royal Jelly, the long bodied bee emerges and spends several days in the hive before she begins her mating flights. Thus, begins a somewhat perilous toing and froing where all manner of things may prevent her from uniting with a dozen or so male drones and being inseminated with 3 billion plus sperm cells. She may find the drones quickly, nearby and successfully fulfil her primary mission. The perils of the weather, predators and accidents may take her, and a new queen then has to be created from an egg as before. When hatched, the queen has to find her competition, other queens growing in the same hive and crown her dominance by killing them with a sting. The life of a queen is a long one, too, living way beyond those of workers and drones.
After an anxious wait of a fortnight, I was given queen 2 in a plastic cage with its entourage of attending bees. It was shown to the rest of the class before I received it. After a debrief from the tutors about the previous experience, I took it home. I placed it as instructed on a frame to allow its imminent introduction to the awaiting queenless colony. During this time, her pheromones are sensed by the collective and hopefully accepted. I can state I saw it on a frame, freed of the cage once but after then no more. I suspect that my frequent intervention, looking in to check and anxiety driven, may have put pay to its continued existence. Either way, I had the dubious honour of having to tell my tutors I was sans queen once again. It was picked up and commented upon in the class by my teachers, and clumsy handling, I suspect, was the overtone of the verdict.
I was devastated, once again, clearly feeling humiliated amongst my peers who had their queens operating effectively, or so it seemed. Recognising the queen is hard for the untrained eye, so I can only imagine others in my class not knowing their whereabouts and hoping, fingers crossed, that eggs laid and the brood forming indicated that. The lesson I learned throughout this process was not to focus too closely on finding her but to rely on observing her eggs and larva as an indicator she was in operation. I also learned to be stronger and less retiring with the tutors when it came to defending myself, and their journey with me continued with many others in the year. I was lucky in one sense that it happened before the active period of nectar gathering, and I had a relatively great deal of experience with the mysteries of queens at an early stage. This journey didn’t stop me from finding alternative ways to combat such dire losses, and I got queens sent to me online from sellers and didn’t bother my teachers much more beyond the honey flow. It made me hardened to the sad fact that poor handling and frequent inspections run a greater risk of such things happening. I learned that lesson the hard way.
The swarm, like a low budget, B-Movie (get it?) title (sigh) is a free nuc. It can also hide disease and a weak queen, but the earnest beekeeper will carefully inspect them and put them aside from other hives. Swarms occur when there is no space for the colony to expand or the real masters, the workers, have advised the queen a new incumbent will soon supersede her. The novice beekeeper has to learn very quickly, in this case, several key things. Primarily, they need to observe and respond to changes in the colony behaviour. The frames inside provide visual cues and present the history of its nature. We must also be aware of the age and productivity of the incumbent queen. Any indication that they are potentially sub-par on egg-laying and brood production will lead to a new queen or supersedure cell. The hive needs splitting, and a new colony is created before swarming. I’ve not been lucky to catch one yet, but I have all the tools at my disposal. This includes a D.I.Y. catcher with a vast water cooler bottle, epoxy resin bonded, to a telescopic poll cleaning pole. It gives me multiple metres of length, if necessary, to get up to the highest nest. From there, when caught, queen included, into a box, bag or nuc with ventilation before being rehomed.
Costs are also worthy of consideration for the would-be beekeeper. I was fortunate enough to have the training at level 3 for free. I would have considered the financial outlay even if it wasn’t so, but we were all informed from the outset that it would entail costs in equipment and the nucleus hive. Prices continue to grow with additions to the hive, boxes and frames, new queens, disease control and association subscriptions. This hobby is about being frugal and practical, being thrifty with what you need to get and maintaining your gear in good order. I have a spare hive, on standby, for a swarm if it comes my way. Costs can be shared with other beekeepers, especially when you have to buy more than you require, especially disease control. I was lucky, too, to be gifted boxes from a friend. However, I was soon to realise this might not be so advantageous if they were carrying disease. In this case, I was confident they were okay.
Having come through the season, I am far wiser now, being more stoic about these matters, less emotional, pragmatic, and interventional. My real fear is A.F.B. – American Foul Brood and Mites. They both draw more energy and focus as they are more significant threats to the health and well-being of the whole colony. The Varroa mite is responsible for many colonies collapsing in the Nelson Marlborough region presently. Clients of mine in Blenheim have witnessed colony collapses in the four hundred plus hives they operate. Nosema, dysentery in effect, has been rife as well. Natural disasters akin to heavy flash flooding have taken many hives this year as well. A.F.B. is a critical and deadly concern. It entails radical elimination of the whole hive, bees and building, all of it when diagnosed. It also needs to be reported to the A.F.B. agency and tests undertaken before the crematorium beckons.
The treatments for the Varroa Destructor mite are varied and can be toxic to mites and humans. Gloves and filtered respirators bring a sci-fi theme to the proceedings when using Formic or Oxalic Acid in heavy mite load cases. I haven’t used them myself yet, but I’m sure it is looming on the horizon. The prophylactic use of mite strips from Bayvarol and Epivar are placed in brood boxes for several weeks before and after mite load checks are done to determine pre and post mite counts. Nosema parasites thrive in the springtime as brood numbers grow, further promoted by unsuitable weather conditions, where bees spend more time in hives and defecate there. Various interventional measures can be employed, using anti-fungal preparations, moving colonies to sunnier locations, and preventing excess moisture inside the hive with ventilation measures. Eradication includes disinfection solutions like acetic acid fumigation or, ultimately, the burning of infected equipment.
Biosecurity looms large here in New Zealand too. One has to just read the litany of clauses on the documents you sign before entering this country. There are genuine reasons for this, affecting many primary industries, including agriculture and environment, jobs and exports. To allude to New Zealand, being clean and green is entirely another matter. Still, we have an advantage here, shared provocatively with Australia next door regarding Manuka and its honey. Exports are enormous, and as are the profits to be made. To regulate the danger of importing infection and disease, protecting the environment, those employed in the industry and ultimately ensure colony and food security, the apiculturist, businessman or hobbyist, has to be registered and regulated with hives annually checked for A.F.B. It is documented and, more importantly, information disseminated to the specific locality upon discovery and outbreaks. A DECA (Disease Elimination Conformity Agreement Certificate) authorisation is given to those who pass a recognition test. They will be certified to check their colonies and report, test, and act upon their findings within a year. The website that mandates this is afb.org.nz. I find it easy to navigate.
Bringing this new knowledge and experience into my professional landscape has helped me observe the duality of the workings of an oral microbiome. The germs or “plaque” in our mouths and how important it is to plan, act and create balance, very much like the host of tens of thousands of bees do within their living and working space, the hive. They work complementarily as a community, hosting, nurturing, learning, protecting and producing. They can become unbalanced, very much like a mouth can with ecology and environmental pressures negatively changing. They work co-operatively to fix, mend, repair and eliminate that which can prolong and increase the risk of their colony collapsing into disease. The natural healing processes, when ineffective, are supplemented by we beekeepers either organically or chemically to bring about positive change and improvement. I see this as very much akin to my role as a registered dental hygienist. That of environmental, ecological balance and sustainability, focused on awareness of the natural balance of the mouth as opposed to imbalance, and act, intercede where necessary, to the benefit of the host, my client and their established and balanced oral microbiome. Honey itself is a complex nutritional food source having a massive burden of fructose in particular. The multitude of honey types, over three hundred at the last count, is drawn from the pollen and nectar foraged from various plant sources via the salivary secretions and enzymes of bees. The watery nectar with added constituents is dehydrated by fanning wings, becoming stickier and stored in wax cells sealed and capped.
Honey is either raw, filtered, unheated, processed, or heated. The heating removes potential pathogens similar to pasteurised milk. The composition of the nutrients of honey, after glucose and fructose, simple one chained monosaccharide sugars, includes proteins, minerals, vitamins, enzymes and polyphenols, including flavonoids. The smooth liquid contains imperceptible tiny crystals, but these can solidify depending upon storage temperatures and the degree of glucose within it. The sugar content of honey is problematic for good dental health, eaten frequently. It is a dilemma I face when I consume raw honey sourced locally to me in Nelson. My advice to myself and others is to be mindful whilst consuming wisely. Ideally, avoid frequent intake, having around mealtimes and drinking water to clear its continued oral presence, elevating to balance pH in addition.
A primary hive product produced by bees is a sticky wax-like structure called propolis. A colony can gather between 150 to 200 grams of propolis in one year. The word propolis originates from ancient Greece as well as the Romans and Persians. It might have been used as an embalming product by Egyptians. The Jews considered propolis a medicine way back in Old Testament times, known as The Balm of Gilead. The Greeks also used propolis in perfumes with aromatic herbs and is recorded in their historical literature. Hippocrates is said to have used propolis to cure wounds and ulcers, both externally and internally. The Roman, Pliny the Elder, in his famous “Natural History” writings, describes the practical uses of this substance. According to his findings, he recorded that propolis has the property of extracting stings, allaying pains of the sinews and dispersing tumours, to name but a few.
In Medieval times propolis lost popularity, and its medicinal use disappeared, quoted in only a few remaining texts. Sources from the Twelfth Century mention this bee glue in treating dental caries (tooth decay) and throat infections. In 1486 the Karabadini, a Georgian book of medical treatment, suggested propolis be useful against tooth decay. Beyond this, the knowledge of propolis health benefits survived into traditional folk medicine and herbal medicine, especially in Eastern Europe, termed “Russian Penicillin”.
In modern times, this sticky and enzymatic bee glue is made to protect the hive from infections and bacteria, constructed from their saliva, wax, and botanical resin. It is composed mainly of resin, wax, essential oils, pollen and other organic compounds. It includes twelve different flavonoids, phenolic compounds and acids. It also contains vital vitamins like B1, B2, B6, C and E and minerals like Magnesium, Calcium, Copper and Iron. Propolis is gathered from tree sap and buds. Its purpose is to fill gaps and strengthen or plug parts of the hive for protection or repair. Dental applications appear in toothpaste, tinctures and sprays for desensitising teeth and its potential in anti-inflammatory, anti-viral, anti-microbial and antioxidant dental therapies used by companies like Comvita. See their research and products at www.comvita.co.nz.
Pollen, the protein-rich food source for bees, is gathered and stored in the frame cells as a rich and nutritious superfood. Nectar is the carbohydrate-rich alternative that bee’s return to the hive. They create bee bread through mixing both, tightly packing the blend into the cells as future fed for newly born bees. Pollen is mechanically liberated from the bees as they enter the hive via pollen traps attached to the hive entrance that carefully plucks off the gathered mass on the bee’s legs as they squeeze through the restricted space into the hive. The beekeeper processes carefully by drying, sorting and dehydrating to remove moisture and contaminants. The end product is a tasty cocktail of pollen in a jar, the colours of which belie its origin. The low pH acidity of honey provides an anti-bacterial property that allows honey to stay as it is, safe and stable.
Unlike table sugar, honey contains vitamins, minerals and antioxidants. The amount, however, only meets the recommended daily intake as directed by the World Health Organisation by about 1%, and more significant amounts would exponentially increase the exposure to the fructose and glucose honey naturally contains. Raw honey is better than processed, but there is no daily recommendation, except eat in moderation. I had a teaspoon of local raw honey in the morning and the evening with pollen. My purpose is to use the local fawner and flora, gathered by bees and minimally processed and filtered by beekeepers, to help my year-round hay fever allergy. From a purely emotional and well-being perspective, I also receive comfort and pleasure from the textural and tasty pollen and the rich, silky texture and favour of honey, raw and in particular Manuka and Honey Dew. This is part of a traditional dietary approach I have adopted in the last few weeks as part of a health improvement programme. Having taken vital measurements and blood work, I will be interested to see what has changed at the three-month point, several weeks away still, if anything. I am curious about inflammatory markers and present blood sugar levels, indicating potential prediabetes due to glycated or “sugar-coated” haemoglobin, especially after starting my twice-daily pollen and honey regime. I’m hoping a real food eating policy incorporating these natural raw bee products may deliver long term benefits. January will reveal the metrics and comparable facts.
Interestingly, the cinema world has seen two recent releases that explore the subject of beekeeping. Honeyland, released in 2019, is a film that explores a Macedonian woman who keeps bees and sells her honey at the local market. Clever cinematography makes one wonder whether it is a drama or a documentary, taking the viewer time to determine. It reveals her husbandry and deep connection to her hives situated in traditional stone structures. Her caring and compassionate behaviour toward her bees reflects how she attends her bedridden, dying elderly mother. A gipsy family arrives in her locality, beekeeping in a savage, less harmonious way. It disturbs the fragile balance between her and the success of her beekeeping, and ultimately her livelihood. It allows a critical comparison between an over commercial practice, intent on profit and not the welfare of their colonies and a more gentle and traditional approach. Sadly, there is no happy ending, leaving us to rail against greed and its destructive effects. Hives, a Kosovan film released recently as part of the New Zealand International Film Festival, is just as sobering. Based on a true story, like Honeyland, it tells the story of a lady enduring the loss of her husband, still missing years after the Balkans War ended. She inherits his hives and begins to unite the local widow community to commercial endeavours, despite the simmering rage of the traditional village menfolk. It relies on simple themes and the struggles of bold women in a misogynous society, whereas Honeyland focuses on tradition meeting modernity.
So, in summing up, how have I changed and the consequences of this journey to the personal and professional me. At times I have felt frustrated and overwhelmed, especially regarding the death of queens and the unemotionally intelligent responses of tutors. I have to confess they are learning too, and we, the students, are the unwittingly willing victims. Blessed are the bee teachers. I have also found that, akin to foraging, beekeeping is obsessive and addictive, endlessly exposing your lack of knowledge and frustrating your ability to feel in control, which you soon discover you don’t have. We have to choose where you gather your additional and future learning, be it in person at meetings or mentors or the vault of online videos in social media in the canon of literature, a vast assortment of bee orientated books. Depending upon what suits your character, you can be a quiet, solitary but engaged apiarist or an activistic sociable character, alive at gatherings and meetings. Myself, being shy and socially distant to those I’m not close to or trusting of, hence the nature of being open in this first-person, living, reflective publication, feels very comfortable with the intimacy of beekeeping. I extend this to friends who want to experience the life of bees, their environment and their process. For those, I am both generous of my time, and limited knowledge as their glee and surprise when we lift the lid on the hive is magical. It makes every sting, as there have been and will continue to be many, and each high and low toned sigh worthwhile.
Mark lifting the lid
Finally, it has given me hope that in these times of uncertainty, upheaval and excessive mandate, apiculture offers the participant unhindered access to an authentic and holistic pursuit. You have a degree of peripheral influence, the location, additional feeding, disease control and the number of hives, but after that, you are ancillary. To end this thread, I will consider taking this journey to the next level, diving deeper into the sage experiences of those I have followed. More hives perhaps, a venture potentially in a commercial sense, that takes me beyond dental into apiculture practice. But that, as they say, is an endeavour yet to be written.
“The small two-way lane dipped down from the railway station at Woking. It was called White Rose Lane and travels the short journey to the road junction where you turn right to Old Woking or left to West Byfleet. Near that junction, on the left around a gentle bend in the road is a private gated drive up to an established high-end housing estate. Oh, how the wealthy live but unbeknownst to them on a triangular patch about ten to twelve square metres stands a grand Oak Tree, on the roadside opposite shrouded by native trees that arch over the road at that point is a street light. The area is well known as a historic hunting lodge for King Henry VIII, literally across the junction, hence the road name, I presume.
However, on a handful of occasions in the calendar year, in the warmer months and after a decent downpour or two appear, as if by magic, the fruiting bodies of a delicious boletus mushroom, the Porcini, AKA the Cep or Penny Bun. To get there before the squirrels and the seasonal lawnmower is the art form here. Our first experience after the gathering was to create a porcini soup which we shared with our friends David and Rachel. They looked a little bewildered at first until we tucked in first, offering ourselves as taste testers. The others we dried and jarred for future use in risottos, sauces and fillings in meat and other dishes.”
My professional and personal journey has taken many a radical turn in the nearly 40 years I’ve been at work. I’m 55 years of age now and many of those who trained around the time I did, in the mid-’80s, have moved on from clinical dental health to other professions or retirement. I must confess there have been more than 1 occasion that I’ve thrown my toys out of the cot and wanted a journey to fresh pasture. I still enjoy my job, the people I work with too but deep down I know I’m on a steady decline and am forever wondering where to go from here. I was once told if you have passion for what you do, you will always succeed. I’ve tried to live by that mantra and continue to do so.
So where to now? I’ve learned, of late, to think “tangentially” about where to go, what road to travel and this began in earnest 2 years ago, literally to the day. I was with my friends Dave and Rachel Annette in Hampshire, in the UK, who were starting a beekeeping business, as well as their day jobs and have since slowly built their passion into something special, ethical, environmental, and sustainable. HoneyBeeHappy is their apicultural baby and has been a constant source of inspiration to me, so much so that in the last year I’ve completed a level 3 certificate in Apiculture and continue, from August, into Diploma territory. That will be for the “ left field” next post, in a few weeks from now, but, ironically the subjects of honey and fungi are very much entwined ap
“I parked the car by the lake, the trees and bushes abound in this place and my destination was but a short walk, across the main road and into the woods via a small path, maintained and trodden by many a forager and casual walker. Twenty metres or so from the entrance to the wood, amongst the beech, oak and birch was a little mound, I suspect either as a consequence of an uprooted tree or the Canadians, who exercised here before D-day many moons ago. The now weathered raised earth is surrounded by moss and covered in tree litter but hidden subtly, easily unobserved were the golden honey coloured shapes of Chanterelles, delicate and tasty, apricot and slight peppery gourmet shrooms.“
This learning journey has taken me to many an ancient forest or a copse of trees, whether it be in England, Scotland or France, even in New Zealand where there are indigenous species of trees as well as “exotic” introduced. The numbers of very edible species I’ve encountered are a mere handful, I’m supremely suspicious of white mushrooms as many are toxic or lethal, it was my decision to stay away from those that come into that category unless identification is obvious. The untrained eye needs to be meticulous in their research and confident of their identification. In France fungi are deeply immersed in the National culinary and pharmaceutical culture. Any mushrooms picked without knowledge of their identity can be taken to a pharmacy and be positively identified. Europeans have none of the fear or mystery of the annual gentle hunt, as they are brought up to know their mushrooms and the trees, bushes, seasonality and climates associated with them. From spring through to late autumn the months become of interest to free food foragers as they observe the weather and locations of mossy, fern-covered, ancient forests through to grassy pasture. The active forager is a fountain of mycological knowledge and range finder, a curious, inquisitive explorer of the nature of things fungi and their deeply rooted an associations.
I have always been interested in mushrooms, but since the mid-noughties, this has spawned a real passion for that which many have fears, that of hunter-gathering/foraging no toxic, tasty edible fungi and learning more about their relationship to man, health and the environment. This is very much the same story for bees and honey. The possibility that this could turn into a part or full-time cash crop and a move away from where I am now professional is a tempting proposition. This post today elaborates on this journey to date, from about September of last year to today, it will tentatively look at what may present itself and arise in the years to come and what I could do to make it work as a noble profession. It also dares to go beyond pure gathering, looking at home cultivation, nootropics, psychotropics and those of the intelligentsia who dare to discover and promote greater awareness of mycelia and fungi for a plethora of reasons.
The Maitai River runs through the Tasman city of Nelson, flowing out into the Pacific, gently meandering through picturesque countryside and the leafy suburbs. King Fishers, Fantails, Tuis and Swifts dart and play along its length, bees in the spring and summer gather nectar and pollen and mushrooms abound locally amongst mycorrhizal associated native and exotic trees and plants. The exotics are a joy to see, the Willow, Beech and Birch all share a presence with the established fauna and flora, the bees, imports too, compete unfairly with the native bee population for resources. The footpath along the river is well-trodden by dog walkers and those enjoying the ambience of the setting. There are mushrooms, of the Boletus variety along with field mushrooms at the right time of the year and after a good downpour. From February through to late April opportunity knocks for those with an eye for a free superfood.
“Mushrooms were the roses in the garden of that unseen world because the real mushroom plant was underground. The parts you could see – what most people called a mushroom – was just a brief apparition. A cloud flower.” Margaret Atwood
Xerocomellus chrysenteron, Also known as the Red Cracked Boletus, is a common visitor to these parts, transported, no doubt, over the long distance as innocent inoculated rootstock. It is paradoxically a deceptively inedible looking edible shroom, for it has a degree of redness to it, associated with other toxic boletus. It is, with some experience, easy to identify and can be dried, stored in jars and used in sauces, stocks and risottos. It has a milder, less meaty taste but this improves after drying.
Leccinum scabrum, also known as Brown Birch Boletus, is also a sneaky migrant from the Northern Hemisphere, hidden, inoculated in the imported rootstock, like the Red Cracked. In my UK foraging experiences these two mushrooms were often overlooked for more choice varieties. However, when in Rome, do what the Romans do, and quite by chance, whilst driving back from my apiculture course this April I looked to my right out of my car window, whilst waiting at a junction and to my huge disbelief stood proudly beneath a few Birch Trees dozens of Birch Boletus. I had to double take, reverse quickly, park up with my four-way flashers on and darted over the quiet road to the scene. Over the next few weeks, multiple return visits, my big glass jars were filled to the rim with these beauties.
Two Birch boletus fresh from the patch
Brown birch boletes are prepared and stored in the fridge before space being available to dry
Brown or Orange birch Boletus, found on these far-flung foreign shores add a great dimension to cooking, their places of discovery become guarded secrets, silent and forlorn for the vast majority of the year, the mere sight of a cluster or individual birch trees becomes memorised for a future visit, at the right time. I’m still hoping to find the ultimate Bolete, the Cep, Porcini or Penny bun, as they have been found here in New Zealand, in Wellington and Christchurch. However, for the time being, I’m satisfied with these for sure.
Notable others found here are Boletus pinophilus, commonly known as the pine bolete, growing predominantly in coniferous forests on sandy soils, and Suillus luteus a common fungus from the British Isles. Commonly referred to as slippery jack or sticky bun in English-speaking countries, its names refer to the brown cap which is characteristically slimy in wet conditions. These too are sliced and dried, like the Birch and Rec Cracked, added to the jars and stored. They need a little more time to prepare, especially the Slippery jack, with its sticky cap surface. I’ve learned to allow them to dry for 24 hours before preparation, making the task easier. They too are for the jar and many an exotic and enticing sauce or meat like filling.
Parkvale Mushrooms in Masterton is a genuinely interesting operation, having been there and picked up a couple of buckets of spore infused medium for us to grow in our shed. We have ordered, online, multiple buckets in the past few years and have been pleased with the quality and quantity of mushrooms, the instructions were easy to follow and the contents can be put onto your veggie patch after the flushes are all blown. The Portobello style mushrooms are meaty, of varying sizes and useful for cooking in many forms. It is a good place to start for any would-be hobbyists and food lovers, no need to identify, pour sceptical eyes and minds over what is growing in front of you and observe with intrigue and wonder how they come about.
“It was July in the Cairngorms, on the rim of the Highlands of Scotland, very near Balmoral and Ballater, the weather was a dream and the scenic drive between them was slow and deliberate. There was no rush but awareness and curiosity of the forestry and flora that abounds at this time of year. Outside of Ballater runs to the disused railway from there to Aberdeen, shut down in the mid to late sixties. Along its path, now a place of walking and foraging, a cornucopia of wild fruit, nuts and shrooms are free for the taking, as is another less trodden and known track only to a Royal few. This was a place, where we ventured at the right time as it was flush with golden chanterelles, as far as the eye could see. The moment was captured in a video as were many of the prime examples of these mushrooms. “
Shiitaki health benefits
Shiitake mushrooms are one of the most popular mushrooms worldwide. They are prized for their rich, savoury taste and diverse health benefits. Shiitake are edible mushrooms native to East Asia. They’re tan to dark brown, with caps that grow between 2 and 4 inches (5 and 10 cm). While typically eaten like vegetables, shiitake are fungi that grow naturally on decaying hardwood trees. Around 83% of shiitake are grown in Japan, although the United States, Canada, Singapore, and China also produce them. You can find them fresh, dried, or in various dietary supplements. Shiitake are low in calories. They are also loaded with fibre, as well as B vitamins and some minerals.
The nutrients in 4 dried shiitake (15 grams) are:
Studies suggest that some of the bioactive compounds in shiitake may protect against cancer and inflammation. However, many of the studies have been done on animals or test tubes rather than people. Animal studies frequently use doses that far exceed those that people would normally get from food or supplements. In addition, many of the mushroom-based supplements on the market have not been tested for potency.
Shiitake as a supplement has long been used in traditional Chinese medicine. They are also part of the medical traditions of Japan, Korea, and Eastern Russia. In Chinese medicine, Shiitaki is thought to boost health and longevity, as well as improve circulation. Shiitake mushrooms may boost heart health. For example, they have three compounds that help lower cholesterol
One study in rats with high blood pressure found that shiitake powder prevented an increase in blood pressure. A study in lab rats fed a high-fat diet demonstrated that those given shiitake developed less fat in their livers, less plaque on their artery walls, and lower cholesterol levels than those that didn’t eat any mushrooms.
Shiitake may also help strengthen your immune system. One study gave people two dried shiitake daily. After one month, their immune markers improved and their inflammatory levels dropped. This immune effect might be partly due to one of the polysaccharides in shiitake mushrooms. While people’s immune systems tend to weaken with age, a mouse study found that a supplement derived from shiitake helped reverse some age-related decline in immune function.
So, from foraging delicious wild fungi to growing medium to large shop type mushrooms, in medium, to having mycelia covered dowels placed into the wood. This challenge was joined by the James household recently as a consequence of our great neighbours “trimming” their oak and plum trees. The access to young fresh hardwood, especially oak, cut into manageable sizes is mana from heaven. I quickly found online Shiitaki inoculated spores, with a world of mycelium covering them all. My garage became the man cave for the introduction of these dowels into the wood, in 3-4 inch spaces, in a diamond shape, sealed with beeswax, melted and kept liquid in a slow cooker. A gentle tap with a hammer and a covering of sealant, the two ends of the logs wax-covered too. Spare pallet boxes were placed in a shaded space and left to natures tender mercies for several months to a year with occasional soakings either naturally from rain or the ubiquitous garden hose. The results of this endeavour will be eagerly anticipated, and the multiple stumps may indeed continue to bear fruit for some years to come.
The dowels before and after being sealed with beeswax in oak logs
Shiitaki logs on a pallet in shade in the garden
The use of mushrooms in medicine is contentious, the psychotropic varieties are illegal, whether gathering or consuming in New Zealand. It also suffers from a degree of little modern scientific research although their use as a healing agent or in ceremonial “rite of passage” events is well documented and continues in some global ancient cultures to today, much as it did generations before. This implies that without the authority of these being undertaken, the benefits of these natural ingredients, extracts and powders are still seen as fringe and have found it hard to become used legally. Despite this, they can be found at online stores and high street health shops. In the USA some states are now legalising the use of psychoactive mushrooms and the legislation will soon be brought further into the mainstream. This poses many questions and potential problems with dosages regarding effect and toxicity but also the success to date in trials with such shrooms for treating mental health and end of life states. Ongoing observational and empirical experiences appear not to have the critical weight that the randomised and longitudinal studies do and modern medicine demands. This ignores the centuries of medicinal and cultural use, especially in the far east, China and Japan. Having met many people who have taken them casually, and survived, is numerous. I have to admit that looking at anecdotal evidence and being encouraged by the opening of the debate about the efficacy of the magic mushroom type varieties of Psilocybin by the likes of Joe Rogan on his podcast, his guests include Sam Harris, Michael Pollan and Paul Stamets, legends, skeptics and advocates in the social media and authorship field. Many people undergo “guided” trips or journeys with clinically trained guides, alert to and aware of the meaning and purpose of the experience beyond the obvious. Learning from these has proven tremendously beneficial to people with post-traumatic stress disorder (PTSD) or coping with end of life stress.
Next, I feel I must discuss the use of mood-enhancing, immune-boosting and calming nootropic mushrooms and their extracts. These are readily available online in many combinations or as one only, even in traditional New Zealand. Nootropics, or “smart drugs,” are a class of substances that can boost brain performance. They are sometimes called cognition enhancers or memory-enhancing substances. Prescription nootropics are medications that have stimulant effects.
The products are encased within a plant-based capsule. MyComplete is a blend of 6 mushroom extracts including Chaga (Inonotus obliquss), Cordyceps (Cordyceps militaris), Lions Mane (Hericium Erinaceus), Maitake (Grifola frondosa), Reishi (Ganoderma lucidum), and Turkey Tail (Trametes Versicolor). There is a single ingredient offering, with just Lions Mane as the extract.
Chaga health benefits
Chaga mushrooms are rich in vitamins, minerals, and nutrients, including:
Chaga is also claimed to slow the ageing process through anti-oxidation, lowering cholesterol, helping blood pressure, fighting cancers, supporting the immune system and fighting inflammation.
Cordyceps health benefits
Of the more than 400 species of Cordyceps discovered, two have become the focus of health research: Cordyceps sinensis and Cordyceps militaris.
In several studies in diabetic mice, Cordyceps has been shown to decrease blood sugar levels. Some evidence suggests that they may also protect against kidney disease, a common complication of diabetes. In a review of 22 studies including 1,746 people with chronic kidney disease, those who took Cordyceps supplements experienced improved kidney function. However, these results aren’t conclusive.
A study found that Cordyceps significantly reduced heart injuries in rats with chronic kidney disease. Injuries to the heart from chronic kidney disease are thought to increase the risk of heart failure, so reducing these injuries may help avoid this outcome. The researchers attributed these findings to the adenosine content of Cordyceps. Adenosine is a naturally occurring compound that has heart-protective effects. Animal research has shown that Cordyceps decrease “bad” LDL cholesterol. Cordyceps have been shown to decrease triglyceride levels in mice. Triglycerides are a type of fat found in your blood. High levels are linked to a greater risk of heart disease. Unfortunately, there is insufficient evidence to determine whether Cordyceps benefit heart health in humans.
Lions Mane health benefits
Lion’s mane mushrooms, also known as hou tou gu or yamabushitake, are large, white, shaggy mushrooms that resemble a lion’s mane as they grow. These mushrooms and their extracts have been shown to reduce the symptoms of memory loss in mice, as well as prevent neuronal damage caused by amyloid-beta plaque, which accumulates in the brain during Alzheimer’s disease. A study in older adults with mild cognitive impairment found that consuming 3gms of powdered Lion’s mane mushrooms daily for 4 months significantly improved mental functioning, but these benefits disappeared when supplementation stopped. New animal research has found that Lion’s mane extract demonstrated anti-inflammatory effects that can reduce symptoms of anxiety and depression in mice. Other studies show improvement in the functioning of the hippocampus, a region of the brain responsible for processing memories and emotional responses. Spinal and brain injury research in this field also indicates help in the recovery with these mushrooms by stimulating the growth and repair of nerve cells, reducing recovery time by between 23-41%, in rat studies, in one particular study indicated a 44% decrease in inflammation and reduction of stroke-related injury.
Lion’s mane extract may protect against the development of stomach ulcers by inhibiting the growth of H. pylori and protecting the stomach lining from damage. Several studies have found that lion’s mane extract can prevent the growth of H. pylori in a test tube, but no studies have tested whether they have the same effects inside the stomach. Additionally, an animal study found that lion’s mane extract was more effective at preventing alcohol-induced stomach ulcers than traditional acid-lowering drugs — and without any negative side effects.
Lion’s mane extract may protect against the development of stomach ulcers by inhibiting the growth of H. pylori and protecting the stomach lining from damage. Several studies have found that lion’s mane extract can prevent the growth of H. pylori in a test tube, but no studies have tested whether they have the same effects inside the stomach. Additionally, an animal study found that lion’s mane extract was more effective at preventing alcohol-induced stomach ulcers than traditional acid-lowering drugs — and without any negative side effects.
Maitake health benefits
The polysaccharides in maitake (above) can reduce LDL (bad) cholesterol without affecting your triglyceride or HDL (good) cholesterol levels. Along with supporting heart health, beta-glucan can help improve your immune system. D-fraction in maitake mushrooms has a strong effect on the immune system. “Maitake” means dancing mushroom in Japanese. The mushroom is said to have gotten its name after people danced with happiness upon finding it in the wild, such are its noted healing properties.
This mushroom is a type of adaptogen. Adaptogens assist the body in fighting against any type of mental or physical difficulty. They also work to regulate systems of the body that have become unbalanced. While this mushroom can be used in recipes for taste alone, it’s considered to be a medicinal mushroom. The mushroom grows wild in parts of Japan, China, and North America. It grows at the bottom of Oak, Elm, and Maple trees. It can be cultivated and even grown at home, though it typically won’t grow as well as it does in the wild. You can usually find the mushroom during the autumn months.
Maitake mushrooms are rich in:
If you’re using maitake to boost your health, you can add it to any food in which you would normally add mushrooms. It can be added to stir-fry, salad, pasta, pizza, omelettes, or soup. You can also fry the mushrooms in butter or grill them. Maitake has a strong, earthy taste, so be sure you enjoy its flavour before adding it to a large amount of food.
If you’re buying maitake fresh, buy it whole to increase its shelf life. Store it in a paper bag in the refrigerator. You may be able to find it dried at some grocery stores. It freezes well, so you can keep it in stock if you can find it fresh. You can also freeze it raw. Maitake may also be taken as a liquid concentrate or in dry form in capsules. If you decide to take it as a supplement, look for maitake D-Fraction, which is an extract of the mushroom.
The correct dosage depends on your age, weight, and health. It also depends on the actual strength of a particular brand of supplement. Be sure to read the instructions carefully before use.
Reishi health benefits
Reishi mushroom has been used to help enhance the immune system, reduce stress, improve sleep, and lessen fatigue. People also take Reishi mushrooms for health conditions such as High blood pressure. High cholesterol.
The Reishi mushroom, also known as Ganoderma lucidum and lingzhi, is a fungus that grows in various hot and humid locations in Asia. For many years, this fungus has been a staple in Eastern medicine.
Within the mushroom, several molecules, including triterpenoids, polysaccharides, and peptidoglycans, may be responsible for its health effects. Reishi mushrooms can enhance immune function through their effects on white blood cells, which help fight infection and cancer. This may occur primarily in those who are ill, as mixed results have been seen in those who are healthy.
Some preliminary studies have shown that Reishi mushrooms could decrease anxiety and depression as well as improve quality of life in those with certain medical conditions. A small amount of research has shown that Reishi mushrooms could improve good cholesterol or blood sugar. However, the majority of the research indicates that it does not improve cholesterol, blood sugar or antioxidants in the body.
Nevertheless, there are several groups of people who should probably avoid Reishi. These include those who are pregnant or breastfeeding, have a blood disorder, will be undergoing surgery or have low blood pressure. Some studies of Reishi mushrooms have not provided safety information, but others have reported that several months of taking it is likely safe. Nonetheless, several cases of severe liver damage have been associated with Reishi extract.
Turkey Tail health benefits
Turkey tail is a medicinal mushroom with an impressive range of benefits. It contains a variety of powerful antioxidants and other compounds that may help boost your immune system and even help fight certain cancers. Plus, turkey tail may improve gut bacteria balance, which can positively impact your immunity
Turkey tail contains a wide variety of phenol and flavonoid antioxidants which help promote your immune system health by reducing inflammation and stimulating the release of protective compounds. Krestin (PSK) and Polysaccharide Peptide (PSP) are two types of polysaccharopeptides found in Turkey tails. Both PSK and PSP possess powerful immune-boosting properties. They promote immune response by both activating and inhibiting specific types of immune cells and by suppressing inflammation. For instance, test-tube studies have demonstrated that PSP increases monocytes, which are types of white blood cells that fight infection and boost immunity.
PSK stimulates dendritic cells that promote immunity to toxins and regulate the immune response. In addition, PSK activates specialized white blood cells called macrophages, which protect your body against harmful substances like certain bacteria. Due to their ability to naturally strengthen the immune system, PSP and PSK are commonly used as anticancer agents in conjunction with surgery, chemotherapy and/or radiation in countries like Japan and China.
Your gut bacteria interact with immune cells and directly impact your immune response and the Turkey tail contains prebiotics, which helps nourish these helpful bacteria. An 8-week study in 24 healthy people found that consuming 3,600 mg of PSP extracted from turkey tail mushrooms per day led to beneficial changes in gut bacteria and suppressed the growth of the possibly problematic E. coli and Shigella bacteria.
A test-tube study found that turkey tail extracts modified gut bacteria composition by increasing populations of beneficial bacteria like Bifidobacterium and Lactobacillus while reducing potentially harmful bacteria, such as Clostridium and Staphylococcus.
My limited experiences with these products are ongoing, there appear to be detractors regarding the quality and safety of some of the ingredients, in particular from China, where there are concerns over heavy metals within them, especially Chaga. My cautiousness would guide me to American based products from the likes of fungi perfecti, at http://www.fungi.com. The effect of taking them feels like a gentle boost, an enhancement of clarity, perhaps like taking a double shot of espresso but without the need to be near a loo for the inevitable, in me, need to evacuate. I’ll leave the rest of the detail to your imagination. I’m interested in growing more of these species, but the bio security implications in New Zealand of importation are tricky.
Freethinkers in the media space and mushrooms
Michael Pollan @ https://en.wikipedia.org/wiki/Michael_Pollan
Paul Stamets @ https://en.wikipedia.org/wiki/Paul_Stamets
Terence McKenna @ https://en.wikipedia.org/wiki/Terence_McKenna
Dennis McKenna @ https://en.wikipedia.org/wiki/Dennis_McKenn
“All Fungi are edible. Some fungi are only edible once.” ― Terry Pratchett
I am an advocate of growing my knowledge base in the things which abide around and within us. The last decade or so has seen me venture into evolving that journey, its progress has been documented in a separate blog, www.offtheplot.wordpress.com where the burgeoning roots of that are documented. The fact that yeasts and fungi abide in our oral microbiota continued my interest in the link to dental research, application and their possible promotion of dental health. This can be read at https://wholedentalhealth.com/2020/08/30/functional-foods-pre-and-probiotics/ just scroll down to “Honey, Propolis, Fungi and Mushrooms, Uncommon Allies in Dental Healthcare and Humanity? A Reflective Personal and Professional Journey.” In this post, as I discuss and explore the dental health/fungal interface and find the literature not so decisive using modern scientific methods. However, I firmly believe that traditionally and empirically we have a lot at stake with our symbiotic relationship with mushrooms and I find our association with them intriguing enough to learn about their behaviour regarding our dental health, general health, their nutritional, medicinal, nootropic and psychotropic (sense and setting, guided and professionally delivered) values. Their benefits have been culturally maligned as were the historical proponents and exponents of them. The failed Nixon inspired “War on Drugs” has stigmatised research on the benefits and value of all sorts of mushrooms, beyond the edible. This is changing, thankfully, as medical curiosity broadens on this subject matter. I hope the future is one where we develop a new scientific and cultural acceptance of the kingdom of fungi and its huge potential.
It’s been quite a while since I’ve had the opportunity to put finger to key pad, a combination of employment changes and a hip operation ( not mine I hasten to add ) has seen little to no time to reflect, until now. Many things have happened of late, most inconsequential, but reading Robert Lustig’s new book, Metabolical, and being interviewed by O’Hehir University’s Tim Ives are both events that have prompted professional thought. I am continuing to dwell on my mycological and apicultural (shrooms and bees) journeys as well, intending to put them into the next post, both are related directed to the original odyssey, as it this, learning undertaken way back in 2019. That will have wait for another day.
Dr. Robert Lustig has always been on my radar as a free thinker, a man of great conviction, an exemplar of new knowledge, honestly correcting himself late in his career, from face value and establishment thinking. His championing of the dark horse that continues to challenge the all-pervading destructive metabolic dietary dogma and holding extreme scepticism regarding the party line of the carbohydrate verse fat argument. The messages woven into his many YouTube presentations and best-selling books barely flinch as he puts his proverbial head over the parapet to face and provoke his entrenched mainstream detractors.
This his latest offering comes with the threat of professional misconduct removed, having recently retired, removing the constraints born of late by the likes of Tim Noakes and Gary Fettke, both restrained and framed for their so-called “fringe” but evidence-based beliefs, both noble lambs to the establishment slaughter, Tim after a long drawn out legal battle was admonished, Gary, sadly not so fortunate. He continues his fight against those in power, he believes influenced by darker forces than just the medical regulatory body. His fight is worth investigation, cancellation of his opinions and beliefs haven’t been successful despite their best efforts. I urge you to follow Gary and appraise yourself of his genuine and ethical ongoing struggle.
As a Dental Hygienist and, I hope a critical free thinker, I’m now acutely aware of the lack of training I received back in the late 80’s. The times I do a simple scale and polish nowadays, similar to those early days are a rare event and when I do I feel strangely nostalgic, not for some golden time but my naivety and ideological conditioning. It wasn’t until recently that I began to think less reductively about dental health and metabolic and systemic health, beyond what was beginning to be revealed by research and wider, more joined up thinking, for example the link and inverse/reverse assocition between Diabetes, a metabolic disease and periodontal (gum) diseases, beie/ng now considered an auto-immune disease.
The internet has played an important role in this curiosity, especially YouTube, the residence of many a maverick podcast downloaded by a cluster of expert proponents of an alternative narrative to the established line. One of these brave souls is Dr. Robert Lustig, MD, MSL. An author of several books, an expert orator on the subject of endocrinology and metabolic health. However, it was not until the release of his latest book, Metabolical, a few months ago, had he attempted to speak truth to authority regarding dental health, a key component of metabolic health, still unbeknownst to many practising clinicians.
Chapter 5, page 77, is the place where Lustig vents his spleen regarding the myths and the established dogma of contemporary dental health. He begins at what he believes is the beginning, way back in 1947, when the science of nutrition was taken off the academic syllabus for dental students, becoming an “inconvenient truth”, “getting in the way” of modern dentistry. This blotted out to inconvient truth of our ancestral dental heritage where dental diseases weren’t common place and, in fact, relatively rare. Our forefathers and mothers didn’t brush their teeth the way we know of today, if at all, and consequentially didn’t have appreciable decay, unlike the modern world where decay rates with intervention are still high.
Fossil records, dating back to the paleolithic era demonstrate some sub-par tooth mineralisation and infrequent poor tooth alignment, and the start of recorded history demonstrating tooth disease in 1-5% of the then population. This stayed that way until the mid-industrial revolution seeing a huge jump up to 25% in a short space of time. The culprits, unknown to hunter gatherers, being refined floor and sugar. The controversy appears to have become more evident after the 1920’s when dentists like Weston A. Price endeavoured to find answers to these alarming, growing and continuing trends. Price began an expedition visiting primitive and industrial countries. He wrote of his investigations and findings associating modern foods with this denigration of arch size and dental decay, traditional diets being a natural antidote to it. In March 1934 a meeting in New York tried to determine the cause of disease increase, in one corner where those who determined that clean teeth don’t decay, AKA Team Bacteria, and those who asserted that countries with traditional diets with unclean teeth had little or no disease, AKA Team Nutrition.
The flaw appears in the Team Bacterial position, who had no idea of the evolution of oral bacteria, being mediated by lifestyle and dietary changes, from ancestral to modern day microbiomes. Bacterial migration, determined from investigation of fossilised calculus has seen a shift in those bacteria from the mouth to the upper gut. The changes indicate a reduction in diversity, introducing bacteria that thrive in modern oral environments nowadays.
The irony is that “Our foraging/gathering ancestors ate tons of carbohydrates and didn’t develop caries” and that traditional flora weren’t dominated by modern bacteria species, specifically the Streptococcus Mutan strains, being acidogenic, aciduric, with potential to produce lactic acid and demineralise. This bacterium is uniquely designed, possessing an enzyme called Fructanase, able to cleave the glucose/fructose bond of sucrose in a nanosecond. It is highly efficient in oral environments where sucrose is frequently available, not only in acid production but dominating the local and regional bacterial flora.
“Would people prefer some decay rather than the elimination of sweets (sucrose)?” William Davis, then researcher and dentist, continues “Let us hope our research workers discover more practical means of controlling or preventing dental decay.” Dr. McCollum, a co-worker of Weston A. Price, conversely proposed “It seems that were we to turn to a low sugar, high fat type diet, such as prescribed for diabetic patients, we might expect a prompt and marked reduction in caries susceptibility. This type of diet is practicable in many countries, but fats are in many countries considerably more expensive to produce than starches or sugars”. This is the devil in the detail it seems, “food” that is cheaper to produce, and in greater quantities, far more readily available, irrespective of its potential negative attributes wins the day.
Was there a modern day solution to this dental health dilemma? Step forward 1945 and the discovery that Sodium Fluoride, at 1 part per million (PPM) that could inhibit dental caries formation. It had the ability to bound into the Calcium Hydroxyapatite crystals of the tooth, hardening the tooths external crystalline structure. It was noted that that decay rates dropped by more than 60% in children when added to the water in that specific concentration. Up to this point fluoride was considered to be toxic, a waste product of the aluminium and phosphate mining industries and a chief contributor to environmental pollution. Between 1971 and 1988 caries rates began to level off, from 25% to 19% in toddlers, 55% to 24% in 6-9 year old’s but never got lower than that. Toothpastes with 1500 PPM saw a reduction in adult dental decay by up to 30%. Increased amounts, up to 5000 PPM saw that rise to 40% never breaking beyond that figure.
The reduction in these disease rates led to dentists having less active disease to treat, fluoride it seemed had become an arbiter for the sugar lobby to encourage people to consume more sugar without getting cavities, dentists became less inclined to offer nutritional advice, and officials afraid to stop fluoridation. Evidence of fluorides negative effects, initially isolated to developmental discolouration of teeth soon moved onto small but significant correlations between fluoride exposure and reduction in child IQ, exacerbated when mixed into infant milk formula. How is this risk seen in New Zealand?
“Typical fluoride intakes from formula feeding using fluoridated water at the levels of fluoridation used in New Zealand are safe, and there is no evidence of any adverse effects on infant health or child development.” NZ Ministry of Health
“The Australia New Zealand Food Standards Code also specifies that powdered or concentrated infant formulae containing naturally higher levels of fluoride must indicate on the label that consumption may cause dental fluorosis and should be discussed with a medical practitioner or other health professionals. That is, those containing more than 17μg of fluoride per 100 kilojoules (prior to reconstitution), or ‘ready to drink’ formulae containing more than 0.15mg fluoride per 100mL.” That’s about 1.5 PPM, higher than water fluoridation recommendations (Author). NZ Ministry of Health
1 ppm is equivalent to 1 milligram of something per litre of water (mg/l) or 1 milligram of something per kilogram soil (mg/kg).
The NZ Ministry of health continues “The workshop concluded that, while there had historically been some infant formula powders with high fluoride content, infant formula products now have very low levels of fluoride, and that infant formula is safe for consumption by infants whether reconstituted with fluoridated or non-fluoridated water.”
It is interesting how they deem low levels of fluoride in formula being higher than population water fluoridation recommendations. Are they assuming that no infant toothpaste formula is being used, remembering first teeth erupt after 6 months of age? Or, are they factoring this into the calculation? Is there a risk of fluorosis to the developing secondary dentition? Are the water fluoridation detractors right?
This has left me feeling slightly uneasy. I was unaware that fluoride was put into some formula, as did my Practising Midwife partner. I don’t see usually see many babies or very young children as clients but I am asked frequently my opinions and position on fluoride. I will reflect more on this particular part of Lustig’s revelations and consider my position more fully. First of all I will look in the local shops and see for myself what is on the shelves and at what strength. Some more calculations will follow.
A final word on this contentious subject comes from the late Aubrey Sheiham, an Emeritus Professor in Dental Public Health. This UK epidemiologist recommended the reduction of dietary sugar to less than 5% of calorific intake, reducing the risk of dental decay to their lowest possible levels with minimal sugar consumption continuing. In this case, I wonder, would fluoride still be needed? Fluoride has not been a magic bullet, hasn’t seen the end of dental caries, has subtly enabled us to take our eyes of the prime driver of cavities, frequent exposure to fermentable carbohydrates, and frequent oral pH imbalance, over time. The dental profession hasn’t, in my opinion, followed the evidence, and has relied on these toothpastes and water fluoridation for the answer, and still does to this day.
Dental Hygienists and Therapists see the evidence of decades of poor advice, reliance on this interpretation of the science and continue to hope those sitting in their dental chair, despite brushing their teeth as they were told too, using the toothpastes recommended, still need the Dental Plan, the need for radiographs and intervention. Why are they not asking the real question, why in the hell am I sitting here despite this? The answer would be, in my opinion, simple and direct, read Chapter 5 of Metabolical, by Dr. Robert Lustig.
Moving swiftly on, I had a peculiar experience recently too, not of the book reading variety but of the online interview kind. This is a novel and fairly contemporary occasion, potentiated by the presence and everyday use of social media. I myself watch many a podcast in the week, preferring it to reading nowadays. I’m guessing COVID lockdowns and time on our hands has led to the growth and acceptance of such platforms and presentations, however, those involved are normally famous people. That leads me to the amusing thought of just who is famous in the dental world nowadays? My guess is those who challenge authority and established doctrine, Dr. Steve Lin, in Australia being the most notable presently. I say World purely because we are all now connected globally and O’Hehir University must be one of the pioneers and forbearers of this communication revolution in learning for dental healthcare professionals today.
Tim, O’Hehir tutor and co-creator, has a good knowledge of my professional journey, the theme of transiting from working in the UK to New Zealand, the cultural differences and how my practice has evolved and where I see it going. Having viewed some of the other interviews there is a rich vein of nuance, making every cast interesting and personal, humanistic in a sense. I liked the flow of the interview, it always appears strange viewing what you say at the time, in the moment. I would have liked, in hindsight, to have given consideration before the event, to the questions Tim posed. I would have liked to have put more meat to some of the responses, they lacked depth I feel. I liked the idea that the conversation could take an unlikely turn but kept loosely to the script. In a future scenario it would be good to focus on one particular aspect of personal and professional development, I’ve seen this in other interviews, and for example, how go about learning in an alternative context, in New Zealand, where courses are limited and sometimes not relevant to your particular workplace would be pertinent in the current climate.
Tim and Trish, the minds and drivers of O’Hehir University find themselves at a peculiar juncture in the evolution of the learning “child” and as it grows how to nurture it. Thankfully, both a keen advocates of alternative styles of professional, and indeed, personal development. I’m intrigued as to the direction they take, the many opportunities that will subsequently arise and the folk that lean on them to make their professional journey as wholesome as mine has been and continues to be so.
Finally, my head is telling me to consider a modern hunter gatherer dietary challenge, consider eliminating breakfast, a modern construct, and this I will give some thought to, along with a bit of bio-hacking to draw metabolic context. Watch this space.
Toni, Rick and Clare in March at Christchurch Horncastle Arena
We meet him, in Christchurch, the man responsible for one of the greatest Eighties hits, a hand shake, a smile of delight and the presentation to him of a bottle of Pinot Noir. It had been a long journey from my cousin Sally in Somerset to the drive from Nelson to the venue. Along with us that day was Clare, my colleague’s wife. She had no idea of what was to happen, she was only aware that we were meeting up to see him play. The look on her face when we were escorted back stage before the gig was priceless and greatly enhanced when he appeared with his agent. This was the week before lockdown came into force. Rick Astley was the perfect antidote the coming storm at the time as was the MarchFest in Nelson a few days later, the last time I’d see any of my family for several weeks.
It is New Year’s Eve in New Zealand as I write and the weather is surprising mild with cloud cover masking the blue sky and sun. This is unusual for the time of year but was predicted as a consequence of global climate change. It happened several years ago when our close friends from the UK came over the same time of the year in search of clear skies and warmth. Sadly, I listened to the BBC radio this morning to hear the news of yet another leap in the COVID body count, this time 981. The radio presenter was discussing this tragic milestone, the worst daily total since April and the grimly predicted a similar picture in the coming weeks, despite the development and introduction, at astounding speed, of a variety of vaccines. Their uptake has just begun but it appears weeks will be required to build immunity and additional boosters necessary to increase their immunological effect.
Knee jerk signage but not at the time!
Who would have considered the word “lockdown” in 2019 to be so contentious and emotive? It seems to me, so far flung from the present UK epidemic of restrictions and curtailments of normal life hard to comprehend. Those living there I’ve communicated with or have heard off appear to be struggling with the immensity of this. It’s long term effects, of isolation from friends and family, to businesses dependent upon those locked down and the greater economy as a whole will be difficult to calculate. What seems to be remarkable though is that the UK health service continues to manage in the way it does. Surely the message of this pandemic is that for the national economy to thrive, even survive, in unique and unprecedented events demands a robust and resilient health service. This aligned with the leadership of the country carefully listening to and appropriately reacting in accordance with their scientific advisers has been the success story of those, including me, living in New Zealand. This is born out by the resulting repatriation of tens of thousands of Kiwis back to their home land when the borders here were reopened in June. This in itself has created many new and unforeseen problems including the unaffordability of housing increasing on an already struggling marketplace.
“What has socialism ever done for us?”
Despite this the country is prospering, comparatively, to other western nations affected by COVID 19. I still go to work, can plan holidays and weekend breaks, am free to travel within New Zealand unrestricted and see friends and family without restriction. This was not the case back in late March. The tumultuous nature of the government’s decision to do a hard lockdown came as a surprise with many doubters and push back. Several weeks later with alert states returning to relative normality and only a handful of fatalities life began to resemble its pre March picture. Contact tracing and testing continued and the pulse of life led to the occasional local outbreak which was dealt with remarkable effectiveness. This I confess has its own problem, that of complacency, and many not conforming to the ritual of scanning QR codes when entering premises and shops anymore.
This reflection on those heady events will now turn to how we, Toni and myself, have adapted to this new normal which really began in January of this year, 2020. It was then that events became more news worthy. Our daughter and her partner were planning a trip to Europe and the UK and I was becoming increasingly concerned about their welfare and ability to return in the event of this news becoming more serious. It seemed that any cold or flu like symptom was an indicator of a COVID infection. An old school friend of Toni’s, living in Canada lost her young Son to COVID in March, or so we thought. The anxiety of this and the rapid onset of measures to combat and control this, its immediacy and the somewhat draconian response was breathtaking. A workplace presentation on sustainability in dental practice was soon changed to become the forum to discuss what we do if or when the inevitable decision to lock down occurred. Toni, as a core midwife at Nelson Hospital, had no choice but to continue regardless of the pandemic but we soon both adopting the strip off at the back door to go directly into the shower, unceremoniously throwing our work clothes into the washing machine. This became the norm until lockdown and continued for Toni through the early weeks of the crisis. I became head chef and gardener and was kept very busy on various projects that were in the long grass. It wasn’t long, however, before New Zealand returned to work and in particular for me stood some obstacles before my headspace and mental health accepted this new reality. I had made this decision based upon the notion the dental hygiene profession would suffer as a fear of COVID, this was reinforced by the fact that we as clinicians deal with all manner of oral flora and our mechanical processes, our instrumentation of biofilms can create bacterial fields potentially harmful to us and others. This concern was reiterated by the governing and regulatory bodies decision to ban the use of ultrasonic and sonic scaling equipment in higher alert levels. I’ll return to this shortly.
Banksy at his best extolling the virtues of essential workers during COVID
At this point I must allude to the role that social and main stream media played during this time. I was glued, like many others at the time I suspect, to the only real form of immediate communication, the internet. I must have spent many hours listening to podcasts and media broadcasts to either understand the nature and response to COVID nationally and globally but also as a distraction. My mother, at the tender age of 81 years, and myself began a Zoom thread that continues weekly to this day. Respect to her, adapting to the new technology scene and adopting this a form of real communication with us. At one point I was organising meetings from here between her, her sister and nephew, all in the UK! Strange times indeed. The media I believe will take some responsibility for its reporting of events during COVID when all the facts are known and lessons learned from it. Social media in particular will be more cautiously approached by those of a more discerning persuasion. Feverish and hungry consumption of any news be it verified or wholly misleading will change I hope after infections and vaccines bring an effective degree of heard immunity and normality return.
A menacing dark cloud taken from our balcony summing up the moment of lockdown
In May, whilst stationed in my home I decided to apply for a new profession, the fear that dental hygiene as I knew it would cease or irreparably change drove my application to train as a nurse at Nelson College. I was surprised that my application was immediately accepted and my headspace began to accept the inevitable move from dentistry, after 38 years. I kept this quiet from my colleagues initially and uncertainty with this decision began to appear when I considered the income I’d lose and debt I’d incur after 3 years of training. I was also perturbed by the fears and anxiety shown by my daughter-in-law who was into her final year of training locally. The idea that you were in a lottery after graduation as to where you ended up working appeared totally Dickensian to me. This affected me and a few counselling sessions and medication helped me traverse the stormy seas of my emotions. Life felt tough to me and affected my workspace as well as my headspace.
Herman our German Toyota Mini Campervan
I am very thankful that we did our odyssey back in 2019. We learned much from it especially the decision to make it our last for quite some time. We decided to buy a tent and all the finery that goes with the camping scene, a tow bar for the Volvo and a decent bike rack to transport the Ebikes around this country. The purpose of this was to save the expense of long haul travel, it’s environmental footprint and impact as well as the time in transit, jet lag and organising headaches. We were also fortunate to meet Cedric in August. He was a traveller from Northern Germany, like many thousands of young folk making a pilgrimage to these shores, supporting the economy with their presence and being witnesses and ambassadors to future tourists wanting to travel to our country. Annoyingly to me they get a bad press in this country, free campers for which Cedric was one, have been bad mouthed for poor toilet behaviour. A few have been responsible for this feverish media assassination but most are abiding and responsible, furthermore they add to the economy in multiple ways and buying Cedric’s converted Toyota Estima was acknowledgement of that and support of him. Herman, the aforesaid Toyota is now a firm family favourite and we thank Cedric for his attention to detail in converting this MPV to a mini mobile home. This is an addition to the travel inventory and Oli, our Spaniel, can now be part of our journey too.
Social Distancing during vintage at Neudorf Winery – Germans and French playing their part
Another positive from 2020, from a completely unforeseen angle was the provision of free training for primary industries. Apiculture being one of these. Now bees have been off my radar of interest until the last few years. Dear friends of ours have been drawn to the beauty and necessity of beekeeping and have inspired me to consider it as a hobby, if not a job in the future. I wasn’t really aware of this opportunity provided as a COVID response to aiding the economy but thanks to Facebook and the Nelson Beekeeping page I fortuitously stumbled upon it. The class of 18 features more females than males, they are really passionate about their learning and contribute much to this journey. I’ve now 2 hives, in the 2 corners of the garden, have endured many ups and downs with Queen bee dramas that many an expert hasn’t had to endure, several stings and a curious obsession with watching them landing on the hive laden with pollen. Anyone who thinks that a foray into keeping bees is an easy ride be warned it is far from that. There is a need for regular inspections, checking for a variety of infestations and diseases and a need to conform to a responsible yearly management plan to protect the bee colonies of New Zealand and their welfare throughout the year.
Bees in a brood box and feeder with bracken as a gym
To sum up 2020 has been a rough ride, an emotional and physical rollercoaster to me and I would reliably assume many others. I’m not in the super COVID risk age group unlike my mum and the in – laws. I have learned much about myself, faced a few demons and changes along the way. I am lucky, as part of the team of 5 million New Zealanders, that we had decisive leadership who took the right advice from the right advisers and the right time. The damage was minimal and the social consequences I hope less than predicted. I will continue as a dentalcare professional, as a gardener, a writer, and now as a budding hobbyist beekeeper. Where this coming year will take me I’m not certain, Toni will hopefully get her new hip and our friends from the States, returning to Aotearoa will find a place and settle back into this great country. I wish all who read this and friends and family the very best, health, happiness and a greater degree of certainty for your future. Kia Ora.
An eternal memory where nature felt more powerful than manned flight – Air New Zealand paralysed and on the deck
If you’d have asked me when I embarked on my learning odyssey back in 2019 (boy that seems such a long time ago now) whether I’d be on a Level 3 Certificate Course in Apiculture, having two hives ready to host colonies of bees and a growing concern and understanding of the nature of bees, their protection and importance to humans I’d have chortled, very loudly. It shouldn’t have been any surprise to me really, given my tendency to explore and deep dive into many non mainstream subjects ranging from craft beer brewing to foraging for nuts, fruit, mushrooms and plants to allotmenteering for exchange and barter or pure home food production. These less than mainstream pursuits meet my innate requirement to tax and satiate my curiosity and left field nature, and, moreover, engage my visual and kinaesthetic learning styles.
Before COVID announced its menacing presence back in March I had spent the previous months being focused on sustainable professional and personal practise development. In my workplace I had undertaken prolonged research into its significance, meaning and application towards my dental health practice and was on the point of presentation and action, hopefully persuading my colleagues. My intention was to make changes along the lines of improving the perception and belief to our cliental that we were taking the looming climate and environment crisis very seriously and were changing our behaviours to meet this existential threat.
https://www.nature.com/articles/s41598-018-32194-8 Extracts of Polypore Mushroom Mycelia Reduces Viruses in Honey Bees. Paul E. Stamets et al. 2018
My dealings with mushrooms and research related to offthplot.wordpress.com and wholedentalhealth.com had brought me to greater awareness of the association between birch polypore mushrooms and the bee population that use them to aid the natural disease prevention of bee deformed wing virus. Discovering this fact and the work undertaken by Prof. Paul Stamets, an global expert in Mycology, including his energy behind the creation of 3D bee feeders for the promotion of bee colonies in back gardens, inspired me to take the next few steps towards a greater journey. This was additionally aided and abetted by dear friends Dave and Rachel Annette at honeybehappy.co.uk, in Alresford, Hampshire, whilst staying with them in the UK last year. They have both undertaken a fundamental lifestyle and value changing venture into keeping bees, educating the public about their benefits and training those inclined to go beyond knowledge into practical application in apicultural practice. I owe Dave and Rachel both directly and Paul, very indirectly, a debt of gratitude in providing not only a substitute for the COVID postponed clinical sustainability project but also to a meaningfully related cause for bee sustainability, aligned to my social values and personal intent.
Enter the real world. How and where to do and achieve this? New Zealand is an agricultural country, especially in the north of the south island where a healthy bee population is essential in pollenating the vast areas of cultivated fruit and plant food production. Native Manuka honey is also a huge export industry, it’s Unique Manuka Factor (UMF) being sited by ongoing research as very beneficial for health. I’m in the right place to be for certain. However, apiculture courses are expensive, running into several thousand dollars NZ, or more, and such course providers not marketing them especially well, perhaps for that very reason. Enter COVID once again and the New Zealand Governments immediate investment in primary industry training programmes, some of which are being fully funded. Also, interestingly, enter stage door left social media, and in my case, FaceBook. The Regional Bee Keepers Association in Nelson had a thread on their page casually promoting this very thing. I immediately latched on and asked the question, where do I sign up? To my amazement it was as simple as that, two great instructors and experts in the industry, Scott and Jezebel Williamson, began the course in Brightwater, Nelson in August through Land Based Training, a commercial organisation promoting primary industry education. Fifteen very rookie and novice students of all ages and sizes turned up for the first day of term not fully knowing quite what to expect.
So, I’m now three months into a nine month course. I’ve two hives, one provided free as part of the training, this we had to construct, treat and paint. It sits on my deck at home presently awaiting a journey to Brightwater this weekend and its temporary future home for its first colony to reside in it. The other was donated to me by my former Marlborough dental boss Ed Durrheim, also a hobbyist beekeeper, which has also been treated, painted and set up for a home based hive here in Nelson. A big thank you to Ed. The neighbours have given consent and I’m priming a spot for its location, sheltered, north facing and exposed to plenty of sunlight. It awaits a Queen nucleus and will be my home learning hive, a fortnight behind the course hive. I’ve two suits and all the equipment required at present, including Adrenaline for bee sting hypersensitivity. Fortunately I’ve recently undertaken a work based first aid course where this was practiced. It appears all my ducks are stars are aligned and the active part of the beekeeping learning journey, post three month theory, begins in earnest this coming Sunday.
There is still so much more to learn, to experience and achieve but my goal is to focus on the health and well-being of bees in my charge, to be fully cognisant of the ways to achieve this, not to be concerned about asking questions, no matter how daft they may seem and to encourage all those I know to be mindful of the importance of the role that bees play in our everyday lives. The honey will be a bonus but not essential if needed by the bees themselves.
In the next thrilling episode of “Too Bee or Not too Bee” I will be more reflective and explicit about managing a hive on two sites, the routines, disease and pest risks and the highs and lows of this adventure. I will, no doubt, have many new experiences to reveal and new knowledge of lessons learned.
“The day went very well. My presentation went off without a hitch and we all retired to the bar afterwards to relax and reflect“. Mark
The day started at 08.30am and the whole team arrived in eager anticipation, a degree of anxiety and earnestness. We knew what to expect in terms of the activities of the day, we had been briefed. We did our 2 yearly CPR catch up, about 5 hour’s worth of theory and practical and I presented on protocols in my dental hygiene practice and an investigation into the oral health products we recommend and their application. I could tell there was a tad of tension in the air, there always is when you venture outside of your clinical comfort zone, ironically to learn about events that can happen inside of one’s clinical comfort zone. I think that this is the consequence of a fear, not of the need to learn, but due to the concern that you might have in making an error in front of your colleagues or failing an on the spot exam. I had also asked my team in an earlier meeting as to what they wanted to learn about my proposed presentation but had not had too much feedback so I kind of went into it blind. I hoped it would be interesting, engaging and a learning experience for everyone.
Preparing my presentation was a timely affair. It must have consumed about 30 hours of reading and writing, slide after slide created for power point and quite a few withdrawn because of time restrictions. However, at 10pm the evening before the day I completed it with animations and slide transitions and was satisfied that, without going through it into much detail before the event, I’d be fine. I had a minor concern regarding technical problems with linking it to the flat screen monitor in the conference room, a previous occasion had uncovered glitches and faults and it couldn’t be screened. Fortunately, I’d had the forethought to check it the week before. I was scheduled for the afternoon so I made the conscious effort to forget about it completely and focus on the main event, CPR.
The two instructors were professional emergency department nurses and had an incredible presence. They were both extremely proficient and gauged the mood precisely. The education was practical and visual, just my style, and for once, after all these years and previous CPR training had no concern or fear, like I had before. Maybe I was distracted by the thought of getting my afternoon session right but I really enjoyed the occasion and learnt some really relevant knowledge especially regarding anaphylaxis. We had a simulation in my chair about this exact same emergency. The irony was not lost on me as some of the oral hygiene products in the market place have the potential to create such as extreme physical reaction. It was also enlightening as it is important in my new hobby of bee keeping and the potential for bee stings to do the same. The need for adrenaline, in my case the need to draw up 0.5 mgs and the opportunity to give an additional dose 5 minutes after if required was new knowledge. I was also mindful of the 2:15 breaths to compression for children and 30: 2 for adults. The technology that helps us get a realistic physical sense of the breathing and compression rates has come a long way since my late teens when I began my professional journey.
The afternoon soon arrived and my turn came to add to the learning day. I had no technicals and the flow was good, I enjoy the moments when the subject can be discussed and was aware that there were some quiet voices in the room but moments arose to bring everyone into the debate. A particular subject, fluoride, demonstrated this perfectly. Some of the team aren’t aligned to the argument there is a problem with it whereas some were interested to question its relevance and validity. This is supported by previous feedback surveys we have undertaken at the practice that had determined that 75% of clients were opposed to it in the water supply and another 50% weren’t happy to use it in toothpaste. It seems to me we need to open to both camps and the many who site in varying positions between the two. Some even need to know the pros and cons with a balance and information to make a self-determined decision. What is important is that we know the noted benefits and the perceived negatives to not only fluoride but additional products, fair and fowl, which cause so much controversy.
Some contemporary oral health products, toothpastes included, have now within them, pre and probiotics. The science in this regard is still in its infancy but is growing exponentially, some are well established like xylitol. The addition to the inventory of products will include these as well as toothpastes that have specific applications to the needs of disease risk reduction in our practice. It was a great moment to explain the appropriate use of these and to whom, in what amount and for how long. It was also important to demonstrate and discuss the contra indications of them too. It was opportune to shed light on calcium phosphate in relation to tooth strengthening, desensitisation, pH balance and elevation as well as our oral biofilm benefiting from its directed use. My mind was changed from recommending no spitting out of fluoridated toothpaste to them clients to deciding for themselves after being given information about it.
What would I do differently and what feedback did I get? I think I’d adjust the presentation slightly, add the slides I edited and extend the length of it from 90 minutes to 2 hours with a break to sample some of the products. The content is sound but I’d like to add a slide or two to add more context. The feedback came back from the receptionist and she was perfectly correct in her request. I was awaiting it as a consequence of self-reflection and will act upon it immediately. I’m going to write a crib sheet for her about the products and their component parts, their benefits, how best to use them and who needs to avoid certain ingredients. I am also going to focus on toothpaste contents and write a briefing sheet for clients, colleagues and myself as they seem to be of great interest to many I see. My learning journey needs to encompass ALL the ingredients of the items we sell. I will also get myself an anaphylaxis syringe, needle and adrenaline vile kit too. All in all, it was a day well spent.
A year to the day 02 September 2020, a reflection on a radical year. September 2019 – August 2020.
March the 23rd, is a day I will never forget. I thought, initially, it would be the last day I practised dental hygiene and strangely, it felt strangely easy on me. After nearly 32 years I was prepared and almost willing to lay down my scalers and hang up my latex free gloves for good. I had been destined to travel to Melbourne, the following week, to do a four day introductory course in myofacial function therapy. This was in jeopardy due to a rapidly unfolding global drama and the spread of COVID 19. This culminated on that Monday, the aforementioned 23rd, when the whole of dentistry, less emergency care, was stood down by the Ministry of Health. That afternoon a final meeting was held at the practice, distances between and masks provided, for each and every one of us, all uncertain of the future and more besides. That very day too, I witnessed something I’d never have considering seeing since my days in East Berlin and Moscow in the heady days of the late 80’s and early 90’s. The beginning of the queue outside food stores had begun. A fit elderly lady on a bike, horrified at the very sight of it, perhaps with memories of her past experiences in leaner times, stopped and hurled abuse at those in the queue. Her ardour was embarrassingly silenced when she fell off her bike, at which point I, observing from a distance, decided enough was enough and cycled home, supplies in hand.
A mere six months before I had returned to New Zealand from a long learning break and started a new adventure in dental health. I have worked in virtually every conceivable dental health scenario except orthodontics. This was about to change with my introduction to orthotropics and orthodontics with Quin Dental in Nelson. My ignorance was blinding, I had hoped to spend a few days observing the practice but the immense jetlag and seasonal adjustment had the better of me as I slowly embarked on the journey of getting to know the intricacies of a new professional landscape, a new uniform, matching clinical footwear and a peculiar personal learning environment to navigate.
The previous weeks had deeply affected me and had shed light upon my less than ideal sustainable approach, and carbon footprint from the previous 9 weeks travel. We decided to stay with one vehicle as we lived near to our places, purchased Ebikes to make future journeys less reliant on the remaining car and began to dig the garden for our vegetable futures. Loaf making, with sourdough yeast from a friend, and continually nurtured by us, became a weekly event. The experiences and experimentation with CBD in the States drew my partner to its legal prescription and use to help her chronic pain. I had also decided that at some point I would reduce my working week to 4 days, so as to be able to focus on completing this project.
My annoyance and regular triggering by the inconsistent and arrogant responses and attitudes of my governing council to the needs of the profession grew stronger as the COVID days went by. This was enhanced by their unwillingness to recognise the fear and uncertainty that registered professionals felt at that telling moment, the significant reduction in income and the demand to pay registration or be deregistered. This was further inflamed by what I suspected would happen with the professional association being inept and unsupportive to their members. Me not being one (thankfully) but I was witness to the enraged voices and rants of those who were via social media. A pathetically drafted and grammatically piss poor effort of a letter to the regulatory establishment was the last straw and I decided that was it, and my time was officially now “up’ so to speak.
To be honest I can imagine this being the case for many people in a similar state of mind to me. My headspace was somewhat fragile, a consequence of post-traumatic stress disorder, from past events. I had spent many years trying to suppress and manage it without professional help, regular journeys with numbing effects to dull the emotional pain which is thankfully being properly addressed now as I write. My decision making had been somewhat reactive and primed I immediately went about considering my options beyond dentistry. I found a degree nursing course locally and applied, surprisingly being rapidly accepted. This was a relief and allowed me the time to contemplate where the future would go and where it would take me, or I take it. It was put to the back of my head and when the alert levels allowed I returned to clinical practice, unsure of what the PPE requirements were despite advice that seemed logical, for once. Everyone had a different interpretation of it, some wore masks everywhere in the clinic, others only in the surgeries and so on.
I was also uncertain how many clients would attend, still numbed and fearful of the risk of COVID but for 102 days New Zealand registered no community spread despite returning citizens and residents, and Trumps apoplectic rantings about this diminutive country’s record on controlling COVID. I continue to treat clients in a as near as normal environment as before. This has been reassuring but the threat of the looming recession and further community spread is upmost in my rear view mirror. I continue as before clinically and will continue to do so, with an addition of another clinical day elsewhere in Nelson to make the total to 4 days a week.
I have also made a decision to withdraw my interest in general nursing, a decision based upon not wanting to accumulate addition debt from study as well as incur a lack of income through not working. Being 55 years of age, a decade or so way from retirement refocused my priorities and changed my decision. Feeling better mentally and emotionally contributed to this move too.
Possibly the biggest decisions I’ve made within this year has come from two sources. Experiences with bee keeping and study of the benefits of honey and being asked to observe a mentor an online learning portal of friends have reframed my thought processes. The learning hub has made me realise I’m not alone with tough decisions, as over half the course have decided to change their present employment in dentistry and go in different directions, being affected as was I, by the COVID crisis. It also taught me to be more lateral in my future career thinking within dentistry, something that is still ongoing but has got the grey matter stoked. Watch this space with novel and enterprising ideas and action in the months and years to come. The other has me immediately engaged, and I begin my Certificate in Apiculture tomorrow. It directly links to my other passion, which I’m less engaged with in this country, that of mycology and free food gathering. Apiculture and foraging are great inquiring hobbies which may also lead to income generation, potential teaching and well-being in the future , so I’m very excited.
Finally, professionally where do I go from here? As I have discussed previously I had intended to do a myofacial therapy course abroad. This is impossible now but a virtual learning programme is being constructed soon and at my annual review I will ask to be put on it. Virtual learning is no stranger to me and the thought of using my skills and experience as a dental hygienist align with this perfectly. It also makes me think that perhaps the future of the dental hygienist, long considered redundant with the advent of the multi-disciplined hygiene therapist, isn’t quite an endangered a species as once I thought. The additional knowledge can be used with orthotropics, sleep disorders, mouth breathing issues and perhaps too, myofacial pain. The thought of getting wise counsel and guidance within the workplace from experts is a golden opportunity to be grasped. This may also bear future fruit with consultancy and mentoring too.
The future still appears to be uncertain, once essential international airline pilots, once criss crossing the skies above us are now filling food store shelves. The trick appears to be to make yourself professional self relevant and essential, consider where the opportunities may lie, deal with one’s demons, as in my case, and not consider yourself past it beyond the age of 55. Continue to plan for and be aware and mindful of the opportunities that still may prevail. I wish you all good luck and the best for your clinical and professional futures as I sign off from this year of discovery, thank you all so much for sharing my journey. Stay well and smile.
A New Hope? Re-Registration for Dental Professionals in New Zealand. A Whole Dental Health Perspective, Appraisal and Reflection.
“A competent Dental Hygienist understands current biological, physical, cultural, social, and psychological factors involved in dental and oral disease, and in attaining and maintaining oral health”. NZDC, Scope of Practice for Dental Hygienists
Dental Hygienists are called, under a set of professional guiding standards, by the New Zealand Dental Council (NZDC) in their daily clinical and professional practice approach. They include putting our patients’ interests first, ensuring safe practice, communicating effectively, providing good care and maintaining public trust and confidence in the dental profession.
The NZDC also provides a legal Scope of Practice (SOP) document for Dental Hygienists in New Zealand, that compliments the Standards by guiding the practitioner to the boundaries of clinical activities pertinent to their specific qualifications. This demonstrates what is determined as “Best Practice” by understanding current scientific knowledge and skills, attitudes, communication, judgement, and demonstrate a commitment to real health promotion.
“Enable patients to maintain and enhance their individual well-being by increasing their awareness and understanding of “health matters”. NZDC Standards Framework Document section 22.
The Dental Hygienist has a legal commitment to follow the NZDC’s continuing professional development (CPD) 2-year recertification cycle presently by being able to demonstrate compliance through a portfolio of evidence if required. The Framework Document and Scope of Practice aligns the clinician with what is deemed necessary to do to achieve future recertification, as well as, of course, paying a practice certificate fee. The cost of that to a New Zealand Dental Hygienist is not unsubstantial, in fact far cheaper than that of a UK Hygienist, and very near to want a practising general Dentist has to pay. 1.
The recertification process has recently come under scrutiny by the NZDC. In February of this year, a summary of the critical features of a final design for their new recertification programme was published and disseminated to the registered body. It has been the subject of focus group attention for several weeks before the approval of its principles. We await the final draft details, but in the meantime, we can posset its incarnation and comparison with the same outcomes that Dental Professionals adopted in the UK in 2018. I find it interesting that the NZDC derives their inspiration for such change from the UK and Europe, once again. Interestingly though it appears they have done things a little differently and, it seems to me, slightly better. Perhaps this alludes to the historical and cultural differences between practice cultures in New Zealand and the UK, as well as the size of the professional populations of both countries.
“Will attending the course change the way you think, or carry out your role in your practice?” Postgraduate Medical and Dental Education for Wales, UK
The key features of the new design include the creation of a Professional Dental Plan (PDP), Professional Dental Activities (PDA’s) replacing the present learning title of CPD, annual online self-declaration to the effect of completion or attendance, a Professional Peer Relationship (PPR) and written reflective practice. These are radical departures from what is presently the norm, and they will come into effect, it is reported, from the 1st April 2021. All the above components are found at the General Dental Council (GDC) of the UK with minor nuanced changes from 2018. 2.
The roots of changes in the UK stem from the need to identify and develop personal, professional skills, in line with your present skill set and workplace environment. The PDP allows you to track and achieve those goals. A degree of flexibility and review of your learning journey is set into the PDP criteria. It is further boosted by the critical and supportive input of a skilled and qualified mentor, in the UK case and, here in New Zealand, a Professional Peer (PP). The PP “must be able to provide knowledge and credible feedback relevant to the practitioners’ professional development”. The New Zealand method is more personal, it can be one on one, via teleconferences or by email. The responsibility of the clinician/professional peer relationship is further emphasised by official confirmation that. “Before a practitioner applies for an Annual Practising Certificate (APC) each year, the PP will need to provide confirmation online that the practitioner has interacted with them during the year, has a PDP, participated in PDA’s and has reflected in writing”. The PP can also assist in developing and reviewing PDP’s and assist in PDA developmental choices.
“Fail to plan, and you plan to fail”. Benjamin Franklin
Primarily though, it allows the clinician learner the ability, responsibility and accountability of self-directing their own knowledge creation. There are a variety of sources to effect meaningful learning. Traditionally we as a professional body have leaned heavily upon the local professional study groups and associated learning events. The annual professional body seminars, Dental Trade Industry (DTI) sponsored events and roadshows are traditionally well-trodden sources of knowledge. There is a cost element attached to belonging to associations and paying for events, mollified by the DTI to some extent, more so in recent years. This brings into focus the issue of PDA’s being overtly linked to commercial interest, in part, where the Industry is in direct contact and potentially influencing the decision making of professionals. Historically the DTI has been on the fringes of conferences and meetings but now appear to be more directly involved in providing CPD. This is effectively brought to the attention of the discerning clinician by Gillis and McNally (2010) who state “University-industry relationships are becoming increasingly common in academe. While these relationships facilitate curriculum relevance, they also expose students to external market forces”. They continue, “Industry’s presence in academe is a concern. Dental educators (and dental health professionals from 2021 – author’s note), as stewards of the profession, must be nimble in brokering Industry’s presence without compromising the integrity of both the educational program and the teaching industry as a whole”. It appears that the NZDC’s move to create a new recertification process has considered this as well. Allowing self-directed study, independent research and authentic learning negate this influence, in part. 3.
“Before you decide to attend a course or an educational event, you need to question the relevance to you of the subject being covered”. Postgraduate Medical and Dental Education for Wales, UK
Additionally, in what I feel is a further bold move, there will be “No mandatory requirement to meet a quota of PDA hours.” There will also be no requirement for PDA’s to be verifiable and will be linked to “Any activity relevant to maintaining and building a practitioners competence in their SOP. PDA activities need to be aligned with “Specific developmental outcomes”. Think about your workplace, your roles within in it, clinically or non-clinically, the nature of the practice and its clients. For example, I work in a general and modern orthodontic practice, I treat both disciplines from a dental hygiene perspective, the parents of the younger orthodontic cases tend to be very involved with their children’s care, they are included too. I work collaboratively with orthodontic auxiliaries, dental assistants, dentists and reception and office staff and managers too, as a team. Planning meaningful and practical PDA may see learning in non-dental related subjects such as leadership, communication or team building.
Writing a PDP begins with an honest appraisal of where you are now professionally, your workspace, where you feel you need to go by identifying your specific career goals and learning needs to ultimately accomplish them. Consider your timeline, the NZDC are preparing a move from it being 2 to 3 years, whereas the GDC, UK have structured 5 into theirs. I’m not sure how I feel about this, the longer would be preferable as learning can be more open-ended and reviewing your PDP might lead to more changes as a consequence, as well as workplace changes leading to modifying learning goals. A 3-year cycle might be justified initially as trialling the new regime, but alterations to future timelines might require adjustment from feedback and experience. The templates for PDPs will be necessary too, created individually or by supportive professionally bodies or the DTI.
“You may wish to reflect after every activity, or at intervals during the year, reflect with your employer, or a peer or mentor”. Postgraduate Medical and Dental Education for Wales, UK
Reflection may be the most significant educational challenge that Dental Professionals face as part of this educational development change process. I had the opportunity to be exposed to reflection during a degree programme at the University of Kent several years ago. Initially, the process was very confusing, understanding the methodology, learning to write and express the sentiment of something you do mentally, every day in many clinical and ordinary experiences. Consider cooking a new recipe, you taste it and realise it may need seasoning or more of something and less of the other to enhance it, the next time you repeat it you alter your process again. This reflective critical self-appraisal doesn’t have to be a novel or a work of literal art but just an honest and revealing attempt to describe a situation in your professional environmental. We need to demonstrate learning that has occurred, what we alluded from it, or not, what would we do differently as a consequence of it. Eventually, it leads onto planning improved practise, and what future developmental directions do you think you need to go.
“Self-reflection is a humbling process. It’s essential to find out why you think, say, and do certain things – then better yourself”. Sonya Teclai
I can remember re-registering with the NZDC in 2013, returning to New Zealand from the UK with a portfolio of evidence of learning, with a PDP, PDA log and reflections linked to education. I was advised that at that time that there were gaps in my portfolio, and I needed to catch up with CPD hours to comply. I was horrified to think that what I had learned from a UK university while doing a dental education degree wasn’t deemed enough. Ironically now, it seems that the NZDC is adopting those things I presented way back then. I will fall back on what I originally learned and prepare a PDP, construct PDA’s and continue to reflect upon my processes. I will find a PP and form a relationship which will help me evolve my practice further. Also, as part 2 of this piece, I will delve further into self-directed learning methods that can help the independently minded critical thinker/learner/researcher to move forward in this COVID19, post COVID19 clinical environment “Brave New World”.
Annual renewal and fees, GDC, UK.
Gillis, MR & McNally ME (2010). The influence of Industry on dental education. https://www.ncbi.nlm.nih.gov/pubmed/20930240
A Personal and Professional Reflective Journey into an unknown and uncertain future. Whole Dental Health, A Brave New World.
Reflection will soon become a requirement of recertification as a Dental Hygienist in New Zealand. I’m not sure how many within the profession have written reflectively but what you find below is a quick example of reflective practice about my recent and ongoing experiences regarding the COVID 19 pandemic as a Dental Hygienist. It is both personal and professional, it could be written in a variety of ways, using different approaches of reflection from Kolb, Gibbs or Schon as examples but I’ve decided to use a What, So What, Now What pathway for its ease of use. For more information and examples, please use the referenced links at the end of the piece. Good luck and remember how beneficial it is they think about what you’ve experienced, how it has affected you and the changes you may consider making as a consequence of them.
“Necessity is the mother of all invention”. Old Proverb
Just three months ago I was looking forward to March, especially the 17th, when I was completing a six-month locum stint in practice in Blenheim, Marlborough. I had work organised in Nelson to replace what I was leaving behind and my professional life, for once, looked peachy. Little did I know that by that date, I had reappraised and adapted my clinical approach to dental hygiene treatment. At the same time, I was feeling underwhelmed by the lack of concern and fragility of fellow professionals being displayed in the clinical environment and in online professional chatline on social media. COVID 19 was a “Clear and present danger” to me and those I respected and cared for both personally and professionally. I had started giving it consideration by about mid-January when the news was slowly filtering from Wuhan via the media that a novel virus was causing lockdowns, infections and, the start of what was to be, many deaths being reported. The concerns of a rising epidemic becoming very real.
After listening to RNZ, I began to think about how I’d respond if it came to New Zealand. I could potentially be seeing asymptomatic, pre viral or even viral cases not far off in the distance. Ironically the first thing I did was to pick up a few masks and brought them home, we had a few boxes of gloves in the house from my Wife’s old locum midwifery practice. She had given me the “are you a conspiracy theorist” look initially but found a quiet place for them, just in case. My children and their respective partners had recently been to Europe on holiday, and all but 1 had experienced colds and fevers either during or on their return. I kept my distance from them and as the epidemic continued the realisation of it going pandemic grew. I started to consider how I was going to modify how I worked, my concerns being the safety of my clients and myself. About this time, a rush on not only toilet roll but hand sanitiser saw both items being panic bought and dental supply companies running out of stock rapidly overnight.
We had intended to have a practice meeting, scheduled on the 25th February, and I was going to present on a “Sustainable Approach to Dental Health”. This I withdrew from and advised the Practice Owner and Manager to consider the meeting’s topic changed to what might potentially happen over the next few days and weeks regarding COVID 19 and how protected and safe our clients and ourselves would be. It felt like we were transitioning to a weird kind of war footing (I had experienced this during Gulf War 1 in 1991) and felt some of our colleagues weren’t as aware of all the facts and even concerned as much as they should be. I’m glad we had the meeting as it began the process of mental adjustment for all and adapting to the threat of COVID. We placed information notices on doors, put out hand sanitisers for clients to use and took stock of the supplies we had and began to order more, especially hand gel, masks and gloves. The unknown became very real when on 28th February when” case of COVID 19 in New Zealand was announced.
One of my Wife’s friends is an Emergency Department Nurse who lives in Canada. Her Son, a young, healthy man in his early Thirties was one the first to die of COVID in his country. We heard this sad news about mid-March, Toni was devasted. She and I began to make the growing COVID risk more apparent to all our friends and family. Some found it too extreme, others were still unconcerned, but very soon the reality was setting in that things were not going to stay the same for much longer. The March Fest in Nelson, a Beer Festival, on the 14th, March was the last event I was to attend with my Sons for some time to come. New phrases like “Physical distancing” and “Flattening the curve” began to become accepted norms, similar as our forefathers call to action with phrases such as “Dig for Victory” and “Careless talk costs lives”. Regular visits to the shops to quietly stock up on food and groceries gathered a pace and our cupboards, once empty began to fill to support our “Bubble” isolation for the weeks to come.
The government initiated a COVID 19 strategy of “Going hard and fast” on protecting the population, stepping up testing and self-isolation for those returning to New Zealand after the 25th March. That week, a rapidly created Alert state had been implemented, we were at level 3 by the 23rd and total lockdown, Level 4, by the 25th, March. My routine and regular practice, something very familiar to me in various clinic guises for some 30 years, ceased that Monday and we held a final impromptu “socially distanced “practice meeting. The future and our careers seemed very uncertain, all of a sudden.
Way before the end of March, I started to reduce and then cease all my aerosol producing clinical activity, despite others continuing it. In particular, I hung up my ultrasonic and airflow systems and began making sure that I displayed to my clients super visual hand washing techniques as reassurance. However, I did continue to use slow handpieces continued, which do create a droplet field. My dilemma was genuine that clients were paying and expected to feel that their teeth were effectively cleaned. Aspiration was the best barrier to reducing its potential contamination. Cleaning down after treatment and set up processes for the next client were more deliberate and measured. I work without chairside support. This will need to change.
The New Zealand Dental Council with the Ministry of Health directed all unnecessary treatment cease from the 23rd, March as previously stated. They drew up unambiguous guidance on what is deemed an emergency and what is not. It was crushing to think that everything I did was effectively non-essential and that would remain true until we drop back to Level 2 from 4. The initial 4-week lockdown could be extended, if required, and no suggestion of when Level 2 is on the horizon as yet. However, the Prime Minister is now asking businesses to plan and consider how they restart or reset when that time approaches. What does this mean to me? I’m using the time to catch up on many things, educational I’m writing the blog, and this is fifth so far. I’ve a plan, set out last year and every excuse under the sun has held me back completing it. Not now. Additionally, and perhaps more importantly, I need to familiarise myself with all the recent updates and mentally preparing myself for an alternative, uncertain professional future.
I am also a little uncertain of this new clinical reality, one which will mean the wearing of Personal Protective Equipment beyond my previous norm in the course of routine dental hygiene treatment. One very visual video I saw on YouTube by the Auckland DHB demonstrated how to dress with PPE, hand sanitisation four times for one process of gown, gloves, masks and protective eyewear being put on and taken off. How many would our practice need and wherein these times of shortages of such items would we get them from? How much would they cost and would our clients accept the changes and additional fees is added to the treatment costs? These decisions I, fortunately, don’t have to make but how I approach my clinical practice, beyond the PPE debate, is evident to me.
PPE will need to be updated with visor and if required gowns. A few trial runs getting to know how to put it on, that’ll be interesting.
So, as per NZDA guidance, all my cases will be categorised as Low-Risk Care, not positive for COVID 19 or any associated exhibiting symptoms, or in close contact with those who do. The international travel aspect will shortly not apply for sure, for some time. No aerosol-generating equipment, all appropriate PPE equipment required, including gowns and our routine surgery use.
I wonder how many of the profession think everything will return to normal rapidly? Some, like myself, may align to that notion only when vaccination is developed and tested, produced in the numbers required to globally distribute and facilitate it. Essential healthcare and general workers, those at risk, the immunocompromised and the elderly will undoubtedly and rightfully be first in the queue. This will take time, and until then I will subscribe to the immortal words of the great Clint Eastwood, “Improvise, Adapt and Overcome” because “Tomorrow is promised to no one”. However, the lingering thought is this, how much will it ultimately cost the profession, additionally the client and will they return in the numbers they used too?
1. Ministry of Health, Dental Council and Professional Associations’ joint statement: COVID-19 update*
2. What is a Critical Reflection? Introducing the “What, So What, Now What” Model – Use the Course environment as your workplace and learning environments
3. Reflecting on a Personal Experience Using the “What, So What, Now What” Model https://youtu.be/_mQ_zDUX9nE
4. Sample Reflection: Reflecting on a Course Activity
Developing my PDA’s and PDP in the light of future changes to recertification. Redesigning from 2019 to 2022. Whole Dental Health – A Brave New World.
From April 2021, to gain recertification as a Dental Hygienist, I am required to create a Professional Developmental Plan (PDP) that lays out my learning and developmental aims and goals for my regulatory board. The New Zealand Dental Council (NZDC) has changed the criteria for Dental Healthcare Professionals (DHP). This is in line with many other regulatory organisations to add depth and quality to continuing professional development (CPD), involve the learner in educational attainment work directed towards their workplace culture and environment. In addition to these, a Professional Peer (PP) will be required to act as a mentor, advocate and overseer of this process combined with a personal written reflective practice of Professional Development Activities (PDA). The method that is demonstrated in figure 1.
Fig 1. GDC UK reflective cycle for PDA’s
In this account, I wish to look back on the previous year, starting April 2019, as the beginning of the new cycle, as the initiation of my PDP. Then account for the learning undertake from then to the present and consider the current situation with COVID 19 disrupting clinical practice for non-essential care. This is also, paradoxically, an excellent opportunity to find where you presently are professionally and where you feel you want or need to go in planning your learning journey. Historically I had created a PDP and record on it my PDA when I was studying at The University of Kent several years ago. It is something I lost touch with coming to New Zealand in 2013 but having prior knowledge of it has led me back to my archives to dust off the means of recreating them.
When choosing goals, I look at the NZDC standards framework guidance, feedback from clients and colleagues, appraisals from employers and management. Give consideration to non-clinical aspects of practice too, leadership, communication, research and teaching skills may form ideas for learning objectives. Prioritise, if possible, your goals in order of importance or in a timeline (authors note). The various methods of achieving learning objectives include conferences be they regional, national or international, the setting whether online learning or workplace training or shadowing. You could also create your own learning journey, focused on your needs where they can’t be met more formally. Authentic learning and action research, similar to inquiry learning, can offer self-directed alternative approaches to new claims to knowledge and more meaningful first personal development in addition to convention education.
Fig 2. PDP log
My practice culture and status over the last year has changed, from a general dental practice setting to a mixed but mainly orthotropic – arch expansion – orthodontic setting with 3 orthodontic auxiliaries, 1 dentist, 3 Dental Assistants, a Manager and Receptionist. The COVID crisis has seen the practice shed a dentist and Dental Assistant. The move from Blenheim to Nelson has seen a role shift into a new dimension of dental hygiene with a greater onus on a strict regime of infection control, being less liberal than the previous practice by some margin. My learning goal became one of catching up. Before starting work in my present location, as can be in figure 1, I was engaged in an epic 9-week overseas sabbatical, see “experimental Learning 19” menu and reflections related to it.
I constructed a way to present it through a website portal. I used WordPress to create a website that could additionally support the goal-setting, evidence gathering and writing. Getting the right themes and menus has been a challenge, the intricacies of knowing how to create pages and posts, how to tag and edit, insert pictures and keep up with new ideas and technical difficulties has been rewarding and, at times, a little stressful. Potentially It could be a useful device for colleagues to adopt if so inclined as a simple way to demonstrate compliance, development and transparency. Below are two links, created by the same person on how to go about creating one.
How To Make a WordPress Website – For Beginners https://youtu.be/8AZ8GqW5iak
How To Make a WordPress Website – In 24 Easy Steps https://youtu.be/2cbvZf1jIJM
It was my intention to develop my role in my current practice by travelling to Melbourne to complete a course in Oral Myofacial Function so I could evolve my practice and create my clinical time. This was cancelled due to the COVID 19 crisis, and there appears to be little prospect of undertaking it in the foreseeable future and, in effect, it is on hold. I am presently considering how I move forward with my PDA goals and have come to the conclusion that writing about topics that interest me, that are linked to my workplace and the future recertification process can take precedence for now. My colleagues have advised me on CPD topics related to orthotropics and oral myofacial function. Still, I’ve decided to engage those when the current Alert state reduces, and I have the inevitable clinical white space at work. The opportunity to focus on professional writing has been scarce until now. Below are two links to those subjects which will be added to the PDP shortly with a duel reflection and discussion with my professional peer.
Growing Your Face by Dr Mike Mew
A Speech Therapist’s Approach to Myofunctional Therapy
During my first few months in Nelson, I began to realise, very quickly, that many of my clients were somewhat “alternative” and investigative in their approach to subjects like fluoride and nutrition. There was also a cohort of clients interested in environmental issues and sustainability. This made me consider my approach to that, as well. In comparison to Blenheim cliental, where I continued to work as a locum for two days of the week, this posed a paradoxical living challenge. The contrast between the two client bases was stark both in terms of their dental knowledge and expectations of the nature of my delivery of care which makes me reflect. One I was cosy with, having worked there for several years and the other new. I had to move deeper into researching and investigating their positions on it. I was curious and willing to listen, to understand without judgement and I was careful to recognise and affirm other people’s opinions, and offer tailored alternative advice or options, especially regarding topics like nutrition and fluoride.
Moving forward, we still await the proposed changes to recertification to be officially confirmed. The NZDC response to the COVID crisis has allowed the professional to breathe a sigh of relief regarding compliance with the strict verifiable CPD hours. This allows an opportunity for all to reflect on the PDA and future educational goals with the time created by the lockdown. This is precisely what I’m doing, I have a project, begun last year to complete, I can continue on the theme of changing practices and direction within the new one, displayed via a website online for the sake of transparency. It also demonstrates my learning journey for others to view and to comment on and promotes my passion for self-directed, appropriate and authentic learning as a juxta-position to the norm.
Progressive Dental Nutrition? Relating the Lessons of the Past with the Present. Weston A. Price.
“We can now visualise our universe, its light, gravity and heat, its seasons, tides, and harvest, which prepare a habitation for the universe of vital forms, microscopic and majestic, which fill the oceans and the forests. We have a common denominator for universes within, and around each other, our world, our food and our life have potentials so vast that we can only observe directions, not goals. We sense human achievements or ignominious race self-destruction. Every creed today vaguely seeks a utopia; all have visualised a common controlling force or deity as the most potent force in all human affairs. Yes, man’s place is most exalted when he obeys Mother Nature’s laws.” Weston A. Price.
Have you ever heard of the name the Weston A. Price concerning your dental training or current practice? In all of my 30 plus years in dentistry, I must confess, until recently, I hadn’t. My first exposure to him occurred during a visit to a highly recommended Chiropractor. He was reasonably alternative, as was Price’s reputation, but respected highly by the person who recommended me to him, my Principal Dentist. Talking to and researching their website brought my attention to Price and their mistrust of fluoride. The warning bells were ringing loudly, but in conversation with him, I began to reappraise my position and reconcile the biases and controversy related to his work, and reflection on them. If you claim to be a holistic practitioner you, I hope, would be well versed with Weston A. Price’s work, just as, if you were a nutritionist, you’d be aware, as well, of the controversial academic and scientific work of one Ansel Keyes.
If you carefully delve into the dental literature and research, you will find it very difficult, if not almost impossible, to uncover anything related to Price. Ironically, the research and publications he undertook in the early decades of the 20th Century, a revolutionary and controversial book published in 1939 revealing his theories on subjects from root canal treatment, soil health, sacred foods to the development of the face and jaw can be found elsewhere. His work is seen by some as the forefather of the popular Palaeolithic dietary and Low Carb nutritional movements with echoes extending to progressive oral health approaches in the treatment and preventing dental diseases like caries and periodontal diseases. Interestingly, the New Zealand Dental Council includes the phrase “holistic” in approaching treatment in its guidance for professionals and encourages collaborative engagement with fellow healthcare professionals as part of our practice standards. It appears that the times are changing so let’s dig a little deeper into this subject.
“Life in all its fullness is Mother Nature”. Weston A. Price
Weston A. Price ( 1870 -1948 ) was born in Ontario, trained and graduated at the University of Michigan as a dentist in 1894. He set up his first practice in the same year but feel ill with Typhoid shortly after. His health was severely affected, and a period of convalescence brought him to the realisation of his future higher cause. He decided to direct his attention to the study of “healthy traditional cultures all over the world”. This may have also brought the birth pains of the focal theory of infection to his attention. This theory proposed that infected teeth should be treated by dental extraction rather than root canals, to limit the risk of more general illness. He spent 25 years working and researching with root treated teeth which lead to the publication in 1925 of Dental Infections and related Degenerative Diseases. Price’s next publication Dental Infections, Oral and Systemic, was used as a reference in textbooks and diagnosis guides published in the mid-1930s. Both contributed to the widespread acceptance of the practice of extracting, rather than root treating, infected teeth. By the mid-thirties his work was widely challenged and fell out of favour. Needless dental extractions were seen as too extreme when infected and diseased teeth could be restored and masticatory units maintained. Ironically, as we know now, the foods we eat need molars and other teeth to break down and allow not only passage through the digestive tract but also to gain maximum nutritional value from it. Without teeth, be they unrestored or not, we don’t fully, nutritionally benefit from what we eat. Efficient digestion requires the food to be well masticated. His focus soon aligned to the subject of traditional nutrition of communities uninfluenced by modernity by began a global learning journey to ascertain whether the “health of the body is reflected in the health of the teeth.”
“Tooth decay is a symptom, not a disease… it is evidence of faulty nutrition”. Weston A. Price
In 1939 Price published his now seminal book “Nutrition and Physical Degeneration” and claiming that “eating a nutritionally dense diet of whole foods, grown naturally in healthy soil and prepared in a traditional method” producing “nourishing and digestible foods enabling them to build strong and healthy bodies, sustainable over generations.’ His work led him to the conclusion of the power of “sacred foods”, such as “unpasteurised dairy foods, offal, pasture-fed animal, seafood, in particular fish eggs, cod liver oils, fermented foods like sauerkraut, kimchi, kefir and animal fats”. The lack of which, he believed, led to “dental caries and deformed arches, resulting in crowded, crooked teeth was a sign of physical degeneration as a result of suspected nutritional deficiencies”. This was due to his close observation and critical study of isolated communities around the world in that period. Price, it is noted, used chemical testing of soil, food quality and the prodigious use of photography in his work. He observed what he described as disease-free indigenous populations with “straight teeth”, “stalwart bodies”, “resistance to disease” and “fine” characteristics, associated with their traditional, nutritionally dense diets.
Interestingly too, Price also alluded to an unknown but healing component which he defines an “Activator X”, found in butter oil. Price concluded that butter, which was produced from rapidly growing grass in the spring, had higher “Activator X” levels than butter produced during the rest of the year. This “vitamin like activator” was to be better understood, after the Second World War, as Vitamin K1. He also deduced that modern processed foods lacked this and other essential vitamins and minerals due to modern food processing effects.
“For humanity to survive, it must eat better – foods must be whole, fresh and unprocessed.” Weston A. Price
Price’s detractors cite poor observational analysis, a simplistic scientific approach and confirmation bias. They claim, also, that he ignored native people who weren’t healthy, and that those who were in contact with European and modern civilisations were affected by diseases unfamiliar to them historically. They claim, with their own confirmation biases, that modern food is wholesome but native people “overconsumed” and didn’t balance their diets correctly.
“The most serious problem confronting the coming generations is the nearly insurmountable handicap of depletion of the quality of the foods because of the depletion of the minerals of the soil”. Weston A. Price
Let us look further back than Price’s influence on the nutritional debate, but perhaps something he may contend today is as essential, that of our very distant ancestors. Fossil records go back nearly 14 million years with Ramapithicus, found in Africa. Our cave-dwelling forefathers evolved over time in different habitats, with different foods, and began to migrate north living and eating seasonally. The lived and worked in communities to hunt and gather foods, designing tools and weapons, working in teams collaboratively to achieve their nutritional necessities. In the mid 20th Century, different hypotheses examined the changes in dietary cultures, meat-eating, seed-eating and, in particular, the Extensive Tissue Hypothesis which related brain and gut size in human evolution. The control of fire, the preparation of starches and meat led to increases in the energy gained from food in comparison to the raw form. The cooking process increased digestion, higher blood glucose, the energy gained through this process increased by nearly 30%. Interestingly too, the human microbiome, a mass of trillions of bacteria, is also responsible for 6-10% of daily energy supply, creating short-chained fatty acids, hormones than regulate hunger and satiety and vitamins, in particular, B6 and B12, passing via the gut lining into the blood supply. The microbiome has now become a subject of scientific research, and its presence into the oral cavity cannot be underestimated in its role in digestion and oral health. It is observed that the modern human microbiome in comparison to apes, monkeys and chimpanzees is far less diverse.
“Don’t eat anything your great-great-grandmother wouldn’t recognise as food”. Michael Pollan
What we know, as a consequence of the research, including the likes of Weston A. Price, is the importance of nutritional behaviour in the prevention and treatment of dental caries and periodontitis. The optimal function of the body’s host defence system is dependent upon an adequate supply of antioxidant micro-nutrients. Micro-nutrient antioxidants are essential for limiting tissue damage but also decreasing prolonged inflammation. Reducing periodontitis is associated with a reduction in HbA1c, a test measuring your average blood glucose over 2-3 months and gives an indication of your longer-term blood glucose control. Reducing blood sugar is also associated with reductions in death-related diabetes and myocardial complications.
“An adequate, well-balanced diet combined with regular physical activity“. World Health Organisation, Definition of Nutrition
Oxidative stress or oxidation is a damaging activity caused by an attack from free radicals. Nutrients called antioxidants help the body’s natural defence system combat this process. A variety of antioxidants including vitamins, A, C, E as well as minerals like Selenium and Zinc, are found in fruits, vegetables, nuts, seeds, oily fish and whole grains. Vitamins D2, from food sources and D3, from sunlight, are vital, along with Calcium, for bone health and repair. It is seen to benefit older age groups, beyond 50 years. Other studies indicate a 20% likelihood of less tooth lose with sufficient Vitamin D blood levels and 14% less likely to lose teeth over 5 years.
“Fermentable carbohydrates are the most relevant common dietary risk factor for caries and periodontal diseases” state Moynihan and Petersen (2004). Vitamin C depletion can lead to profuse gingival bleeding, known historically as Scurvy. Periodontal diseases demonstrate lower serum Magnesium and Calcium levels as well as lower antioxidant micronutrient levels. Using Vitamin D supplementation combined with Calcium has been shown to reduce risk in the elderly. The concentration and bioavailability of carbohydrates and starchy foods and the lack of Vitamin D, K and Calcium in the developmental growth of teeth increase the risk of dental caries.
“Let food be thy medicine”. Hippocrates
Upon reflection, it is advisable to create a guide for my clients regarding what will benefit healing and repair of dental diseases nutritionally. This I did in the light of an authentic learning project undertaken in 2017, but does it require updating? I would consider a deeper dental orientated nutritional discussion with all clients who have active periodontal disease, including bleeding on probing over 10% with no attachment loss. This would include supplementation of Vitamin D and Calcium with an additional emphasis on an antioxidant-rich diet and a significant reduction in fermentable carbohydrates. I’d consider, in severe cases, advising them to test for serum Vitamin D levels and advise exposure to a recommended level of sunlight too, depending upon the season. In the case of dental caries in the light of no new knowledge, I would continue with a reduction, cessation where possible, and regulation of fermentable carbohydrates. The onus on oral health improvement measures with both diseases are multifactorial, not just purely nutritional, but it does, however, play a significant role in both.
“Going against the principles of nature does nothing but harm for us, the animals and the environment”. Weston A. Price
Weston A. Price, I believe, was a principled and holistically minded individual worthy of study and attention. The mantle for his ancestrally linked nutritional improvement for better health has been handed over to many others, books are written, careers changed, lifestyles altered for the better and his legacy continues. I have learned to put his cannon of work into the context of time and his life experiences. I won’t judge him too harshly on what we know where he was incorrect but will maintain and protect the best intentions and knowledge gained from his work. He attracts and continues to influence those who associate good nutritional behaviour with better environmental practice and those who hold the values of our ancestral dietary legacy in line with their belief in nature.
Carmody N, Weinstraub G, & Wrangham R. (2011) Nat Academy of Science, USA.Energetic consequences of thermal and nonthermal food processing. Nat Academy of Science, USA.
Schmidt K. (1997) Interaction of antioxidative micronutrients with the host defence mechanisms. A critical review. Int J Vit Nutr Res.
Simpsom T, Needleman I, Wild S, Moles D, & Mills E. (2010) Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database.
Dietrich T, Joshipura K, Dawson-Hughes B, & Bischoff H. (2004) Association between serum concentrations of 25(OH)D3 and periodontal diseases in the US population. Am J Clin Nutr.
Jemenez M, Giovannucci E, Krall Kaye E, Joshipura J, Dietrich T. (2014) Predicted vitamin D status and incidence of tooth loss and periodontitis. Public Health Nutr.
Zahn Y, Samietz S, Holtfreter B et al. (2014) Prospective study of serum 25-hydroxy Vitamin D and tooth loss. J Dent Res.
Moynihan P, & Petersen P. (2004) Diet, nutrition and the prevention of dental diseases. Pub Med.
Leggott P, Robetson P, Rothman D, Murray P, & Jacob R. (1986) The effect of controlled ascorbic acid depletion and supplementation on periodontal health. Journal of Perio.
Van der Velden U, Kuzmanova D, & Chapple I. (2011) Micronutritional approach to periodontal therapy. Journal of Clinical Perio.
Krall E, Wehler C, Garcia R, Harris S, & Dawson-Hughes B. (2001) Calcium and vitamin D supplements reduce bone loss in the elderly. Am Journal of Medicine.
Miley D, et al. (2009) Cross-sectional study of vitamin D and calcium supplementation effects on chronic periodontitis. Journal of Perio.
Chapple et al. (2017) Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases. Consensus report EFP/ORCA.
Eat well, keep gums healthy, live longer. Juliette Reeves RDH UK – https://www.nature.com/articles/bdjteam201940
Weston A. Price – Overview – https://youtu.be/OH1HSG9AOS8
CARTA: The Evolution of Human Nutrition – https://youtu.be/jGUsMYXdDDc
Weston A. Price’s appalling legacy-https://sciencebasedmedicine.org/sbm-weston-prices-appalling-legacy/
Weston Price – https://en.wikipedia.org/wiki/Weston_Price
The gang of five. Alternative approaches to dental disease prevention and celebrating the diversity of progressive opinions. Whole dental health and beyond.
When we critically look at scientific research (this assuming we do) our aims are to look at the type of research, the quality of the question, its methodology, their outcomes and results, subsequent conclusions and its relevance to our uniquely individual workplaces. The traditional face value approach featured heavily in the first half of my professional journey as a registered dental hygienist. To pass my certificate in dental hygiene back in 1988 it required of me a straightforward context. To believe everything I was shown or taught, reproduce it in writing and action, to a standard pass. My real learning began on my first day in clinic, post-graduation. My over sharpened and extremely thin sickle scaler fractured at the tip between the lower anterior teeth on my first client. I can remember my overconfidence, not born of experience but of the outcomes I magically and naively envisaged. I was the “master technician”, with all the data inputted, the on switch to go and the power selected for perfection.
I really had no expectation of a need to update on my own, I had been breastfed by the “gated” institutional culture of my learning, latching on at specific points of time and refuel with knowledge relayed from the institutional mothership. No thought of questioning my own practice every crossed my mind initially, to consider enquiring about anomalies observed in my everyday practice or connections between other healthcare practices and my own. The dentist was the one and only direct port of call, but the occasional trade or professional body publication revealed very little edifying additional new knowledge. The annual symposiums were the only real learning hubs available to me, the attending audience obediently and diligently offered applause to every keynote speaker and after each session fled sheeplike to the resident trade stand after which an orgy of sample taking unravelled.
My first experience of open critical thinking began at such an event a dozen or so years into practice, that long. A speaker, talking to a mass of hygienists, brutally and honestly stated that there was no research evidence to demonstrate that flossing was effective at reducing gingivitis, this would be a hot potato, many years later. I was horrified to hear this, I was an advocate to its efficacy and felt affronted by this preposterous charlatan. It challenged all I was wedded too and that was the point. I immediately put up my hand and challenged him back. He was probably waiting for this moment, well prepared and responsive in a friendly, calm and measured manner. The audience has silent, aware of the relevant context of the exchange. Afterwards, in the trade hall, he tracked me down, laptop and research in hand and explained in further detail, supporting his claim. He was, of course, right. I hadn’t a sound grounding in research, in fact very little at all until that point, thus began my contrarian journey into research, aided and abetted by this and many more fact-finding experiences to come.
I suppose the real rub of the green moment occurred after a year of study at the University of Kent where I studied part-time for a year in the mid-noughties. The first excursion into evidence-based practice learning, critical thinking and reflection were transformative. After that experience, I began blogging on topics close to my heart, getting to grips with new technologies of caries risk assessment and beginning self-directed learning journeys. This culminated in educational trips to New York, Key Opinion Leading and mentoring for Philips Sonicare and presenting to audiences at regional and national meetings. This lifelong learning worm had turned. The final flag-planting assent into learning enlightenment presented itself with O’Hehir University, and action research and reflective practise became active companions in my workplace.
Since then, I’ve taken a somewhat left-field approach to new knowledge creation for creative and curious is what it is to me, without exception. It provides a platform for the unorthodoxy of self-directed or independent person growth. It creates a playing field for new ideas to disseminate, to flow, challenge, and complement the landscape of my personal dental education. The independent researcher, the workplace learner, and reflective practitioner appear to be the future of education in dental health. The educational and regulatory establishments in several countries are now beginning to progressively embrace this new environment and are opening the gates to innovative practices. This also reflected to need to learn what was relevant in the unique workspace, required for the personal and professional development of the clinician.
In this alternative habitat of new learning brought about by modern technologies are a new breed of progressive, professional free thinkers. They are eloquent, motivational and provocative. The first exponent of this “dark dental” movement is Dr. Kim Kutsch. Kim has been active in the field of caries risk management for many years and must qualify, in my mind, as the Godfather of this genera. He is responsible for a significant resurgence into actively treating caries as a disease of imbalance, of pH and specific acidogenic, aciduric bacteria, as well as the more obvious importance of dietary fermentable carbohydrate. He also alludes to the significance of dry mouth, oral hygiene and our DNA. He advocates, as do many other like-minded thinkers the environmental and co-existing balanced approach to dental disease prevention. He has gone commercial one stage further. The creation of www.carifree.com provides a range of research and educational elements alongside a variety of products that can be used to identify at-risk individuals and solutions to pH and bacterial imbalances in caries cases. He has also worked with the research by Professor John Featherstone, a pioneer in caries research, to create caries risk assessment tools. Kim keeps his campaign to reduce disease in teeth up to date and relevant but also engages in active participation in educational topics, fronting presentations both online and in-person across the world and has a large following.
The xylitol prebiotic benefits are at the forefront of Kim’s approach after the destruction of the dysbiotic oral biofilm to help reseed the ecology of the mouth after, over time. This process is further supported by Dr. Mark Cannon, another American dentist and oral environmental activist. Mark is a proponent of the Neuro Arterial Gingival Simplex, positing the implication of a specific bacterial type, Porphyromonas Gingivalis. This alludes to this bacteria’s accountability in gingival diseases, atherosclerosis, and Alzheimer’s disease.
Mark has an intriguing divergent interest, growing amongst alternative and progressive healthcare professionals nowadays, in the evolutionary aspects of dentistry. He has studied and discusses with clarity the nutritional role in the development of the mouth, the evaluation of oral forms in the mouth, frenulum, tonsils and adenoids, the ecology of balanced play, processes that promote it and the benefits of our gateway oral microbiome to the rest of the body. These include, like Kim, the use of xylitol but also a similar sugar alcohol, erythritol. He also advocates the use of calcium phosphate-based toothpaste and Silver Diamine Fluoride in caries risk reduction and remineralisation strategies. You can find out more about the mark at www.drmarklcannon.com.
Dr. Steven Lin, a practising Australian dentist in Sydney in Australia is to me, living in New Zealand, a more local dental health legend. Steve began his journey into enlightening others with his activistic research in 2017. He then published his book, The Dental Diet, gaining a broad international audience. His participation in regional, national and international presentations further added kudos to his moral crusade. He starts by bringing back to the dental world the controversial figure of Weston A. Price, a long forget and conveniently ignored and published dentist with controversial environmental dental health research. The premise of Price with recent advocacy from Lin is not to ignore our ancestral dental past, in particular when compared to current dental issues of the arch under development, crowding of teeth and the nutrition of the body and the mouth with whole food. The importance of micronutrients like vitamins D, A and the recently discovered vitamin K2. He proposed that eating these and other micro and macronutrients are important for dental health. Steve also began the conversation and journey into oral myofacial function and epigenetics. Find out more about this progressive dentist at www.drstevelin.com.
Professor Philip Marsh, based at Leeds University in the UK, and the Health Protection Agency, is an world renown expert in bacterial behaviour in humans. He describes oral health is more than just the absence of disease but also crucial in boosting and promoting general health. He goes onto further propose that pathogenic bacteria grow in the mouth due to changes in the lifestyle of the individual. Beneficial bacteria produce natural benefits, regulating heart health and the immune system and gut health. Our human microbiome has co-evolved with us, living in structurally functionally organised communities communicating with themselves and our human cells. A great YouTube video can be viewed at https://youtu.be/zuxNMVR2nVM.
Last but by no means least is Dr. Bonnie Bassler, a Professor in Microbiology with interest in chemical signalling mechanisms of bacteria. Bonnie has been a keen observer in the growth and development of bacteria, their benefits and negative impacts on the body. She succinctly reveals the importance of bacteria to us, their scale and size comparatively in both cell and gene numbers but more importantly describes the incredible intricacy of their means of quorum sensing or communication. They create hormones to converse, talking and hearing, to neighbouring cells in multiple cellular languages, demonstrating collective behaviours. Her aim is to determine whether this community of communication can be disrupted or modified to produce human health benefits in the future. See more at https://youtu.be/KXWurAmtf78.
The world of dental health education continues to grow, the means to deliver it is evolving too. The age of the book continues with the likes of Dr. Steve Lin, await more publications from him both in paperback and eBook formats. Others will continue with online platforms like websites and video channels as well as podcasts. A special mention must go to Dr. Ryan Nolan for his series of podcasts that includes the likes of Steve, Kim, Mark, and many more besides. You’ll find these at www.thebiofilmfactor.com, ideal for company during a long walk with earphones in or at the gym when working out.
Understanding the Nature and Intent of the Anti-Water Fluoridation Movement in the Context of My Workplace – A Whole Dental Health Reflection.
If you want to assert a truth, first make sure it is not just an opinion that you desperately want to be true. Neil deGrasse Tyson.
From the German 16th century Martin Luther to the Tolepuddle Martyrs of early 19th century Britain, there have been many human movements demanding change, calling for greater representation, challenging authority and creating opposition to the established norm. Such pressure groups range from the political and cultural to those championing causes from the environment, animal, religious and human rights to global public health. In this of late has a dental dimension, related to the contention of fluoridation of community water supplies. Rather that accepting the status quo and established public health agenda of imposing it on all the population without means of proper address pressure groups and activists have rallied to challenge its scientific validity.
In New Zealand, where I live and practice, 40 percent of 5 year old children have tooth decay, whereas only 27 out of 67 councils fluoridate their water supply and 54 percent of the population have un-fluoridated water. The adoption of water fluoridation nationally, in line with World Health Organisation recommendations, has become a highly contentious public health issue. Alleged negative outcomes of it range from the risk of reactive biological effects of water fluoridation, the dosages of which are up to 200 times higher than is found in mothers breast milk. It is perceived however, in the New Zealand national context to be beneficial due to lower than globally accepted levels of Fluorine, one of a many natural occurring chemical elements, in the native soil. The debate rumbles on beyond our teeth to other parts of the body, and into our professional learning needs as I hope this account demonstrates.
My clinical setting brings this strikingly into focus. I have a broad range of clients with differing opinions on fluoride, more so than I have ever experienced before. The client base is attracted to the “natural” philosophy of the dental practice where I work part-time. Many also show an active scepticism with respect to the myriad of additional products found in many toothpastes, beyond the well-known offenders, Triclosan and Sodium Lauryl Sulphate.
Fluoride is a negatively charged ion of fluorine and is one of the most abundant elements found in nature. Sodium Fluoride is an inorganic salt of fluoride used topically or in community water fluoridation programmes to prevent dental caries. Fluoride appears to bind to calcium ions in the hydroxyapatite of surface tooth enamel, preventing corrosion of tooth enamel by acids. This agent may also inhibit acid production by commensal oral bacteria. However, Sodium Fluoride is an extremely toxic substance, just 200mg of it is enough to kill a young child and 3-5gms, a teaspoon, is enough to kill an adult. The worldwide criticism of systemic fluoride stems from contention with “low margins of safety and lack of control over the amount of individual intake when administered on a community level.”
Who are the opposition? They appear to be well organised and motivated, mainly libertarian and environmental activists, the movement of which began in 1960’s and gained more strength as scientific research began to further support their philosophies. They critically claim that once fluoride is in the water supply it is impossible to control the individual dose and, that fluoride is found in other natural and “added to” products, like tea and mouth rinses, can increase that dosage increasing risk over time. The bigger argument alludes to the moral issues revolve around human rights, mass medication, informed consent necessary to comply ethically for prescriptions of all medication. This is the reason most Western European countries have ruled against its use. The lines are drawn between the “official” evidence, its interpretation and determination as to its veracity within the a given country’s political and social context.
The party line is represented by the scientific community such as the established and renown Centre of Disease Control and Prevention (CDC) in the US. They state that “Fluoridation of the community drinking water is a safe, cost effective and efficient strategy of reducing dental decay among Americans of all ages and from all social strata”. The CDC maintains and attributes a steep decline in tooth decay in the US to fluoride, whereas the lobbyist perspective is that disease rates are globally reducing despite the wide distribution of fluoridated products. They assert that serious research attributes improvement with fluoride as only between 40% – 50%.
The anti-fluoride lobby arguments continue beyond teeth:
The related long term health effects of water-fluoridation is the greater bone of contention with my clients. They are well informed in this matter and their fundamental discord with this element extends in some to the belief that topical fluoride is a problem too.
To add fuel to the smouldering fire The Cochrane Collaboration, a robust, renowned critical scientific organisation looked at 20 studies on the effects of fluoridated water on tooth decay and 135 studies on dental fluorosis. They published the results in 2015. They concluded that “all results are based predominantly on old studies and may not be applicable today. Within the ‘before and after’ studies we did not find any on the benefits of fluoridated water for adults” but there was “insufficient information about the effects of stopping water fluoridation”. They also found “insufficient information to determine whether fluoridation reduces differences in tooth decay levels between children from poorer and more affluent backgrounds”. “Overall, the results of the studies reviewed suggest that, where the fluoride level in water is 0.7 ppm, there is a chance of around 12% of people having dental fluorosis that may cause concern about how their teeth look”.
When reviewing the considered opposition to fluoride I am bewildered by the lack of academic dental advocacy for water fluoridation to counteract them. Those who choose to face educated and fundamental opinion, from well-read academics to informed members of the general public. I also feel, upon reflection, that I have never been fully conversant with all the facts upon consideration. New truths revealed can pose a dilemma to professionals who hold to established doctrine.
How deeply would we go down the rabbit hole of confronting our knowledge gaps? Do we solely rely on the dental industry, who cleverly veil their commercial interests by support professional bodies financially and at the same time promote the benefits of their products, with verifiable education? Are we really serving our client community and their need by paying lip service to what we are promoted to learn? A deeper awareness of their attitudes towards alternative approaches and concepts, alternative oral health products should be engaged with, free of judgement. Some may be persuaded by radiographic or visual evidence of a need to change their oral health habits in the direction of conventional methods like the use of topical fluoride clinically or at home. Conversely, a caries free mouth, demonstrably managed and maintained requires us to think differently in our approach to their support. What have they done to achieve that and what can we learn from it?
Being wedded to our belief system doesn’t make us right, we maybe the product of our initial and ongoing dental education. But by questioning everything, not relying on lazy face value attitudes, reflecting on our own and another’s stand point drives enlightenment and ultimately action upon it. The a result of new knowledge gain is enlightenment, and is ongoing. In the bubble of my clinical culture here in Nelson I would continue to be guided by evident clinical risk and need but also a policy of treating not just what I see but who I see. I would also advocate for associated lifestyle and nutritional behaviour change if indicated. The obvious “big elephant in the room” is the need for high quality oral health education, effective saliva function, beneficial bacteria predominating, fermentable carbohydrate restriction and control.
As the food supply historically evolved it has negatively deviated from ancestrally orientated diets to less nutritional and more simple carbohydrate loaded foods, which in turn play to addictive eating behaviours. The dawn of the modern diet, championed by “experts in the field” of nutrition after the last world war, has led to an increase in chronic communicable diseases, like dental caries. Some even suggested that decay in teeth was a so called” nutritional “side effect” of a healthy diet composed mainly of carbohydrates. Fluoride it seems was the answer to this condition.
Dental health education, in the form of better oral hygiene, nutritional advice and the use, where necessary of topical fluoride is championed loudly by the opposition as an alternative to needless and ineffective water fluoridation. I was pleasantly surprised that they were more supportive of what I champion as a dental healthcare professional. I was deeply disappointed that the proponents of water fluoridation weren’t advocating for these measures in as much magnitude.
We must never forget who benefits from continuing professional development, our clients first and foremost, their safety and health are our primary concern and how we attend the need of updating that knowledge is a sacred truth, where does it come from, who is delivering it, want is their intent, and how do we interpret it? I fall on the side of healthy scepticism regarding water fluoridation, it’s safety and benefits as a result of this inquiry. I will continue to propose the use of topical fluoride in those who have “at risk” lifestyle behaviours and nutritional choices less than optimal for stable oral health. I will give support to those who continue to refuse to use fluoride products with options and advocate behaviour changes that afford a similar outcome to topical fluoride use.
5.The Fluoride Debate: The Pros and Cons of Fluoridation
6.The Case Against Fluoride, Paul Connett in New Zealand 22Feb2013
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