In January 2026 a maxillofacial professor at Goethe University Frankfurt published a paper with the two men most associated with the claim that hidden holes in the jawbone make people ill. It reported that something does remain in the socket after a tooth comes out. It then declined to call that something a disease. Neither camp has said much about it since.

Biological dentistry is not one claim. It is many, with different levels of research support. Some are now regulatory policy across the European Union. Others have never been studied by anybody at all. Which doesn’t make them false, it just means that the research is yet to be done.

The pages answering this question — almost all of them written by clinics that sell the treatments, and almost all of the rebuttals written by people defending the procedures under attack — tend to present the bundle as a single proposition, to be swallowed or rejected whole. That doesn’t do the subject justice. Graded one at a time, against what biological dentistry actually is, it looks like this.

Which benefits of biological dentistry are supported by evidence?

Each claimed benefit is graded on a five-point scale. The grades describe the state of the evidence, not the competence of the practitioner.

Grade	Meaning
Established	Accepted by mainstream dental bodies and reflected in routine practice
Supported	Peer-reviewed evidence exists, but it is not yet mainstream practice
Emerging	Early research only; no consensus either way
Contested	Practitioners assert it and cite evidence; mainstream bodies dispute it
Not demonstrated	No clinical study has established it either way

Claimed benefit	Grade	What supports it	What doesn’t
Avoiding new amalgam reduces your mercury exposure	Established	EU use ban since January 2025; Minamata COP-6 agreed a global phase-out by 2034; UK restrictions since July 2018 for under-15s and pregnant women	Regulators acted on environmental mercury, not patient harm. SDCEP: the restrictions “are not a result of any safety concerns”
Removing amalgam benefits people with a diagnosed allergy or adverse reaction	Established	Endorsed by every body that opposes elective removal. SDCEP permits replacement “in patients with an allergy or adverse local reaction”; the FDA lists known allergy among its avoidance groups; the ADA’s ethics rule applies only to the “non-allergic patient”	Diagnosed allergy is uncommon, and the diagnosis should come from outside the practice proposing the removal
Protective protocols reduce exposure when amalgam is removed	Supported	Warwick et al. (2019), in an occupational-health journal, found drilling volatilises mercury above safety thresholds for more than an hour and concluded standard exposure assessment is inadequate	The components are standard practice. No mainstream body has evaluated the bundled SMART protocol, in either direction
Removing intact amalgam improves health in people without an allergy	Not demonstrated	Mercury vapour release from intact fillings is measurable. Nischwitz reports it helped a minority of his early cases	ADA Code of Ethics §5.A.1 calls it “improper and unethical”. FDA advises against. SDCEP: “no reason to replace clinically sound” restorations. Drilling spikes exposure and destroys sound tooth
Ceramic implants are a durable alternative to titanium	Established	ITI 7th Consensus Conference (2023): zirconia five-year survival 97.2%, “comparable to published data for titanium-based implants”	Atalay et al. (2026) report 83.8% at five years. The evidence applies mainly to one-piece designs
Ceramic implants look better	Supported	Padhye et al. (2023): zirconia scored better on aesthetics in head-to-head studies	Only four qualifying studies, 199 implants, twelve-month follow-up
Ceramic implants avoid titanium sensitivity problems	Emerging	Restelli et al. (2026): titanium hypersensitivity “rare but clinically relevant”. Kotsakis and Ganesan (2025) and a Rutgers group (2026) put titanium particle release into mainstream periodontology	Sicilia et al. found 0.6% allergy-positive in 1,500 patients. No validated diagnostic test exists. ITI: no evidence zirconia prevents peri-implantitis
Platelet-rich fibrin improves healing after extraction	Emerging	Autologous, low risk, and used well beyond biological dentistry in oral surgery	Ghanaati’s own 2025 randomised trial found unhealed sockets persisted despite PRF
Treating gum disease reduces whole-body inflammation	Supported	EFP–IDF consensus: the periodontitis–diabetes link is bidirectional, and periodontal treatment reduces HbA1c	American Heart Association (2025): “causality has not been established” for cardiovascular disease. Cochrane found no preterm-birth benefit
Cavitation surgery relieves facial pain in diagnosed NICO	Contested	Sekundo et al. (2022) found pain remission of 66–100% across 29 studies. Ghanaati’s 2026 paper confirms tissue remains in healed sockets. A 2025 scoping review from a conventional Polish group treats the entity as real	Up to a third showed minimal improvement or recurrence; all studies observational; no gold-standard diagnostic. AAE “cannot condone” the surgery. Keith (2025) asks whether NICO is pseudoscience
Removing a chronically infected root-treated tooth reduces inflammatory burden	Contested	The endodontic-medicine literature associates apical periodontitis — untreated infection at the root tip — with systemic inflammation. Chronic infection is a recognised inflammatory load	Umbrella reviews (Gomes et al., 2020) rate the evidence weak. The literature’s answer to an infected root-treated tooth is usually retreatment rather than extraction
A successfully treated, uninfected root canal causes systemic disease	Not demonstrated	Weston Price’s 1920s rabbit experiments, where the claim originates	AAE: “no valid scientific evidence”. British Endodontic Society: “unfounded and malicious”. Price’s extraction campaigns produced no benefit. Nischwitz does not make this claim
Removing dental metal reduces electromagnetic effects on health	Not demonstrated	The physics is real and measured: Jovanović et al. (2025) found a titanium implant roughly doubles local field strength and raises peak SAR	No study connects that to a patient outcome. WHO: “no scientific basis to link EHS symptoms to EMF exposure”. Nischwitz concedes there is “no study showing these effects”

What has biological dentistry got right?

On four questions the field was early, and the mainstream has since moved towards it.

Amalgam. Dr Dominik Nischwitz, one of the world’s highest profile biological dentists, was arguing for mercury’s removal from dentistry when that position cost him a national press campaign against him and an attempt on his licence. The EU banned it from January 2025. Minamata COP-6 set a global phase-out for 2034. The argument he was shouted down for in 2019 is now law across twenty-seven countries. That the regulators moved on environmental grounds rather than clinical ones does not change who was pushing.

Ceramic implants. The ITI’s 2023 consensus puts zirconia at 97.2% five-year survival and accepts it as an alternative to titanium. Fifteen years ago it was a fringe preference.

Titanium particles. Kotsakis and Ganesan, in the Journal of Dental Research in 2025, describe particles shed from implant surfaces as significant exposomes that “exert profound effects on local immune surveillance.” A Rutgers group reported in PNAS Nexus in April 2026 that the same particles impair macrophages’ ability to clear bacteria. Conventional periodontology, arriving belatedly at a concern biological dentists raised two decades ago.

The socket that does not fill in. Ghanaati told Nischwitz the idea was quackery when they first met. He now co-publishes with Johann Lechner and Jerry Bouquot, and his group has confirmed by CBCT that tissue remains in healed extraction sites, which means the field has been early more than once, and that dismissing it wholesale has a poor track record.

Does avoiding mercury amalgam benefit your health?

Amalgam is going, and it is going for environmental reasons.

The EU banned its use from 1 January 2025 under Regulation 2024/1849, subject to a clinical-necessity exception, and legislated a manufacture and import ban to follow from 1 July 2026. At Minamata COP-6 in Geneva in November 2025, dental amalgam was added to Annex A with a global phase-out year of 2034. The African Group had pushed for 2030.

In Great Britain it remains legal. It has been restricted since 1 July 2018 for pregnant and breastfeeding women, children under 15 and deciduous teeth. Northern Ireland holds a derogation running to 31 December 2034.

Read the instruments and the subject is mercury in rivers, not mercury in patients. The Scottish Dental Clinical Effectiveness Programme, part of NHS Education for Scotland, is unusually direct about it: the restrictions “aim to help reduce environmental mercury pollution and are not a result of any safety concerns,” and there is “no evidence that dental amalgam presents a direct health risk to individuals who have amalgam restorations.” The Oral Health Foundation says none of the claims linking amalgam to Alzheimer’s, autism, muscular dystrophy or Parkinson’s “have been substantiated.”

The FDA has gone furthest. In September 2020 it recommended that specific groups avoid amalgam where possible — pregnant and nursing women, women planning pregnancy, children under six, and people with pre-existing neurological disease, impaired kidney function or known allergy — while maintaining that the majority of the evidence shows no negative health effects in the general population. A precautionary carve-out, not a reclassification.

The transition carries a cost the benefits pages omit. A Newcastle University cost-consequence analysis published in the British Dental Journal in July 2026 found that in English NHS care, amalgam outperformed composite for patients, practitioners and funders on everything except appearance. The British Dental Association, which has campaigned for a phase-down rather than a phase-out, reports members seeing amalgam prices rise around 150% in three years and says no alternative yet matches it “on speed and ease of placement or longevity.”

So the mercury goes. Whether the population is measurably healthier for it is a separate question.

Is there a benefit to having existing fillings removed?

It depends entirely on whether you have an allergy, and that distinction is missing from most of the pages on both sides of the argument.

If you do, removal is uncontroversial. SDCEP permits replacement “in patients with an allergy or adverse local reaction.” The FDA lists known allergy among the reasons to avoid amalgam. The ADA’s ethics rule, quoted below, applies specifically to the non-allergic patient. Every body that opposes elective removal makes the same carve-out.

If you do not, the evidence runs the other way. Dr Dominik Nischwitz, author of It’s All in Your Mouth and the best-known advocate of the strong version of this theory, tried it on his own patients first:

“When I was in my first year after university, geek, I thought if I take out all these mercury fillings safely, that’s the holy grail. I’m going to heal every single patient. Wasn’t the case. It worked for a few, but from 80% of all the cases, it was like they actually got not even better, or something happened, or it was definitely not the holy grail.”

It is a useful admission, although the professional position is firmer. The ADA’s Code of Ethics, section 5.A.1, filed under Veracity rather than under safety:

“Based on current scientific data, the ADA has determined that the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation of the dentist, is improper and unethical.”

That is a rule about what a dentist may truthfully recommend, and it is routinely quoted as though it were a finding about the procedure. The FDA’s objection is the practical one: drilling out an intact filling spikes mercury exposure and destroys sound tooth structure. The Oral Health Foundation warns that removal “can weaken the teeth.”

Where the biological dentists are plainly right is on how removal is done. Warwick et al., in the Journal of Occupational Medicine and Toxicology in 2019, found that high-speed drilling volatilises mercury vapour above safety thresholds for more than an hour afterwards despite engineering controls, and concluded that standard exposure assessment appears inadequate. An occupational-health journal, making their case for them. If a filling has failed and is coming out anyway, the protective protocol is worth asking for.

One caution on the label. Rubber dam, high-volume evacuation, sectioning rather than drilling out, water spray, external suction: all standard, all uncontroversial. The bundle sold under the IAOMT’s SMART name has never been evaluated by the ADA, FDA, BDA or SDCEP in either direction — an absence that clinic websites render, optimistically, as approval.

Are ceramic implants better than titanium?

Lisbon, 2023. The International Team for Implantology’s 7th Consensus Conference: “zirconia implants show a mean survival rate of 97.2%, range: 93.8%–100% at 5 years, comparable to published data for titanium-based implants.” ITI accepted one-piece zirconia as an alternative to titanium for single crowns and three-unit fixed prostheses.

Three caveats came attached. The evidence applies mainly to one-piece designs. Two-piece zirconia has limited long-term data. And there is no clinical evidence that zirconia beats titanium at preventing peri-implantitis. A fourth arrived in 2026, when Atalay et al. reported five-year zirconia survival at 83.8% in Clinical Oral Investigations — thirteen points below the consensus figure.

On appearance the evidence is thin and points one way. Padhye et al. screened 6,040 records in 2023 and found four qualifying head-to-head studies covering 199 implants. No significant survival difference at twelve months. Zirconia scored better on aesthetics.

Titanium sensitivity is the murk. Sicilia et al. found 0.6% of 1,500 consecutive patients positive for titanium allergy. Müller-Heupt et al. concluded in 2022 that no validated diagnostic test exists — one study returned 37.5% MELISA-positive and 0% patch-test-positive in the same patients. A 2026 systematic review by Restelli et al. lands on “rare but clinically relevant,” which undercuts the dismissal and the testing industry in the same sentence.

What has moved is mainstream attention, and it has moved towards the biological dentists. Kotsakis and Ganesan, in the Journal of Dental Research in 2025, describe titanium particles shed from implant surfaces as significant exposomes that “exert profound effects on local immune surveillance.” A Rutgers group reported in PNAS Nexus in April 2026 that the same particles impair macrophages’ ability to clear bacteria. Both frame the particles as contributory within a host–microbiome–biomaterial system rather than independently causal — which is roughly what a careful biological dentist has been saying for years.

Ceramic is a real alternative that looks better and avoids a material now under mainstream suspicion. It is not yet a demonstrated upgrade in survival.

Can biological dentistry resolve chronic illness?

There are two ways to approach the claim. The strong version — that a successfully treated, uninfected root canal is a systemic disease reservoir — is settled against. The American Association of Endodontists finds “no valid scientific evidence” for it. The British Endodontic Society calls it “unfounded and malicious.” The BDA wrote to members in 2019 about the Netflix film Root Cause, which it said was “propagating misinformation.”

That version did not merely fail peer review. It failed in the clinic. Weston Price’s work had no control groups and rested on an inoculum artefact that made sepsis inevitable — extracted teeth implanted under the skin of rabbits at bacterial doses far beyond any physiological equivalent. What finished it was the wholesale extraction campaigns it inspired for rheumatoid arthritis, which produced no benefit whatever.

Nischwitz does not make that claim:

“So if you have a root canal right now and you feel perfectly fine, then just leave it, no problem.”

The narrower version is a different proposition, and it has support. A field called endodontic medicine studies whether apical periodontitis — untreated infection at the root tip, meaning the disease rather than the treatment — associates with systemic inflammation. Umbrella reviews rate the evidence weak, but the associations are reported, and chronic infection is a recognised inflammatory load. Where that literature and the biological dentists part company is on the remedy: the endodontic answer to an infected root-treated tooth is usually retreatment, not extraction. We have gone through that debate separately in whether root canals are safe.

Cavitations are the contested ground, and something is moving on it. Sekundo et al. screened 4,051 articles in 2022 and included 29; pain remission after surgical curettage ranged from 66% to 100%. A 2025 scoping review from a conventional Polish academic group treats fatty degenerative osteonecrosis of the jaw as a real entity and recommends imaging and surgical intervention.

Against that, the same Sekundo review found up to a third of patients showing minimal improvement or recurrence, could identify no gold-standard diagnostic method, and rated every included study observational and at high risk of bias. The AAE’s position statement says it “cannot condone surgical interventions intended to treat suspected NICO lesions,” and that extracting root-treated teeth to prevent them “is unethical and should be reported immediately to the appropriate state board of dentistry.” Aetna, less delicately, files the surgery and its imaging as experimental. Keith, at the Harvard School of Dental Medicine, titled his 2025 paper in the Journal of Pain Research “Scientific Controversy or Pseudoscience?” and answered his own question.

Then Ghanaati. Deputy Director of Oral, Cranio-Maxillofacial and Facial Plastic Surgery at Goethe University Frankfurt, publishing in Bioengineering in January 2026 alongside Lechner and Bouquot, and introducing Covered Socket Residuum: a healed but incompletely ossified socket. CBCT in a randomised trial confirms the tissue is there. The authors then state that these areas “may represent a physiological outcome of socket collapse and incomplete ossification rather than a pathological condition,” describe the evidence on cause and treatment as very limited, and call for controlled trials.

The observation is now mainstream. Whether it is a disease is open. What people actually notice is covered in the symptoms of hidden dental infections.

Nischwitz on why one intervention rarely explains a chronic illness:

“Of course, we have to work on all foundations, because there’s never one thing. Never. That’s completely wrong. Don’t trust that. There’s not one thing. It’s a multitude of things.”

Does treating your gums reduce whole-body inflammation?

Yes, and it is the oral–systemic benefit biological dentistry markets least.

The periodontitis–diabetes relationship is accepted as bidirectional by consensus of the European Federation of Periodontology and the International Diabetes Federation, and periodontal treatment measurably reduces HbA1c in patients with both. A whole-body benefit from dental treatment, demonstrated.

Cardiovascular is weaker than it is usually presented. The American Heart Association’s statement in Circulation in December 2025 found the association strengthened and said plainly that “causality has not been established,” with insufficient evidence on whether treatment improves cardiovascular outcomes. On pregnancy the association is accepted and the treatment benefit is not: a Cochrane review of fifteen randomised trials and 7,161 women found no clear difference in preterm birth.

Then the case that belongs alongside every oral–systemic claim ever made, in either direction. Porphyromonas gingivalis enzymes turned up in the brains of Alzheimer’s patients in Science Advances in 2019, and a drug programme followed. Atuzaginstat missed both co-primary endpoints in October 2021. The FDA imposed a clinical hold in January 2022 over liver toxicity. Cortexyme discontinued the programme in August 2022. Plausible mechanism, mainstream backing, pharmaceutical money, and it still did not translate.

Treat your gums. Be careful with anybody — selling or debunking — who gets from there to a named chronic disease.

What do UK dental bodies say about these benefits?

No UK professional body endorses biological dentistry as a discipline, and the General Dental Council does not recognise it as a registrable specialty. On the individual claims, UK institutions are consistently narrower than the marketing.

SDCEP: no evidence of direct health risk from amalgam already in the mouth, no reason to replace sound restorations, and restrictions that are environmental rather than clinical. The Oral Health Foundation: not a significant health risk, and do not replace fillings, because removal weakens teeth. The British Endodontic Society: unfounded and malicious. The BDA’s current line is that amalgam “remains an option for restorative dental treatments in the UK,” being “durable, cost-effective, and highly suitable for a range of clinical scenarios.”

On cavitations, no UK body has published anything at all. Every professional statement available in English is American — which cuts both ways. There is no UK endorsement, and there is no UK refutation either.

What are the risks and trade-offs?

Removal is not neutral. Drilling out an intact filling spikes mercury exposure and destroys sound tooth structure. Taking out a root-treated tooth removes something that was holding the bite and the bone, and alveolar bone recedes where a tooth has gone. Nischwitz makes the same point about half-finished work: taking out a root canal “without any long-term solution, this is insanity.”

The diagnostics are not validated. No gold-standard method exists for identifying a cavitation. No validated test exists for titanium sensitivity — the same patients returned 37.5% positive on one test and 0% on another. Treatment is being recommended on measurements nobody can yet rely on.

The money is private. NHS dentistry in England is banded: £27.90 for examination and advice, £76.60 for fillings and root canal treatment, £332.10 for crowns and dentures. Essentially nothing biological dentistry offers beyond conventional restoration is available on the NHS, and UK practices do not publish comparable fee data, so nobody can shop on price. Our treatment-by-treatment comparison sets out what each procedure involves.

And the practitioner who decides whether you have a cavitation is usually the practitioner who would operate on it. That is a structure rather than an accusation — it applies equally to the endodontist who decides you need the root canal — and it is why a second opinion is worth more here than almost anywhere else in dentistry.

Who is most likely to benefit from a biological dentist?

Five groups, on the evidence above. Anyone needing a new filling or crown who would rather not have amalgam — a preference most of the world’s regulators now share. Anyone with a diagnosed amalgam allergy. Anyone having failed amalgam removed anyway and wanting the exposure minimised while it happens. Anyone needing an implant with reason to avoid titanium, or who wants the better-looking result. And anyone with gum disease, where the whole-body evidence is strongest.

The hardest case is the group the field recruits most: people with unexplained chronic symptoms and no diagnosis. The claim there is not absurd — chronic infection is a real inflammatory load, and Ghanaati has now confirmed that the sockets in question are not always filling in. It is unproven, and expensive to test by surgery. That combination argues for a second opinion and a slow decision, not for dismissal.

Nischwitz’s own criteria are narrower than his field’s:

“However, if you have some sort of nagging health issues that you wouldn’t even closely relate to your mouth — brain fog, skin eczema, frozen shoulder, elbow, knee problems, sleeping issues, mental health issues that no one can fix — maybe then it’s time to find one of my real certified biodentists to assess.”

A referral into his own network, and conditional. Either those unfilled sockets are a disease, or they are what healing looks like in a jaw that has lost a tooth. A hundred years after Weston Price, nobody has run the study that would settle it. Somebody should.

Biological dentistry benefits: key facts

Best-evidenced benefits: avoiding new amalgam, removing it where an allergy is diagnosed, ceramic implants as a titanium alternative, and treating gum disease.

Weakest claims: that removing intact fillings in non-allergic patients improves health, that an uninfected root-treated tooth causes systemic disease, and that removing dental metal reduces electromagnetic effects.

Where the field was early: amalgam regulation, ceramic implants, and titanium particle release — all three have since moved its way.

Regulatory position: amalgam use banned in the EU since 1 January 2025 (Regulation 2024/1849); global phase-out by 2034 agreed at Minamata COP-6 in November 2025; still legal in Great Britain, restricted since July 2018 for under-15s, pregnant and breastfeeding women and deciduous teeth; Northern Ireland derogation to 31 December 2034.

Guideline recognition: zirconia implants. ITI 2023 puts five-year survival at 97.2%, though a 2026 study reports 83.8%.

Most contested: cavitation surgery. The AAE will not condone it; a January 2026 paper from Goethe University Frankfurt confirms tissue remains in healed sockets while leaving open whether it is pathological.

UK position on cavitations: none published, for or against.

Availability: almost entirely private.