Patients who come to us after years at a conventional practice often say the same thing after their first appointment: “I’ve never had a dental visit like that.”
Not because it was uncomfortable. Usually the opposite. But because someone finally asked questions no dentist had ever asked them, looked at things no dentist had ever looked at, and connected dots that had been sitting there, unconnected, for years.
Here’s what a holistic dental exam actually looks like — and what makes it fundamentally different from a conventional one.
IT STARTS BEFORE YOU EVER SIT IN THE CHAIR
Your first clue that this practice operates differently is the intake form.
Our medical history questionnaire is extensive. Patients sometimes laugh and say it feels like we want to know everything — and honestly, we do. If your big toe hurts, we want to know about it. Not because we’re treating your toe, but because everything in the body is connected, and the more context we have, the better we can understand what’s happening in your mouth and what your mouth might be contributing to elsewhere.
Most patients haven’t yet made the connections between their oral health and their sleep, their jaw pain, their headaches, their energy levels, their gut health, or their immune function. The intake form is often the first time someone asks them to think about all of it together.
A FULL SET OF RECORDS — INCLUDING THINGS MOST OFFICES SKIP
Before the exam even begins, we take a comprehensive set of records that gives us a complete picture of where you are right now.
This includes:
Full radiographic records — panoramic X-ray, a complete set of bitewings and periapical images, and a cone beam CT (CBCT) when indicated. The CBCT gives us a three-dimensional view of the jaw, airway, joints, and bone that a flat X-ray simply cannot provide.
Intraoral and extraoral photographs — not just smile photos, but images of how your teeth come together, the shape of your tongue, the size of your tonsils and airway, the texture and color of your oral tissues. We photograph your posture and your profile. These records tell us things that can’t be captured in an exam alone, and they give us a baseline to track change over time.
THE EXAM ITSELF — STARTING OUTSIDE YOUR MOUTH
A conventional dental exam starts in your mouth. Ours starts with you.
Before I look at a single tooth, I’m observing. What does your skin look like — is it rosy and healthy, or does it look depleted? Are there bags under your eyes? Are you hydrated? How are you breathing right now — through your nose, or your mouth? These aren’t irrelevant details. They’re clinical data.
Then I move to the extraoral exam — which most patients have never experienced at a dental office:
Muscle and joint assessment — I palpate your masseter muscles, your temporalis, your jaw joints, your SCM, your suboccipitals, your neck, your traps. I’m feeling for tension, asymmetry, tenderness, areas that feel off. Chronic muscle tension in the jaw and neck is often connected to bite imbalance, nighttime clenching, or airway issues — and it shows up in the muscles before it shows up anywhere else.
Range of motion — I assess how far your jaw opens, whether it opens straight or deviates to one side, whether there are clicks, pops, or catching. Is one joint working harder than the other? Are things moving in balance?
Swallow pattern — I observe how you swallow. Most people have never had a dentist watch them swallow. But the swallow pattern tells me a great deal about tongue posture and function, which directly affects jaw development, airway, and bite.
Lymph node screening — a thorough oral cancer screening that includes palpating the lymph nodes both inside and outside the mouth. Every single appointment.
INSIDE YOUR MOUTH — BEYOND THE TEETH
Arch shape and palate — I look at the shape and width of your upper and lower arches. Is there room on the roof of your mouth for your tongue to rest fully? Or is the palate narrow and highly vaulted, forcing the tongue to fall back and down — and potentially compromising your airway? A narrow palate isn’t just an orthodontic issue. It’s often an airway issue.
Tongue — size, posture, and function — Where does your tongue rest when you’re not thinking about it? Does it have full range of motion, or is it restricted? Are there scalloped edges from chronic pressing against the teeth? The tongue is one of the most important and most overlooked structures in the mouth.
Tonsil and airway assessment — We photograph and assess tonsil size and airway space. In children especially, enlarged tonsils are frequently contributing to mouth breathing, poor sleep, and behavioral concerns that no one has connected to the airway.
Wear patterns — I look at how your teeth are wearing — not just whether there are cavities, but what the wear patterns tell me about how your bite is functioning. Flat, worn surfaces tell me about grinding. Notching at the gumline tells me about bite forces. Cracked teeth tell me about how stress is being distributed. Each pattern tells a story.
Materials assessment — I look at what’s in your mouth. Are there amalgam fillings? Mixed metals? How old are your restorations, and are they contributing to stress on the surrounding tooth structure? Biocompatibility matters and we take it seriously.
WHAT WE DON’T USE — AND WHY
We don’t use the sharp metal periodontal probe — that pointed instrument that makes a scraping sound on your teeth and invariably makes your gums bleed. When a probe pushes into potentially compromised tissue, it can drive bacteria deeper. Instead we use the DIAGNOdent — a laser-based cavity detection system that reads relative density in the tooth structure by shining a light on the surface. It finds early lesions without physical penetration, without introducing bacteria, and without the discomfort.
A DIFFERENT APPROACH TO GUM HEALTH
Here’s something that surprises almost every patient we see: we disclose on everyone. Every appointment. We use a disclosing solution that temporarily stains plaque so we can see exactly where bacteria are living — and show you exactly what we’re removing and where your home care needs attention. Most dental offices don’t do this. We think it’s essential.
We also don’t reflexively recommend mouthwash — particularly not alcohol-based antiseptic rinses. Products that claim to kill 99.9% of bacteria kill the good bacteria right along with the bad. Using one daily is essentially taking a low-grade antibiotic every day. For most patients, warm salt water is genuinely superior — it soothes inflamed tissue, draws out excess fluid, and supports healthy healing without disrupting the microbiome you’re trying to maintain.
For patients with active gum disease, rather than defaulting immediately to scaling and root planing, we use a protocol of thorough, repeated cleanings approximately two weeks apart. By cleaning slightly deeper each time and giving the microbiome time to shift between appointments, we change the bacterial environment rather than just scraping the damage.
THE THING WE FIND MOST OFTEN THAT OTHER DENTISTS MISSED
If I had to name one thing that comes up again and again — it’s gum recession.
Almost universally, patients with recession have been told: “You’re brushing too hard.”
I want to address this directly. Brushing hard enough to mechanically wear away your gum tissue — while not noticing it happening — is nearly physiologically impossible. And here’s the bigger issue: what patients are calling “gum recession” is usually not recession of soft tissue alone. It’s bone loss. The gum follows the bone. And bone doesn’t disappear because of a toothbrush.
In the vast majority of cases I see, the primary driver of that bone loss is occlusal forces — the way the bite loads the teeth, often combined with grinding or clenching. When a tooth is under chronic excessive force, the bone around it resorbs in response to that stress. The gum follows. What looks like recession is really the bone responding to mechanical overload.
THE PHILOSOPHY UNDERNEATH ALL OF IT
You won’t find something you’re not looking for. That sounds simple, but it drives everything we do.
We look further, ask more, document more, and connect more dots than a conventional exam because we believe your mouth is telling us things about your whole body — and your whole body is telling us things about your mouth. Our job is to understand that conversation, not just count the cavities.
To schedule a new patient exam at Supremia Dentistry, call 919-556-6200 or request an appointment online.
Dr. Morgan Herman, DDS, is a holistic, airway-focused dentist and TMD specialist at Supremia Dentistry in Wake Forest, NC. She is a Diplomate of the American Academy of Dental Sleep Medicine, a Fellow of the Las Vegas Institute for Advanced Dental Studies and the International Academy of Dental Facial Esthetics, and a member of the International Academy of Oral Medicine and Toxicology (IAOMT).
