An overview of the background and pharmacology of homeopathic remedies, and their clinical use in oral health care
This course was published in the August 2017 issue and expires August 2020. The author has no commercial conflicts of interest to disclose. This 2 credit hour self-study activity is electronically mediated.
This course was published in the August 2017 issue and expires August 2020. The author has no commercial conflicts of interest to disclose. This 2 credit hour self-study activity is electronically mediated.
After reading this course, the participant should be able to:
- Educate team members and patients about basic homeopathic principles, oversight and how this approach relates to dental treatment.
- Explain where homeopathy fits within the context of alternative and complementary health care treatment.
- List the main determinants for selecting a homeopathic treatment regimen.
- Discuss homeopathic pharmacology and application in clinical settings.
Increasing numbers of patients are seeking complementary and alternative therapies and give preference to practitioners who are knowledgeable about treatment options that embrace this branch of therapy.1 Complementary medicine views the healthy human body as an organism in a physically, mentally and emotionally balanced homeostasis, not merely a living being with the absence of discernible disease. Any interference with this balance will threaten homeostasis.
Naturopathy is an approach to medicine that employs manipulations, diets, herbs and even attitudes exhibited by the patient.2,3 Herbalism uses plant products in a nontoxic manner, conceptually the same as conventional drugs, and their efficacy can mimic and interact with pharmacological products. An example is the blood thinning effect of garlic, ginseng and ginkgo supplements, which may interfere with hemostasis during and after dental surgeries — potentially to the point of causing hemorrhaging.4 While homeopathy falls under the umbrella of alternative or complementary medicine, it is not to be confused with naturopathy or herbalism. Homeopathy is defined more narrowly than naturopathy, and is a school of medicine founded in 1810 by Samuel Hahnemann that differs from the orthodox school of medicine or allopathy. This branch of complementary medicine demands competent knowledge of all subjects included in the term “medicine,” from physiology, biochemistry, anatomy and pathology to microbiology, psychiatry and clinical diagnosis. Homeopathy is one of the most frequently used — yet most controversial — complementary therapies worldwide.3,5
In deference to patients who prefer alternative therapies, it behooves dental practitioners to know the differences between various complementary modalities so they can help with informed consent, especially when patients request complementary treatments. This article will highlight the general limitations and applications of homeopathic treatments, and emphasize the importance of providing the standard of dental care, as recommended by the American Dental Association and dental specialties’ professional organizations.
Homeopathy — from the Greek homoios (similar) and pathos (suffering) — is based on the principle of “like cures like,” and utilizes the physiological efficacy of ultramolecular solutions.6 The “law of similar” originates from a classic medical background. Hippocrates observed two ways of healing disease: one by using opposites, and another by using similars. Substances that are poisonous in their natural state can be employed to cure — but only to cure that which they can cause.
According to the U.S. Food and Drug Administration (FDA), homeopathy is the practice of treating syndromes and conditions constituting disease with remedies that have produced similar syndromes and conditions in healthy subjects.7
PHARMACOLOGY AND APPLICATION
The FDA regulates the manufacturing and distribution of homeopathic medicines, which have been subject to strict guidelines as drugs since the Food, Drug and Cosmetic Act of 1938 (although their safety and efficacy are not evaluated). Most homeopathic medicines are available over-the-counter, and marketing of nonprescription preparations is restricted to self-limiting conditions that can be recognized by consumers. The official compendium is the Homeopathic Pharmacopeia of the United States (HPUS), recognized by the FDA and referenced in the United States Pharmacopeia.
Drug products containing homeopathic ingredients in combination with non-homeopathic active ingredients are not classified as homeopathic drugs,7 and if herbal products are confused with homeopathics, adverse effects can occur. Ultramolecular concentrations of substances — derived from vegetation, animals, minerals or chemicals, as well as bacteria, viruses, protozoa, fungi and even diseased, but uninfected tissues — are attenuated. The medicines are formulated as impregnated sugar pellets, tablets or drops to be administered sublingually or applied topically as mouthwash, ointments, lotions, gels and creams.
The potencies of homeopathic drugs are specified in terms of dilution, for example, 1X (1/10 dilution), 2X (1/100 dilution) and so forth. Homeopathic drug products must contain diluents commonly used in homeopathic pharmaceutics.
The Compendium of Homeotherapeutics is described as “an addendum to the HPUS which contains basic premises and concepts of homeopathy and homeotherapeutics; specifications and standards of preparation, content and dosage of homeopathic drugs; a description of the proving process used to determine the eligibility of drugs for inclusion in HPUS; and the technique of prescribing the therapeutic application of homeopathic drugs.”8
ETIOLOGY AND TREATMENT
While pathogenesis is the process by which disease occurs, it is also the clinical presentation on a cellular, psychological, physiological, subjective or objective level. In homeopathy, pathogenesis is determined by “provings” (from the German Prüfung, or test); these are trials in which healthy patients are given various dilutions of a new remedy. Elicited symptoms, especially those for which the remedy was formulated, are documented. Homeopathic treatment is primarily selected not according to the diagnosis, but, rather, by the “individualized patient,” meaning that therapy is carefully tailored and the prognosis is proportional to the practitioner’s competence and experience, as well as patient biology. Homeopathic drugs are not administered in conventional pharmacological doses, but in minute to ultramolecular doses prepared per pharmacopoeial methods. These solutions are serially diluted and succussed (agitated) until the desired potency is produced. Greater dilution is said to lead to greater potency of the medicine.
Aggravation occurs when a homeopathic remedy produces the subjective or objective signs it is supposed to eliminate. Aggravation during homeopathic treatment can result when potency is too high, the dose is given too frequently, or in cases of significant subject sensitivity. Homeopathic aggravation is a “temporary worsening of existing symptoms after taking a homeopathic prescription.”8 It is rare, mostly transient and can usually be managed by the homeopath. In other words, an aggravation is an exaggeration of former symptoms, while a proving is newly developing symptoms. In such occurrences, the remedy should be stopped.
HOMEOPATHIC PHARMACEUTICAL TECHNIQUE
The goals of homeopathic preparations are first, to attenuate chemical and biological toxicity, and, second, to preserve, enhance or develop the medicinal effect. Designed to ensure quality and uniformity, there are three stages of homeopathic preparation, which must take place in FDA-approved facilities:
- Selection and initial preparation (of mother tincture, denoted by Ø, MT or TM)
- Potentization (of the homeopathic preparation)
- Impregnation (of the carrier)
Selection and initial preparation takes place with the substance (a plant, for example) in its optimal biological and pharmacological state. The washed and disrupted material is macerated in ethanol-water (60% to 80%) in a tightly stoppered glass vessel that is agitated daily. The water content of the substance, as calculated by desiccation, determines the solution’s percentage. The mother tincture is the liquid yielded after the contents of the vessel have been decanted, strained and filtered. The mother tincture should never be confused with the homeopathic preparation of the medicine.
The serial dilution of 1 in 1012 (potency 6C) contains ultramolecular pharmacological concentrations, in which even the most noxious contaminant has negligible chemical toxicity; consequently, any higher potencies will contain infinitesimal doses (1 in 1024 = potency 12C).
Such dilutions are used to impregnate the carrier (such as sugar pellets, lotions and tablets) or are administered in their liquid potency.
DOSAGE AND DILUTION
The mother tincture contains certain amounts of crude drug materials in alcohol, and is serially diluted and agitated as follows:9
- One part MT + 99 parts of alcohol + agitation = Dilution 1C
- One part of Dilution 1C + 99 parts of alcohol + agitation = Dilution 2C
- One part Dilution 2C + 99 parts of alcohol + agitation = Dilution 3C, etc.
–— or –—
- One part MT + 9 parts of alcohol + agitation = Dilution 1X
- One part Dilution 1X + 9 parts of alcohol + agitation = Dilution 2X
- One part Dilution 2X + 9 parts of alcohol + agitation = Dilution 3X, etc.
Practitioners who primarily prescribe in the frame of clinical homeopathy (e.g., following the therapeutic index) are advised to stay within the dilution range of 6C to 30C. Higher dilutions belong in the hands of highly experienced or classic homeopathic providers. The lower the number, the more frequently the dose can be repeated (e.g., every hour); the higher the number (i.e., dilution), the more general the medicine’s effect.
After three days of application, if symptoms worsen or resolve, the medication should be stopped. If the condition continues to progress and does not resolve, further diagnostics and data collection (or a referral) may be indicated.
Proper use of the therapeutic index is based on the ability to select the correct conventional diagnosis.
The repertory, which contains individual subjective and objective signs and symptoms, helps clinicians select modalities and features based on the patient and condition. Its use does not depend on the orthodox diagnosis. It is organized in rubrics and helpful when prescribing or in clinical homeopathy application. Repertorization can be useful for syndromes that are difficult to classify by a diagnosis, even after extensive data collection and diagnostics — examples include facial pain or temporomandibular joint syndrome.
After narrowing down suggestions from the therapeutic index and repertorization, the materia medica helps clinicians select a remedy based on the practitioner’s experience. The medicines are listed alphabetically and their properties are stratified under various headings. The curative and pathogenetic aspect of the remedy is listed, as is its efficacy and dosage.
Homeopathic medicines can have a systemic constitutional effect or a clinical and pathology-related action. Along with the dental diagnosis, the clinical signs and symptoms of the individual patient must be considered when selecting a medicinal therapy. Remedies may interrelate and have complementary (synergistic), antidotal (oppositional) or inimical (undesirable) effects.
Concomitant symptoms are called modalities, and may include:
- Laterality (e.g., left side, right side or extremity)
- Mental state (e.g., friendly or anxious)
- Pain quality (e.g., stabbing, sharp or throbbing) and quantity (e.g., intermittent or constant)
- Positional (e.g., laying down or sitting up)
- Periodicity (i.e., occurring at a consistent time)
- Thermal (e.g., improving with heat; worsening with cold)
Drugs are selected according to patient-specific susceptible typology and pathology. This means that a certain type of patient (predisposition and personality) will likely be sensitive to the action of a certain remedy, extending into constitutional aspects of pathological prescribing. Pathological prescribing will focus on clinical signs and symptom presentation of the pathology that is being treated with the pathological simillimum. For example, homeopathic chamomilla is the go-to prescription for teething, however, depending on the pain quality (which may be difficult to assess in small children), or in case of concomitant hypersalivation, the remedy Mercurius solubilis in its appropriate homeopathic dilution might be better indicated.
Drugs exhibiting congruence between their pathogenesis and the clinical presentation of that pathology are “homeopathic” to the disease. Medicines with the greatest similarity to the objective and subjective symptomatology of the condition are called simillimum (most similar). It should be emphasized that the symptom presentation may be different within the same clinical diagnosis, and thus require individualized treatment with a different prescription.
The pathological simillimum is the medicine most indicated and associated with the presentation of the clinical phenotype of the condition to be treated. “Leading symptom” or “keynote” are terms describing the modality or quality that stands out and is most strongly associated with the remedy. This may aid in drug selection, especially when it fits the case in other aspects. It can be a typical or strange sensation or symptom. If three keynotes match a particular remedy, the prescription is very close to the simillimum.
SIDE EFFECTS AND RISKS
The principles of homeopathy postulate that the lower the dose of the medication, the greater its efficacy. Homeopathic remedies are highly diluted and contain only submolecular concentrations of the original substance.
According to a 2007 study by the National Institutes of Health, “highly diluted homeopathic remedies taken under the supervision of trained professionals are generally safe and unlikely to cause severe adverse reactions. However, like any drug or dietary supplement, these products could pose risks if they are improperly manufactured (for example, if they are contaminated with microorganisms or incorrectly diluted).”8 Adverse effects have been reported when inappropriately low dilutions of toxic base elements were used, herbal supplements were mislabeled as homeopathic, or when homeopathy was used in place of indicated conventional treatment.8 From this, it appears most risks associated with homeopathy are due to practitioner or manufacturer error, rather than risks inherent to homeopathic treatment.
Medications prescribed by a physician should not be discontinued by a dentist without the physician’s consent. No significant and clinically relevant interactions between conventional drugs and (correctly produced and administered) homeopathic remedies have been reported. In addition, supplementations of vitamins and minerals, as well as oral nutrition, may complement homeopathic treatment and contribute to its therapeutic effects.10
It is of fundamental importance to understand, that homeopathy is not a substitute for sound dental practice. Rather, it complements traditional dental treatment of apprehensive or alternative-dentistry-oriented patients, and potentially improves outcomes by improving the biological response to treatment.
In the United States, regulatory controls surrounding the practice of complementary or alternative medicine and dentistry encompass six associated areas of law: licensing, scope of practice, malpractice, professional discipline, third-party reimbursement, and access to treatment. State laws govern the first five areas, while federal laws, predominantly through the FDA, chiefly regulate the sixth.11 Per malpractice rules, “practitioners are liable when their professional practices deviate from standards of care applicable to their locale and specialty, and when patient injury results.”12 This is problematic because, by definition, complementary/alternative care deviates from conventional/allopathic standards of care.13 Like traditional/allopathic clinicians, complementary/alternative practice providers are subject to professional disciplinary actions, which are frequently raised in conjunction with civil malpractice lawsuits.14
Homeopathy is unregulated in many states and third-party reimbursement is regularly denied to patients receiving such treatments because insurance companies classify the therapies as experimental and/or not medically necessary. Complementary/alternative therapies are infrequently included in benefit packages, although the number of insurers and managed care organizations offering coverage is increasing.15 When complementary/alternative therapies are covered by third parties, they tend to have high deductibles and copayments, and are bound by rigid restrictions on the number of appointments or total amount covered.16
Adjunctive homeopathic prescriptions for treatment of complex and chronic dental and oral conditions should only be written by experienced practitioners trained in homeopathy and who possess a solid background in pathology, etiology and prognosis when treating such conditions with the traditional standard of care.17 As noted, while homeopathy is no substitute for the standard of care in dental practice, it can be used in addition to conventional treatments and drug regimens.18 In addition, it is advisable to keep patient expectations realistic and in congruence with the provider’s expertise. Most problems arise when a condition that is not self-limiting remains undiagnosed or misdiagnosed, and is consequently not treated or mistreated.
Homeopathic therapy and prescribing are not recommended until the provider has accumulated specialized training and experience. As clinical knowledge expands, the practitioner is likely to become more aware of treatment choices and their limitations. With this in mind, alternative and complementary dentistry — as well as conventional or allopathic medicine — are not a panacea, and despite a clinician’s best efforts, may not produce the desired outcome.
Recognizing that the discussion of homeopathy as a treatment modality is highly polarized and charged, dental providers, even if not complementary oriented, will benefit from being knowledgeable about alternative therapies that support today’s patient-centered standard of care.18–21
The author wishes to acknowledge the assistance of Christopher Aloise, BA, and Samuel L. Rabins in preparing this manuscript.
- Darby P. How homeopathy can be used in dental practice. Dental Nursing. 2011;7:634–637.
- Eames S, Darby P. Homeopathy and its ethical use in dentistry. British Dental Journal. 2011;210:299–301.
- Reilly D. The puzzle of homeopathy. J Altern Complement Med. 2001;7 (Suppl 1):S103–S109.
- Spolarich AE, Andrews L. An examination of the bleeding complications associated with herbal supplements, antiplatelet and anticoagulant medications. J Dent Hyg. 2007;81:67.
- Vickers AJ. Clinical trials of homeopathy and placebo: analysis of a scientific debate. J Altern Complement Med. 2000;6:49–56.
- Dei A, Bernardini S. Hormetic effects of extremely diluted solutions on gene expression. Homeopathy. 2015;104:116–122.
- U.S. Food & Drug Administration. CPG Sec. 400.400 Conditions Under Which Homeopathic Drugs May be Marketed. Available at: fda.gov/iceci/compliancemanuals/compliancepolicyguidancemanual/ucm074360.htm. Accessed July 12, 2017.
- National Institutes of Health. Health Information. Available at: nccih.nih.gov/health. Accessed July 12, 2017.
- Banerji P, Banerji P. The Banerji Protocols: A New Method of Treatment with Homeopathic Medicines. West Bengal, India: PBH Research Foundation; 2013.
- Lessell CB. A Textbook of Dental Homeopathy For Dental Surgeons, Homoepathists, and General Medical Practitioners. Saffron Walden; 1996:1–224.
- National Institutes of Health Revitalization Act of 1993. Public Law 103-43. Available at: history.nih.gov/research/downloads/pl103-43.pdf. Accessed July 12, 2017.
- Cohen MH. Complementary & Alternative Medicine Legal Boundaries and Regulatory Perspectives. Baltimore, Maryland. The Johns Hopkins University Press;1998:1–177.
- World Helath Organization. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review. Available at: apps.who.int/medicinedocs/en/d/Jh2943e/5.18.html#Jh2943e.5.18. Accessed July 12, 2017.
- Corpus Juris Secundum. St. Paul, Minnesota: Volume 70. West Publishing Co; 1987:1–396.
- Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA. 1998;11:1569–1575.
- Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Eng J Med. 1993;328:246–252.
- Farrer S, Baitson ES, Gedah L, Norman C, Darby P, Mathie RT. Homeopathic prescribing for chronic and acute periodontal conditions in 3 dental practices in the UK. Homeopathy. 2013;102:242–247.
- Goel P, Torwane NA, Hongal S, Chandrashekar BR. Homeopathic medicine–an adjuvant for dentistry: a Review. IAMJ. 2014;2:203–210.
- Merrell WC, Shalts E. Homeopathy. Med Clin North Am. 2002;86:47–62.
- USGPO. Alternative Medicine–Expanding Medical Horizons: A Report to the National Institutes of Health on Alternative Medical Systems and Practices in the United States. Washington DC: U.S. Government Printing Office, 1995:1–372.
- Kantor JM. Homeopathy within alternative and orthodox care. Med Interface. 1997;10:60–64.
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From Decisions in Dentistry. August 2017;3(8):34–36, 39.