The Stress Prescription (Against Aging!)

10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

The Stress Prescription (Against Aging!)

This is Dr. Elissa Epel, whose work has for the past 20 years specialized in the effect of stress on aging. She’s led groundbreaking research on cortisol, telomeres, and telomerase, all in the context of aging, especially in women, as well as the relationship between stress and weight gain. She was elected member of the National Academy of Medicine for her work on stress pathways, and has been recognized as a key “Influencer in Aging” by the Alliance for Aging Research.

Indeed, she’s also been named in the top 0.1% of researchers globally, in terms of publication impact.

What’s that about stress and aging?

In her words,

❝Women with the highest levels of perceived stress have telomeres shorter on average by the equivalent of at least one decade of additional aging compared to low stress women❞

Source: Accelerated telomere shortening in response to life stress

We say “in her words”, as she is the top-listed author on this paper—an honour reserved for the lead researcher of any given study/paper.

However, we’d be remiss not to note that the second-listed author is Nobel Prize Laureate Dr. Elizabeth Blackburn. What a team! Maybe we’ll do a spotlight feature on Dr. Blackburn’s work one of these days, but for now, back to Dr. Epel…

What does she want us to do about it?

She has the following advice for us:

Let go of what we can’t control

This one is simple enough, and can be as simple as learning how to set anxiety aside, and taking up the practice of radical acceptance of what we cannot control.

Be challenged, not afraid

This is about eustress, and being the lion, not the gazelle. Dr. Epel uses the example of how when lions are hunting gazelles, both are stressed, but both are feeling the physiological effects of that stress in terms of the augmentation to their immediate abilities, but only one of them is suffering by it.

We’ll let her explain how to leverage this:

TED ideas | Here’s how you can handle stress like a lion, not a gazelle | Dr. Elissa Epel

Build resilience through controlled discomfort

Don’t worry, you don’t have to get chased by lions. A cold shower will do it! This is about making use of hormesis, the body’s ability to build resilience to stressors by small doses of controlled cortisol release—as for example when one undergoes thermal shock, which sounds drastic, but for most people, a cold shower (or even an ice bath) is safe enough.

You can read more about this here:

A Cold Shower A Day Keeps The Doctor Away

Connect with nature

You don’t have to hug a tree, but you do have get to a natural (or at least, natural-seeming) environment once in a while. Simply put, we did not evolve to be in the urban or even suburban settings where most of us spend most of our time. Getting to be around greenery with at least some kind of regularity is hugely beneficial. It doesn’t have to be a national park; a nice garden or local park can suffice, and potted plants at home are better than nothing. Even spending time in virtual reality “nature” is an option:

Effect of Virtual Reality on Stress Reduction and Change of Physiological Parameters Including Heart Rate Variability in People With High Stress: An Open Randomized Crossover Trial

(you can see an example there, of the kind of scenery this study used)

Breathe deeply, and rest deeply

Mindful breathing, and good quality sleep, are very strongly evidence-based approaches to reduce stress, for example:

Practice gratitude to build optimism

Optimism has a huge positive impact on health outcomes, even when other factors (including socioeconomic factors, pre-existing conditions, and general reasons for one person to be more optimistic than another) are controlled for.

Read: Optimism and Cause-Specific Mortality: A Prospective Cohort Study

There are various ways to increase optimism, and practising gratitude is one of them—but that doesn’t necessarily mean abandoning realism, either:

How To Practise (Non-Toxic) Positivity

There are other ways too, though, and Dr. Epel discusses some with her friend and colleague, Dr. Elizabeth Blackburn, here:

TED ideas | Could your thoughts make you age faster? And can we reverse that? | Dr. Elizabeth Blackburn & Dr. Elissa Epel

Want to learn more from Dr. Epel?

We reviewed one of her books, The Telomere Effect, previously. It’s about what we can do to lengthen our telomeres (a key factor in health aging; effectively, being biologically younger). You also might enjoy her newer book, The Stress Prescription, as well as her blog.

Enjoy!

Don’t Forget…

Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

Recommended

  • The Sweet Truth About Glycine
  • Not quite an introvert or an extrovert? Maybe you’re an ambivert
    Meet the ambiverts: adaptable individuals blending extroversion and introversion traits, mastering communication, leadership, and stress management.

Learn to Age Gracefully

Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Feel Better In 5 – by Dr. Rangan Chatterjee

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve featured Dr. Rangan Chatterjee before, and here’s a great book of his.

    The premise is a realistic twist on a classic, the classic being “such-and-such, in just 5 minutes per day!”

    In this case, Dr. Chatterjee offers many lifestyle interventions that each take just 5 minutes, with the idea that you implement 3 of them per day (your choice which and when), and thus gradually build up healthy habits. Of course, once things take as habits, you’ll start adding in more, and before you know it, half your lifestyle has changed for the better.

    Which, you may be thinking “my lifestyle’s not that bad”, but if you improve the health outcomes of, say, 20 areas of your life by just a few percent each, you know much better health that adds up to? We’ll give you a clue: it doesn’t add up, it compounds, because each improves the other too, for no part of the body works entirely in isolation.

    And Dr. Chatterjee does tackle the body systematically, by the way; interventions for the gut, heart, brain, and so on.

    As for what these interventions look like; it is very varied. One might be a physical exercise; another, a mental exercise; another, a “make this health 5-minute thing in the kitchen”, etc, etc.

    Bottom line: this is the most supremely easy of easy-ins to healthier living, whatever your starting point—because even if you’re doing half of these interventions, chances are you aren’t doing the other half, and the idea is to pick and choose how and when you adopt them in any case, just picking three 5-minute interventions each day with no restrictions. In short, a lot of value to had here when it comes to real changes to one’s serious measurable health.

    Click here to check out Feel Better In 5, and indeed feel better in 5!

    Share This Post

  • Red Light, Go!

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Casting Yourself In A Healthier Light

    In Tuesday’s newsletter, we asked you for your opinion of red light therapy (henceforth: RLT), and got the above-depicted, below-described, set of responses:

    • About 51% said “I have no idea whether light therapy works or not”
    • About 24% said “Red light therapy is a valuable skin rejuvenation therapy”
    • About 23% said “I have not previously heard of red light therapy”
    • One (1) person said: “Red light therapy is a scam to sell shiny gadgets”

    A number of subscribers wrote with personal anecdotes of using red light therapy to beneficial effect, for example:

    ❝My husband used red light therapy after surgery on his hand. It did seem to speed healing of the incision and there is very minimal scarring. I would like to know if the red light really helped or if he was just lucky❞

    ~ 10almonds subscriber

    And one wrote to report having observed mixed results amongst friends, per:

    ❝Some people it works, others I’ve seen it breaks them out❞

    ~ 10almonds subscriber

    So, what does the science say?

    RLT rejuvenates skin, insofar as it reduces wrinkles and fine lines: True or False?

    True! This one’s pretty clear-cut, so we’ll just give one example study of many, which found:

    ❝The treated subjects experienced significantly improved skin complexion and skin feeling, profilometrically assessed skin roughness, and ultrasonographically measured collagen density.

    The blinded clinical evaluation of photographs confirmed significant improvement in the intervention groups compared with the control❞

    ~ Dr. Alexander Wunsch & Dr. Karsten Matuschka

    Read in full: A Controlled Trial to Determine the Efficacy of Red and Near-Infrared Light Treatment in Patient Satisfaction, Reduction of Fine Lines, Wrinkles, Skin Roughness, and Intradermal Collagen Density Increase

    RLT helps speed up healing of wounds: True or False?

    True! There is less science for this than the above claim, but the studies that have been done are quite compelling, for example this NASA technology study found that…

    ❝LED produced improvement of greater than 40% in musculoskeletal training injuries in Navy SEAL team members, and decreased wound healing time in crew members aboard a U.S. Naval submarine.❞

    ~ Dr. Harry Whelan et al.

    Read more: Effect of NASA light-emitting diode irradiation on wound healing

    RLT’s benefits are only skin-deep: True or False?

    False, probably, but we’d love to see more science for this, to be sure.

    However, it does look like wavelengths in the near-infrared spectrum reduce the abnormal tau protein and neurofibrillary tangles associated with Alzheimer’s disease, resulting in increased blood flow to the brain, and a decrease in neuroinflammation:

    Therapeutic Potential of Photobiomodulation In Alzheimer’s Disease: A Systematic Review

    Would you like to try RLT for yourself?

    There are some contraindications, for example:

    • if you have photosensitivity (for obvious reasons)
    • if you have Lupus (mostly because of the above)
    • if you have hyperthyroidism (because if you use RLT to your neck as well as face, it may help stimulate thyroid function, which in your case is not what you want)

    As ever, please check with your own doctor if you’re not completely sure; we can’t cover all bases here, and cannot speak for your individual circumstances.

    For most people though, it’s very safe, and if you’d like to try it, here’s an example product on Amazon, and by all means do read reviews and shop around for the ideal device for you

    Take care! 😎

    Share This Post

  • 3 drugs that went from legal, to illegal, then back again

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Cannabis, cocaine and heroin have interesting life stories and long rap sheets. We might know them today as illicit drugs, but each was once legal.

    Then things changed. Racism and politics played a part in how we viewed them. We also learned more about their impact on health. Over time, they were declared illegal.

    But decades later, these drugs and their derivatives are being used legally, for medical purposes.

    Here’s how we ended up outlawing cannabis, cocaine and heroin, and what happened next.

    Peruvian Syrup, containing cocaine, was used to ‘cure’ a range of diseases. Smithsonian Museum of American History/Flickr

    Cannabis, religion and racism

    Cannabis plants originated in central Asia, spread to North Africa, and then to the Americas. People grew cannabis for its hemp fibre, used to make ropes and sacks. But it also had other properties. Like many other ancient medical discoveries, it all started with religion.

    Cannabis is mentioned in the Hindu texts known as the Vedas (1700-1100 BCE) as a sacred, feel-good plant. Cannabis or bhang is still used ritually in India today during festivals such as Shivratri and Holi.

    From the late 1700s, the British in India started taxing cannabis products. They also noticed a high rate of “Indian hemp insanity” – including what we’d now recognise as psychosis – in the colony. By the late 1800s, a British government investigation found only heavy cannabis use seemed to affect people’s mental health.

    Cannabis indica extract
    This drug bottle from the United States contains cannabis tincture. Wikimedia

    In the 1880s, cannabis was used therapeutically in the United States to treat tetanus, migraine and “insane delirium”. But not everyone agreed on (or even knew) the best dose. Local producers simply mixed up what they had into a tincture – soaking cannabis leaves and buds in alcohol to extract essential oils – and hoped for the best.

    So how did cannabis go from a slightly useless legal drug to a social menace?

    Some of it was from genuine health concerns about what was added to people’s food, drink and medicine.

    In 1908 in Australia, New South Wales listed cannabis as an ingredient that could “adulterate” food and drink (along with opium, cocaine and chloroform). To sell the product legally, you had to tell the customers it contained cannabis.

    Some of it was international politics. Moves to control cannabis use began in 1912 with the world’s first treaty against drug trafficking. The US and Italy both wanted cannabis included, but this didn’t happen until until 1925.

    Some of it was racism. The word marihuana is Spanish for cannabis (later Anglicised to marijuana) and the drug became associated with poor migrants. In 1915, El Paso, Texas, on the Mexican border, was the first US municipality to ban the non-medical cannabis trade.

    By the late 1930s, cannabis was firmly entrenched as a public menace and drug laws had been introduced across much of the US, Europe and (less quickly) Australia to prohibit its use. Cannabis was now a “poison” regulated alongside cocaine and opiates.

    Movie poster for 'Reefer Madness'
    The 1936 movie Reefer Madness fuelled cannabis paranoia. Motion Picture Ventures/Wikimedia Commons

    The 1936 movie Reefer Madness was a high point of cannabis paranoia. Cannabis smoking was also part of other “suspect” new subcultures such as Black jazz, the 1950s Beatnik movement and US service personnel returning from Vietnam.

    Today recreational cannabis use is associated with physical and mental harm. In the short term, it impairs your functioning, including your ability to learn, drive and pay attention. In the long term, harms include increasing the risk of psychosis.

    But what about cannabis as a medicine? Since the 1980s there has been a change in mood towards experimenting with cannabis as a therapeutic drug. Medicinal cannabis products are those that contain cannabidiol (CBD) or tetrahydrocannabinol (THC). Today in Australia and some other countries, these can be prescribed by certain doctors to treat conditions when other medicines do not work.

    Medicinal cannabis has been touted as a treatment for some chronic conditions such as cancer pain and multiple sclerosis. But it’s not clear yet whether it’s effective for the range of chronic diseases it’s prescribed for. However, it does seem to improve the quality of life for people with some serious or terminal illnesses who are using other prescription drugs.

    Cocaine, tonics and addiction

    Several different species of the coca plant grow across Bolivia, Peru and Colombia. For centuries, local people chewed coca leaves or made them into a mildly stimulant tea. Coca and ayahuasca (a plant-based psychedelic) were also possibly used to sedate people before Inca human sacrifice.

    In 1860, German scientist Albert Niemann (1834-1861) isolated the alkaloid we now call “cocaine” from coca leaves. Niemann noticed that applying it to the tongue made it feel numb.

    But because effective anaesthetics such as ether and nitrous oxide had already been discovered, cocaine was mostly used instead in tonics and patent medicines.

    Hall's Coca Wine
    Hall’s Coca Wine was made from the leaves of the coca plant. Stephen Smith & Co/Wellcome Collection, CC BY

    Perhaps the most famous example was Coca-Cola, which contained cocaine when it was launched in 1886. But cocaine was used earlier, in 1860s Italy, in a drink called Vin Mariani – Pope Leo XIII was a fan.

    With cocaine-based products easily available, it quickly became a drug of addiction.

    Cocaine remained popular in the entertainment industry. Fictional detective Sherlock Holmes injected it, American actor Tallulah Bankhead swore by it, and novelist Agatha Christie used cocaine to kill off some of her characters.

    In 1914, cocaine possession was made illegal in the US. After the hippy era of the 1960s and 1970s, cocaine became the “it” drug of the yuppie 1980s. “Crack” cocaine also destroyed mostly Black American urban communities.

    Cocaine use is now associated with physical and mental harms. In the short and long term, it can cause problems with your heart and blood pressure and cause organ damage. At its worst, it can kill you. Right now, illegal cocaine production and use is also surging across the globe.

    But cocaine was always legal for medical and surgical use, most commonly in the form of cocaine hydrochloride. As well as acting as a painkiller, it’s a vasoconstrictor – it tightens blood vessels and reduces bleeding. So it’s still used in some types of surgery.

    Heroin, coughing and overdoses

    Opium has been used for pain relief ever since people worked out how to harvest the sap of the opium poppy. By the 19th century, addictive and potentially lethal opium-based products such as laudanum were widely available across the United Kingdom, Europe and the US. Opium addiction was also a real problem.

    Because of this, scientists were looking for safe and effective alternatives for pain relief and to help people cure their addictions.

    In 1874, English chemist Charles Romley Alder Wright (1844-1894) created diacetylmorphine (also known as diamorphine). Drug firm Bayer thought it might be useful in cough medicines, gave it the brand name Heroin and put it on the market in 1898. It made chest infections worse.

    Allenburys Throat Pastilles
    Allenburys Throat Pastilles contained heroin and cocaine. Seth Anderson/Flickr, CC BY-NC

    Although diamorphine was created with good intentions, this opiate was highly addictive. Shortly after it came on the market, it became clear that it was every bit as addictive as other opiates. This coincided with international moves to shut down the trade in non-medical opiates due to their devastating effect on China and other Asian countries.

    Like cannabis, heroin quickly developed radical chic. The mafia trafficked into the US and it became popular in the Harlem jazz scene, beatniks embraced it and US servicemen came back from Vietnam addicted to it. Heroin also helped kill US singers Janis Joplin and Jim Morrison.

    Today, we know heroin use and addiction contributes to a range of physical and mental health problems, as well as death from overdose.

    However, heroin-related harm is now being outpaced by powerful synthetic opioids such as oxycodone, fentanyl, and the nitazene group of drugs. In Australia, there were more deaths and hospital admissions from prescription opiate overdoses than from heroin overdoses.

    In a nutshell

    Not all medicines have a squeaky-clean history. And not all illicit drugs have always been illegal.

    Drugs’ legal status and how they’re used are shaped by factors such as politics, racism and social norms of the day, as well as their impact on health.

    Philippa Martyr, Lecturer, Pharmacology, Women’s Health, School of Biomedical Sciences, The University of Western Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Share This Post

Related Posts

  • The Sweet Truth About Glycine
  • Swordfish vs Tuna – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing swordfish to tuna, we picked the tuna.

    Why?

    Today in “that which is more expensive is not necessarily the healthier”…

    Considering the macros first, swordfish has more than 8x more total fat, about 9x more saturated fat, and yes, more cholesterol. On the other hand, tuna has more protein. An easy win for tuna.

    In terms of vitamins, swordfish has more of vitamins A, B5, D, and E, while tuna has more of vitamins B1, B2, B3, B6, and B12. A marginal win for tuna, unless you want to weight the other vitamins more heavily, in which case, more likely a tie, or maybe even an argument for swordfish if you have a particular vitamin deficiency on that side.

    When it comes to minerals, swordfish has more calcium and zinc, while tuna has more iron, magnesium, manganese, phosphorus, potassium, and selenium. A clear win for tuna.

    One other thing: they’re both very rich in mercury, and while tuna is bad for that, swordfish has nearly 3x as much.

    In short, both have a good spread of vitamins and minerals, and both are quite tainted with mercury, but in relative terms, there’s a clear winner even before considering the very different macros, and the winner is tuna.

    Want to learn more?

    You might like to read:

    Farmed Fish vs Wild Caught: Important Differences

    Take care!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Blueberries vs Elderberries – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing blueberries to elderberries, we picked the elderberries.

    Why?

    Both are certainly top-tier fruits! But…

    In terms of macros, elderberries have more than 2x the fiber, while the two berries are approximately equal on other macros. An easy win for elderberries in this category.

    In the category of vitamins, blueberries have more of vitamins E, K, and choline, while elderberries have more of vitamins A, B1, B2, B3, B5, B6, B7, B9, and C, scoring another win for elderberries here.

    When it comes to minerals, blueberries have more magnesium, manganese, and zinc, while elderberries have more calcium, copper, iron, phosphorus, potassium, and selenium—one more win for elderberries.

    In terms of phytochemicals, both berries are (like most berries) an abundant source of polyphenols, but elderberries have more, including more quercetin, too.

    Adding up the sections makes for a convincing win for elderberries, but by all means enjoy either or both; diversity is good!

    Want to learn more?

    You might like:

    Herbs For Evidence-Based Health & Healing ← elderberry significantly hastens recovery from upper respiratory viral infections 😎

    Enjoy!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Dentists Are Pulling ‘Healthy’ and Treatable Teeth To Profit From Implants, Experts Warn

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Becky Carroll was missing a few teeth, and others were stained or crooked. Ashamed, she smiled with lips pressed closed. Her dentist offered to fix most of her teeth with root canals and crowns, Carroll said, but she was wary of traveling a long road of dental work.

    Then Carroll saw a TV commercial for another path: ClearChoice Dental Implant Centers. The company advertises that it can give patients “a new smile in as little as one day” by surgically replacing teeth instead of fixing them.

    So Carroll saved and borrowed for the surgery, she said. In an interview and a lawsuit, Carroll said that at a ClearChoice clinic in New Jersey in 2021, she agreed to pay $31,000 to replace all her natural upper teeth with pearly-white prosthetic ones. What came next, Carroll said, was “like a horror movie.”

    Carroll alleged that her anesthesia wore off during implant surgery, so she became conscious as her teeth were removed and titanium screws were twisted into her jawbone. Afterward, Carroll’s prosthetic teeth were so misaligned that she was largely unable to chew for more than two years until she could afford corrective surgery at another clinic, according to a sworn deposition from her lawsuit.

    ClearChoice has denied Carroll’s claims of malpractice and negligence in court filings and did not respond to requests for comment on the ongoing case.

    “I thought implants would be easier, and all at once, so you didn’t have to keep going back to the dentist,” Carroll, 52, said in an interview. “But I should have asked more questions … like, Can they save these teeth?”

    Dental implants have been used for more than half a century to surgically replace missing or damaged teeth with artificial duplicates, often with picture-perfect results. While implant dentistry was once the domain of a small group of highly trained dentists and specialists, tens of thousands of dental providers now offer the surgery and place millions of implants each year in the U.S.

    Amid this booming industry, some implant experts worry that many dentists are losing sight of dentistry’s fundamental goal of preserving natural teeth and have become too willing to remove teeth to make room for expensive implants, according to a months-long investigation by KFF Health News and CBS News. In interviews, 10 experts said they had each given second opinions to multiple patients who had been recommended for mouths full of implants that the experts ultimately determined were not necessary. Separately, lawsuits filed across the country have alleged that implant patients like Carroll have experienced painful complications that have required corrective surgery, while other lawsuits alleged dentists at some implant clinics have persuaded, pressured, or forced patients to remove teeth unnecessarily.

    The experts warn that implants, for a single tooth or an entire mouth, expose patients to costs and surgery complications, plus a new risk of future dental problems with fewer treatment options because their natural teeth are forever gone.

    “There are many cases where teeth, they’re perfectly fine, and they’re being removed unnecessarily,” said William Giannobile, dean of the Harvard School of Dental Medicine. “I really hate to say it, but many of them are doing it because these procedures, from a monetary standpoint, they’re much more beneficial to the practitioner.”

    Giannobile and nine other experts say they are combating a false public perception that implants are more durable and longer-lasting than natural teeth, which some believe stems in part from advertising on TV and social media. Implants require upkeep, and although they can’t get cavities, studies have shown that patients can be susceptible to infections in the gums and bone around their implants.

    “Just because somebody can afford implants doesn’t necessarily mean that they’re a good candidate,” said George Mandelaris, a Chicago-area periodontist and member of the American Academy of Periodontology Board of Trustees. “When an implant has infection, or when an implant has bone loss, an implant dies a much quicker death than do teeth.”

    In its simplest form, implant surgery involves extracting a single tooth and replacing it with a metal post that is screwed into the jaw and then affixed with a prosthetic tooth commonly made of porcelain, also known as a crown. Patients can also use “full-arch” or “All-on-4” implants to replace all their upper or lower teeth — or all their teeth.

    For this story, KFF Health News and CBS News sought interviews with large dental chains whose clinics offer implant surgery — ClearChoice, Aspen Dental, Affordable Care, and Dental Care Alliance — each of which declined to be interviewed or did not respond to multiple requests for comment. The Association of Dental Support Organizations, which represents these companies and others like them, also declined an interview request.

    ClearChoice, which specializes in full-arch implants, did not answer more than two dozen questions submitted in writing. In an emailed statement, the company said full-arch implants “have become a well-accepted standard of care for patients with severe tooth loss and teeth with poor prognosis.”

    “The use of full-arch restorations reflects the evolution of modern dentistry, offering patients a solution that restores their ability to eat, speak, and live comfortably — far beyond what traditional dentures can provide,” the company said.

    Carroll said she regrets not letting her dentist try to fix her teeth and rushing to ClearChoice for implants.

    “Because it was a nightmare,” she said.

    ‘They Are Not Teeth’

    Dental implant surgery can be a godsend for patients with unsalvageable teeth. Several experts said implants can be so transformative that their invention should have contended for a Nobel Prize. And yet, these experts still worry that implants are overused, because it is generally better for patients to have their natural teeth.

    Paul Rosen, a Pennsylvania periodontist who said he has worked with implants for more than three decades, said many patients believe a “fallacy” that implants are “bulletproof.”

    “You can’t just have an implant placed and go off riding into the sunset,” Rosen said. “In many instances, they need more care than teeth because they are not teeth.”

    Generally, a single implant costs a few thousand dollars while full-arch implants cost tens of thousands. Neither procedure is well covered by dental insurance, so many clinics partner with credit companies that offer loans for implant surgeries. At ClearChoice, for example, loans can be as large as $65,000 paid off over 10 years, according to the company’s website.

    Despite the price, implants are more popular than ever. Sales increased by more than 6% on average each year since 2010, culminating in more than 3.7 million implants sold in the U.S. in 2022, according to a 2023 report produced by iData Research, a health care market research firm.

    Some worry implant dentistry has gone too far. In 10 interviews, dentists and dental specialists with expertise in implants said they had witnessed the overuse of implants firsthand. Each expert said they’d examined multiple patients in recent years who were recommended for full-arch implants by other dentists despite their teeth being treatable with conventional dentistry.

    Giannobile, the Harvard dean, said he had given second opinions to “dozens” of patients who were recommended for implants they did not need.

    “I see many of these patients now that are coming in and saying, ‘I’ve been seen, and they are telling me to get my entire dentition — all of my teeth — extracted.’ And then I’ll take a look at them and say that we can preserve most of your teeth,” Giannobile said.

    Tim Kosinski, who is a representative of the Academy of General Dentistry and said he has placed more than 19,000 implants, said he examines as many as five patients a month who have been recommended for full-arch implants that he deems unnecessary.

    “There is a push in the profession to remove teeth that could be saved,” Kosinski said. “But the public isn’t aware.”

    Luiz Gonzaga, a periodontist and prosthodontist at the University of Florida, said he, too, had turned away patients who wanted most or all their teeth extracted. Gonzaga said some had received implant recommendations that he considered “an atrocity.”

    “You don’t go to the hospital and tell them ‘I broke my finger a couple of times. This is bothering me. Can you please cut my finger off?’ No one will do that,” Gonzaga said. “Why would I extract your tooth because you need a root canal?”

    Jaime Lozada, director of an elite dental implant residency program at Loma Linda University, said he’d not only witnessed an increase in dentists extracting “perfectly healthy teeth” but also treated a rash of patients with mouths full of ill-fitting implants that had to be surgically replaced.

    Lozada said in August that he’d treated seven such patients in just three months.

    “When individuals just make a decision of extracting teeth to make it simple and make money quick, so to speak, that’s where I have a problem,” Lozada said. “And it happens quite often.”

    When full-arch implants fail, patients sometimes don’t have enough jawbone left to anchor another set. These patients have little choice but to get implants that reach into cheekbones, said Sohail Saghezchi, an oral and maxillofacial surgeon at the University of California-San Francisco.

    “It’s kind of like a last resort,” Saghezchi said. “If those fail, you don’t have anywhere else to go.”

    ‘It Was Horrendous Dentistry’

    Most of the experts interviewed for this article said their rising alarm corresponded with big changes in the availability of dental implants. Implants are now offered by more than 70,000 dental providers nationwide, two-thirds of whom are general dentists, according to the iData Research report.

    Dentists are not required to learn how to place implants in dental school, nor are they required to complete implant training before performing the surgery in nearly all states. This year, Oregon started requiring dentists to complete 56 hours of hands-on training before placing any implants. Stephen Prisby, executive director of the Oregon Board of Dentistry, said the requirement — the first and only of its kind in the U.S. — was a response to dozens of investigations in the state into botched surgeries and other implant failures, split evenly between general dentists and specialists.

    “I was frankly stunned at how bad some of these dentists were practicing,” Prisby said. “It was horrendous dentistry.”

    Many dental clinics that offer implants have consolidated into chains owned by private equity firms that have bought out much of implant dentistry. In health care, private equity investment is sometimes criticized for overtreatment and prioritizing short-term profit over patients.

    Private equity firms have spent about $5 billion in recent years to buy large dental chains that offer implants at hundreds of clinics owned by individual dentists and dental specialists. ClearChoice was bought for an estimated $1.1 billion in 2020 by Aspen Dental, which is owned by three private equity firms, according to PitchBook, a research firm focused on the private equity industry. Private equity firms also bought Affordable Care, whose largest clinic brand is Affordable Dentures & Implants, for an estimated $2.7 billion in 2021, according to PitchBook. And the private equity wing of the Abu Dhabi government bought Dental Care Alliance, which offers implants at many of its affiliated clinics, for an estimated $1 billion in 2022, according to PitchBook.

    ClearChoice and Aspen Dental each said in email statements that the companies’ private equity owners “do not have influence or control over treatment recommendations.” Both companies said dentists or dental specialists make all clinical decisions.

    Private equity deals involving dental practices increased ninefold from 2011 to 2021, according to an American Dental Association study published in August. The study also said investors showed an interest in oral surgery, possibly because of the “high prices” of implants.

    “Some argue this is a negative thing,” said Marko Vujicic, vice president of the association’s Health Policy Institute, who co-authored the study. “On the other hand, some would argue that involvement of private equity and outside capital brings economies of scale, it brings efficiency.”

    Edwin Zinman, a San Francisco dental malpractice attorney and former periodontist who has filed hundreds of dental lawsuits over four decades, said he believed many of the worst fears about private equity owners had already come true in implant dentistry.

    “They’ve sold a lot of [implants], and some of it unnecessarily, and too often done negligently, without having the dentists who are doing it have the necessary training and experience,” Zinman said. “It’s for five simple letters: M-O-N-E-Y.”

    Hundreds of Implant Clinics With No Specialists

    For this article, journalists from KFF Health News and CBS News analyzed the webpages for more than 1,000 clinics in the nation’s largest private equity-owned dental chains, all of which offer some implants. The analysis found that more than 70% of those clinics listed only general dentists on their websites and did not appear to employ the specialists — oral surgeons, periodontists, or prosthodontists — who traditionally have more training with implants.

    Affordable Dentures & Implants listed specialists at fewer than 5% of its more than 400 clinics, according to the analysis. The rest were staffed by general dentists, most of whom did not list credentialing from implant training organizations, according to the analysis.

    ClearChoice, on the other hand, employs at least one oral surgeon or prosthodontist at each of its more than 100 centers, according to the analysis. But its new parent company, Aspen Dental, which offers implants in many of its more than 1,100 clinics, does not list any specialists at many of those locations.

    Not everyone is worried about private equity in implant dentistry. In interviews arranged by the American Academy of Implant Dentistry, which trains dentists to use implants, two other implant experts did not express concerns about private equity firms.

    Brian Jackson, a former academy president and implant specialist in New York, said he believed dentists are too ethical and patients are too smart to be pressured by private equity owners “who will never see a patient.”

    Jumoke Adedoyin, a chief clinical officer for Affordable Care, who has placed implants at an Affordable Dentures & Implants clinic in the Atlanta suburbs for 15 years, said she had never felt pressure from above to sell implants.

    “I’ve actually felt more pressure sometimes from patients who have gone around and been told they need to take their teeth out,” she said. “They come in and, honestly, taking a look at them, maybe they don’t need to take all their teeth out.”

    Still, lawsuits filed across the country have alleged that dentists at implant clinics have extracted patients’ teeth unnecessarily.

    For example, in Texas, a patient alleged in a 2020 lawsuit that an Affordable Care dentist removed “every single tooth from her mouth when such was not necessary,” then stuffed her mouth with gauze and left her waiting in the lobby as he and his staff left for lunch. In Maryland, a patient alleged in a 2021 lawsuit that ClearChoice “convinced” her to extract “eight healthy upper teeth,” by “greatly downplay[ing] the risks.” In Florida, a patient alleged in a 2023 lawsuit that ClearChoice provided her with no other treatment options before extracting all her teeth, “which was totally unnecessary.”

    ClearChoice and Affordable Care denied wrongdoing in their respective lawsuits, then privately settled out of court with each patient. ClearChoice and Affordable Care did not respond to requests for comment submitted to the companies or attorneys. Lawyers for all three plaintiffs declined to comment on these lawsuits or did not respond to requests for comment.

    Fred Goldberg, a Maryland dental malpractice attorney who said he has represented at least six clients who sued ClearChoice, said each of his clients agreed to get implants after meeting with a salesperson — not a dentist.

    “Every client I’ve had who has gone to ClearChoice has started off meeting a salesperson and actually signing up to get their financing through ClearChoice before they ever meet with a dentist,” Goldberg said. “You meet with a salesperson who sells you on what they like to present as the best choice, which is almost always that they’re going to take out all your natural teeth.”

    Becky Carroll, the ClearChoice patient from New Jersey, told a similar story.

    Carroll said in her lawsuit that she met first with a ClearChoice salesperson referred to as a “patient education consultant.” In an interview, Carroll said the salesperson encouraged her to borrow money from family members for the surgery and it was not until after she agreed to a loan and passed a credit check that a ClearChoice dentist peered into her mouth.

    “It seems way backwards,” Carroll said. “They just want to know you’re approved before you get to talk to a dentist.”

    CBS News producer Nicole Keller contributed to this report.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

    This article first appeared on KFF Health News and is republished here under a Creative Commons license.

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: