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Fred Pockrass,
DDS and Ina Pockrass
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Walking along a jasmine-scented brick path and
listening to the enchanting chimes of a Tibetan bell, you approach
a building. Upon entering, you are offered a warm cup of tea and
given a pair of slippers. As you remove your shoes and put on
the slippers, you rest your feet on carpets of untreated wool,
which are placed on floors composed of marmoleum, a vinyl alternative
made from flax, wood flour, and rosin. Sitting in furniture made
from recycled woods and upholstered with cotton, silk, and wool,
and listening to the soothing sound of water flowing onto smooth
rocks in a fountain, you are surrounded by wallpaper made from
reclaimed paper pulp and bark.
You might have to pinch yourself to remember that
you are sitting in a dental office—namely, Transcendentist®,
on Ashby Avenue in Berkeley, California. The comfortable surroundings
here were built primarily with renewable, reusable, and recyclable
materials by the husband-wife team Fred Pockrass, DDS, and Ina
Pockrass, pioneers who created the first fully eco-friendly practice
in the country in 2002. Transcendentist® is certified by the
Bay Area Green Business Program (www.greenbiz.ca.gov) and the
East Bay Sustainable Business Alliance (www.sustainablebiz.org).
By combining elements of a wellness spa with pain-free, environmentally
sound dentistry, Transcendentist® transforms smiles with state-of-the-art
techniques, biocompatible materials, and handmade restorations.
Providing care that is good for both people and the environment,
this model of eco-dentistry is a powerful example of Ecologically
Sustainable Medicine.
This sustainable approach to dentistry incorporates
ecologically sustainablematerials and practices that reduce the
impact of medical procedures on the environment as well as protecting
clients from toxic materials. Lighting and electricity is provided
by renewable energy resources such as wind power, made possible
by 3 Phases Energy Center (www.3phases.com). The Pockrasses utilize
only recycled paper and environmentally safe cleaning products
and service provided by Tibby Janitorial. They have reduced the
amount of paper they use by implementing a digital patient charting
system and using washable, reusable pure cotton terry bibs, which
are washed on location. In eco-dentistry, the dental procedures
involve a filtration system that ensures an environmentally sound
disposal of extracted mercury fillings; this prevents contamination
of waterways. Eco-dentistry utilizes digital imaging as an alternative
to x-rays. This change reduces exposure to radiation by 75-90%.
In addition, they use steam-based instrument sterilization,eliminating
the use of harmful and toxic chemicals.
Since graduating from McGill University in Montreal,
Canada, Fred Pockrass has been practicing general and restorative
dentistry for over 23 years. After eight years in practice, he
fulfilled a lifelong dream of studying with a meditation master
in India. While in the Himalayas, he created a Western-style dental
clinic where he served as personal dentist to a renowned Indian
guru and provided dental care to clients from around the world
until late 2000. Dr. Pockrass has a degree in meditation and is
a certified Tai-Chi teacher, and lifelong yoga practitioner. Ina
Pockrass, J.D., has a background in intellectual property law
and has been a partner in several prestigious law firms; she is
also chair of the board of directors of Circle of Life, the nonprofit
founded by Julia Butterfly Hill. She is a lifelong meditator and
a practitioner of yoga and NIA™ movement techniques. The
staff at Transcendentist® integrates exceptional ecologically-sustainable
dental care and such spa-type services as tea, slippers, and foot
rubs in the dentist’s chair—a fulfillment of Ina’s
dream to “create a model where the consciousness of the environment
and the human beings we were serving came first.”
In the true ecological spirit of interdependence,
the Pockrasses give back to the community that supports them.
When someone refers a client to Transcendentist®, they make
a donation to a non-profit in honor of the referer. They have
donated toothbrushes for children in El Salvador and hosted community
programs on topics ranging from Chinese herbs to women’s
wellness and meditation.
To learn more about the principles and practices
of eco-dentistry, Teleosis executive director Joel Kreisberg spoke
with them in their Berkeley office.
Would you share
with the readers of Symbiosis the inspiration and vision that
led to the creation of Transcendentist®?
I was very
inspired by Julia Butterfly Hill. I am the chair of the board
of Circle of Life, the organization she founded. One saying that
she often uses resonated with me profoundly—Mahatma Gandhi’s,
“be the change you want to see in the world.” Don’t
just talk about it, but actually be that.
We were also
inspired by our own personal experiences. As we were designing
our space we were fortunate to be invited into many offices in
the Bay Area, and a number of them were newly created. Brand new,
fresh dental offices. There was one in particular where I had
an incredible allergic reaction. We knew that there must be off-gassing
coming from the paint and the carpets. I had never experienced
that before, so it really caught me by surprise. We realized that
we are the human beings who live in this kind of environment eight
hours a day. Our clients come in for about an hour at a time.
We wanted to create a space where everyone would feel comfortable.
So it began
by creating a space for yourselves, as the primary occupants?
Sustainability—ecological
sustainability —really begins with the first person, and
that’s you. It’s the old adage, “Physician heal
thy self.” First you heal yourself on an emotional level,
on a physical level, on a spiritual level. Once that healing takes
place, then as a doctor you will be much more effective in being
able to offer guidance and healing to your clients. When you open
yourself up to transformation, the mirror reflects both ways.
Is Transcendentist®
a holistic dental practice?
We don’t
call ourselves holistic, but rather we are whole-person oriented.
We are whole-person centered, so we relate to each person as a
whole person. Meditation is a big part of that. First and foremost,
the dentist needs to meditate, then encourage the staff to meditate,
because when the dentist is peaceful, that peacefulness will radiate.
We use various types of meditation and other ancient methods that
guide your brain to go into deeper and deeper states of relaxation.
How do you
manifest and maintain your vision through your office space?
We set out intentionally
to create a healing environment. First and foremost, we wanted
it to be an environment where we could help people transform their
previous experience of what it meant to go to the dentist. So,
Transcendentist® is about transformation of your experience.
It’s about health, beauty, and wellness; it’s also about
discovering your inner smile. It’s really about transforming
your whole experience. We took a client-centered approach rather
than a doctor-centered approach. We wanted our space to feel more
like a spa, or like you were walking into your best friend’s
living room. A place where you would be warmly welcomed with beautiful
music in the background, beautiful plants, organic teas, comfortable
furniture to sit on, pleasing sounds of music, and attractive
sights and smells that didn’t have the typical dental office
sounds and smells.
So the built
environment is sustainable. What are some of the techniques you
implemented that qualify as ecologically sustainable?
We have a healthy
gum program, which is a nonsurgical approach to healthy gums.
It’s now known that gum disease affects your cardiovascular
system. There are linked effects to your immune system. There
are normally over 200 species of microorganisms in your mouth,
but when you have gum disease bacteria are able to permeate your
gum tissue and get into your bloodstream. This affects so many
other areas, not just the gum tissues. Very typically our clients
tell us they don’t feel any pain during our nonsurgical gum
therapy approach.
In addition
to a reduction in pain, are there other benefits of this nonsurgical
approach?
The day after
treatment, clients say they feel a sense of lightness and well-being
and an overall sense of greater vitality. This makes sense, because
you’re clearing the bacteria out of the mouth. The mouth
feels fresher, the breath feels fresher, and digestion improves.
Everything feels so much lighter, because you are getting rid
of all those toxins that would otherwise just be sitting in your
mouth as the focal point of infection.
It sounds as
though there is an immediate relief from the removal of toxins.
How do you ensure that the treatment room itself is not being
contaminated by these procedures?
We run negative
ion generators in all of our rooms. We have special hi-tech filter
systems that both clean and purify the air. These hi-tech filter
systems run a UV light plus a HEPA filter, plus the negative ion
generator. The air in the rooms is constantly being cleansed.
We are trying to protect ourselves as well as our clients. I think
we’re at more risk to exposure than our clients are. So for
myself and for my staff, we put those systems in place. When we
built the office we also put in a mercury separator system on
our suction systems. We worked with an OSHA consultant because
we wanted to make sure that everything we were doing was up to
standard and even beyond that. We wanted to set up a very new
type of a practice, but we wanted to do it in such a way that
we were really dotting our i’s and crossing our t’s,
so we sought guidance from an OSHA expert.
I’m impressed
with your efforts. What are some of the alternatives to chemically
based, toxic solutions and processes that came out of this consultation?
We wanted to
be sure that our infection control procedures were sound. The
consultant recommended that rather than using toxic disinfectants
in our treatment rooms, we use something called CaviCide®.
It’s used in neonatal care units, so it’s hospital grade,
extremely low in toxicity, and it’s extremely effective.
Another decision was whether to use traditional x-rays or digital
imaging. Digital imaging was 75-90% less radiation and did not
involve any toxic x-ray development chemicals. It cost more, but
we decided to buy the digital. And we wanted to have our patient
bibs be reusable, not something that you would throw away, so
we bought cotton ones that we wash onsite in our energy efficient
machines. We had our OSHA consultant work with us on what constellation
of detergents and disinfectants we could use that weren’t
chlorine-based and weren’t polluting the environment. So
when we were deciding what kind of sterilizer to buy, we chose
a steam rather than a chemical sterilizer. Instead of using a
lot of paper pouches for instruments, we have cut way back on
that and now sterilize instruments in reusable towels.
It’s actually
a surgical drape that you wrap the instruments in and they go
through the ultrasonic to sterilize. Everything gets wrapped up
in these surgical drapes and that passes through the whole disinfection
system, so when you open them up, you have a sterile tray and
the instruments in there. There is nothing disposed and it’s
all reusable.
I know that
you have a mercury amalgam separator. Is there a standard protocol
for this type of extraction?
We follow the
safety protocols that were set out by the IAOMT, which is the
International Association of Oral Medicine and Toxicology. The
safety protocol includes providing an independent air supply through
a nose piece. Some clients decline, but some choose to use that
process.
And we provide
a cloth to cover the face while the procedure is going on.
FP: We only remove mercury amalgam in the presence
of a mercury dam. This is a little latex sheet that sits over
your teeth and protects your mouth so that none of the little
chunks or bits of the old filling can fall into your mouth, so
you don’t have to worry about swallowing them. That’s
a big concern. People say, “Well, I heard it’s more
dangerous to get my fillings out than to leave them in.”
We always put on a rubber dam, which helps to isolate the mouth,
and it allows us to just see the tooth we’re working on.
What other
practices do you use to make this experience more ecologically
sound?
FP: In terms of ecological dentistry, or eco-dentistry™,
as we’ve coined it, we use a combination of guided mediations.
For example, take the process of numbing or freezing. We guide
our clients through a type of hypnosis approach as they are getting
the numbing. So, we pre-numb the area first with a topical cream.
Then we’ll do a guided breathing exercise with our clients,
and very often they report that they didn’t feel anything
at all; or if they felt something, it wasn’t painful. It’s
something that all dentists can do. What we believe makes the
difference is truly honoring each person who walks through the
door. It’s not a tooth that walks in the door; it’s
a whole person.
How do you
ensure patient buy-in with these treatments?
We spend a
lot of time educating our clients, so the very first contact with
the clients is not done in a treatment room. Our first contact
with clients is done in the consult room. Here, we sit knee-to-knee,
eye-to-eye, and we talk. We like to find out what the client’s
expectations are. Why are they here and what are they looking
for? What have their previous experiences been in dental work?
We want to find out who our clients are. Then, when we get into
the more clinical phase, we want to find out what’s going
on with their mouth, how healthy are their mouths? Is there disease
present? How could we help to resolve the problems and help people
to stay healthy?
How are your
clients responding to this shift in dental care?
It is profound.
I’ll just give you an example of a person who had not been
to the dentist in more than seven years. A highly educated man
with plenty of financial resources; it wasn’t money that
had been stopping him from seeing a dentist. He found out he had
some health problems and needed to see a dentist. Part of the
problem related to the health of his gums, which were infected
and in extremely poor condition. This man was literally trembling;
he had to bring his wife with him. He sat in here, he was pouring
with sweat, nervous. But he had an incredible experience. We give
everyone a foot massage when they get their teeth cleaned. He
had his wife with him the whole time. He comes back here now,
every three months. He walks in and says, “Hey, how you doing?
Oh, I’m good. I’m glad my time has come again. Can I
just hang out here for half an hour? My wife can’t pick me
up till then.” So what has happened is that what used to
be a horrible ordeal to be avoided at all costs has been transformed.
He now looks forward to his dental visits as a way to take care
of himself, and he doesn’t have to be afraid anymore.
So Transcendentist®
takes the fear of out dentistry. Is that the main incentive?
I had a patient
the other day who came in and said, “You know, I was really
looking forward to coming to the appointment today, because I
know I’m so busy and so stressed out in my life. I know that
at least for the next hour, I can relax. Do whatever you need
to do, fix my teeth, take care of everything.” This is not
the exception; it’s more often the rule.
That’s
encouraging. How has your leadership in this arena helped to shift
the dental industry as a whole?
I don’t
know if we’re the leaders, but we’re doing it. It’s
important to show that it can be done. And it’s not that
hard. Yes, it is a little more expensive, but what is the true
cost of putting mercury into our water systems so that all of
us drink it for the next 30 years? We are really encouraged, for
example, that Alameda County is now requiring dental offices to
install amalgam separators. I think that’s a good example
of things changing. These are simple things; they’re not
complicated.
Where do you
see this shift in health care coming from?
Once the human
beings who encounter health care practitioners and wellness practitioners
begin to raise the awareness of the practitioners, that is when
we will begin to see profound change. It is not going to be top
down; rather it’s going to be a consumer saying, “This
is what I want.”
Part of that
will happen with privatization, which is a trend in health care
delivery. The insurance industry is overwhelmed, to say the least.
That’s a separate topic! But what happens is that consumers
are beginning to take more responsibility for and control of their
own health decisions. As consumers, they recognize that they are
in a position to make their own decisions; they are starting to
vote with their dollars. This means that people will be consuming
in such a way that consumer choices will drive the marketplace.
In terms of health care as a marketplace, consumer choices will
in effect change how health care is delivered. As people realize
the power of making health care decisions for themselves, they
will want to be treated a whole person, rather than as just a
wisdom tooth.
How do you
see this as part of the larger picture of greening health care?
I think it’s
huge. In terms of the dental community itself, there is certainly
a lot of room for growth. And it doesn’t mean that every
dental practice will therefore need to be green-certified. Even
small steps, such as using 100% recycled paper for printers, can
help. If every single medical office did just that, it would reduce
medical waste dramatically. There are so many different areas
in which you can apply energy efficiency. Any professional office—whether
it’s a dentist, a doctor, a lawyer, an architect, or a chiropractor—can
apply some of the recommendations of the green certification program.
I can only
imagine the positive outcome if every office implemented this
approach. How does one help people justify the cost of making
the steps towards sustainable care?
Ina brought
up the question of the real cost of having a non-green business.
Well, it’s more expensive to use no-VOC paint, but look more
closely at the true costs involved, down the road, for the health
of our children and the health of the environment. Looked at that
way, not greening health care actually has a much bigger price
tag. First and foremost, I think once you create that internal
change in the head and the heart of each medical practitioner,
awareness grows and deepens. You start looking for the ways in
which you can provide healing in a truly healing environment.
How does this
work extend beyond the self into the community?
The term eco
really means that we are interdependent. Every action you take
is interrelated with every other action, so we’re not trying
to be all things to all people. Rather, we are integrated with
the greater community at large. It’s in everyone’s best
interest to be eco-minded and sustainable. In terms of the whole
community— the business community, the medical community,
and the community at large—part of the definition of eco-interdependence
is that the rising tide raises all boats. This is our planet,
it’s our home, we all have to interdependently interact with
each other. If we are destroying the rainforest in the Amazon,
we’re affected by it up here. So if the choice to use recycled
paper and paying a few pennies more can make a difference, that
is the contribution that I am choosing to make because I am looking
at it as a long-term investment in our collective future.
It is interesting
to see that the way dental health is done has a profound effect
on the global environment. How do you maintain a positive outlook
when it comes to creating a shift in the way we treat our planet?
Well, you could
say we live in a world that has been clear-cut, where there is
just rank destruction. Yet there are some healthy, vibrant forests,
where there is clean air and a real diversity of wildlife. Fred
and I have chosen to surround ourselves with people who are living
in the forest—that’s our community. It is a community
of likeminded health care professionals, businesses, clients,
and friends.
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smiles