March 30th – April 5th was declared Root Canal Awareness Week by the American Academy of Endodontists in a national effort to raise awareness of root canals “so that patients and general dentists know to contact a specialist when a root canal is needed. It is an excellent time to explain the important role endodontists play in dental health, and to teach the public that root canals should not be feared,” they say. I know these specialists are for the most part, very well-meaning. I also know almost everyone in my circle is fully aware of them and disagree with their position because evidence points in a different direction.
Root Canal Roulette
Viper venom dripping from fangs is an efficient killer. Its swirls of toxic proteins multitask. Some paralyze the nervous system by blocking nerve-to-muscle messages, others can misdirect messenger hormones, dissolve tissues, or make blood so sticky the resulting clots stop the heart or so thin the victim quickly bleeds out.
Just as surely, dead or dying human teeth can harbor similar killers working on at least as many levels throughout the body. The sophisticated multilevel attack of oral microbes, their metabolic waste products, and their interaction with dental materials gives us ample opportunity to puzzle over after an immune system crash manifests in multiple disguises. Is a root canal procedure a gamble you want to take?
Economics versus Health: There is Always a Price
The complexity of interactions and time delay before oral toxins express noticeable symptoms compared to fast-acting venom work well for the institution of dentistry and dental insurance companies, but it does not work for you. You know institutions are by nature invested in the status quo. The insurance industry’s business model is no different from most other business models – it values the bottom line over robust health.
We are left on our own to tease out root causes of disease. It is only after the scare of cancer, the exhaustion of chronic fatigue, a nervous system derailment causing Parkinson’s tremors, Multiple Sclerosis (MS), or Bell’s Palsy, or even autoimmune issues such as lupus, or ALS (Lou Gehrig’s disease), that some people make the difficult decision to consider a “dental revision” to help the body recover. A dental revision is no less than removing all possible toxic stressors of oral origin – dead teeth, dead jawbone, heavy metals like mercury, nickel, and chromium, gum disease therapy, and often, removing meridian blockers like implants. You can escape to clean mountain air or the ocean’s cleansing waves, but you can never escape your internal environment.
The two lab reports in this Dental DNA Labs file are but two examples of DNA sequenced microbial profiles found in the jawbone socket of an extracted root canal treated tooth and in cavitations. The root canal treated tooth showed no clinical or physical signs of failing. These interesting lab reports also connect the pathogens with their waste products’ target tissues.
What is a Root Canal?
A root canal is an embalming procedure dentists perform on a tooth. Root canals are designed to keep a dead tooth mechanically functioning in a live body. Teeth die as a result of trauma (including sometimes, the trauma of a high speed drill creating too much heat or sucking the organic material from the microscopic tubules that assist in keeping it alive) or from microbial invasion from deep decay or gum disease into the pulp that nourishes each tooth.
This video offers key considerations about root canals.
It is no longer a huge secret that root canals crank out microbial metabolic toxins; even some root canal specialists (endodontists) are starting to “own” it. For instance they acknowledge that “condensing osteitis” around a root-canal treated tooth is common. As the video mentions, condensing osteitis is a thickening of the bone around a dead tooth as the body tries to wall off the infective toxins seeping from them. America’s top dental ozone gurus have spoken by invitation to the endodontic graduate department at Tufts University Dental School and dental schools in Detroit and Florida. As one endodontist reportedly quipped, “Ozone gives us a chance to hold on to our profession.”
On the other hand, the American Association of Endodontists (AAE) position statement on the matter (2012) states, “… the practice of recommending the extraction of endodontically treated teeth for the prevention of NICO [sometimes painful jawbone death due to poor blood supply], or any other disease, is unethical and should be reported immediately to the appropriate state board of dentistry.
And yet: A “recent evidence-based review of the outcomes of both treatment modalities noted that if evidence-based principles are applied to the data available for both treatment modalities, few implant or endodontic outcome studies can be classified as being high in the evidence hierarchy.”
What Do You Do Next?
No doubt about it, losing a tooth can be emotionally charged. I think it is one reason dentists work so hard to perfect tooth embalming procedures. The decision tree for considering tooth replacements is complex and solutions all involve compromise. There are a lot of hop off places for people to enter into De Nile. Examine your own priorities and philosophies and go with your best solution.
“I have three root canals? What do I do now? Are all root canals toxic? ”
Probably. Eventually. Yet people have varying abilities to sustain the stress of toxins – and of course that ability varies over time. Some biological doctors may recommend a root canal if a patient has a strong immune system, great genetics, and superior lifestyle. They suggest if one’s immune system crashes it can always be extracted later. I personally move further and further away from the idea of assaulting the immune system with unnecessary challenges.
Proper Diagnosis is Key
Since health effects of root canals and cavitations are similar and one can arise from the other, I’ll digress a moment about cavitations. The existence of cavitations, also known as ischemic osteonecrosis (meaning “death of bone due to lack of adequate blood supply) when there is no pain present and NICO when there is, seems to equate to a religious belief. Is there or isn’t there?
It might depend on if you have skin in the game; root canal specialists, state dental boards, and insurance companies cast aspersions on their existence and threaten far more as noted above. Like the huge disservice of the domestic cooking oil manufacturers’ vilification of tropical fats decades ago, the stance of these special interests may equally hurt public health.
Part of the problem is that diagnosis is difficult. Typical dental x-rays can no more accurately diagnose cavitations than they can accurately diagnose subtle root canal pathology. They show only the most obvious cavitations. CT scans are excellent if all metals are absent from the mouth, but they are expensive and come with the price tag of high radiation exposure.
There is no definitive way to judge how infected a root canal treated tooth or cavitation is, but a thermogram, such as many use to detect early stage breast cancer can give guidance. A thermography image displays infrared heat emissions, with each color gradation indicating different heat emissions.
A new type of system, the AlfaSight™ 9000, offers a more comprehensive and precise thermograph than the more widely known digital-imaging camera thermography noted above. This more objective thermometry system delivers a functional physiologic assessment of the body’s bio-regulation system and offers insights into underlying dysfunction that both precedes and provokes developing disease processes.
Infrared measurements of skin temperature at over 100 points on the body including the head, torso, and back, taken both before and after exposure to a cool ambient room temperature assess how the body regulates temperature stress via the autonomic nervous system. Connected organs, glands, and other tissues influence the capillary blood vessel bed beneath each skin point location. Changes indicate either clear or blocked channels.
Scientific evidence shows that internal physiological abnormalities and dysfunction affect skin surface temperatures and that, therefore, skin temperatures and behavioral responses can reveal information about associated organ function. Medical clinics worldwide have studied, correlated, and validated over 40 temperature patterns that define regulation incapacities, called signature recognitions. Alfa Thermodiagnostics’ AlfaSight™ 9000 captures these signature patterns and provides a vivid integrative, computerized summary report that illustrates a system-wide overview and detailed dental, breast, and prostate evaluations. ALFA THERMO- Sample Test Report Female age 57. [Note: The AlfaSight 9000™ has obtained CE marking and Health Canada licensing and is available for purchase in Europe Economic Area (EEA) countries, Canada, and Asian Markets. The AlfaSight 9000™ is also on the “fast track” for U.S. FDA 510k clearance.]
Just as seismologists use acoustic energy to look for oil and OBs image fetuses with ultrasound, some dentists use a Cavitat to explore 3D images of cavitations in jawbone. As with first generation Thermograms, it requires a skilled clinician and there is room for error. In the process of gaining FDA approval, tests using the Cavitat showed 94% of old extraction sites were positive for bone lesions. In a recognizable technique, Aetna Insurance discredited cavitations and the Cavitat.
As Dr. Wes Shankland states in an open letter, “Aetna Insurance Company contacted other insurance companies and reported that jaw bone cavitations did not exist. Aetna Insurance Company also informed others that the Cavitat was inaccurate and those who used this device were “quacks”. Such negative and inaccurate publicity literally ruined Cavitat sales. With no other recourse, Cavitat Medical Technologies made a decision to file a federal law suit, in Denver, against Aetna Insurance Company.” Aetna lost and was ordered to pay a serious judgment, but the damage was done.
EAV (Electro Acupuncture According to Voll)
An EKG measures electrical flow through the heart. Expressed as a graph, it pinpoints heart damage, since current does not flow through dead tissues. EAV works the same way. The EAV test uses an ohm meter to measure energy flow along meridians at acupuncture points.
If you understand meridians and you’ve signed on to “Healing is Voltage,” “The Body Electric” and understand the science behind “earthing”, you know low-functioning organs are low in negative ions. This state hinders electron flow along the body’s energy meridians. Dr. WA Tiller, Professor Emeritus of Materials Science at Stanford University, set out to discredit the EAV, but became an advocate as his research verified organ degeneration correlated with low conductance. In fact, it was he who mapped Meridian Tooth Charts. These help you correlate each tooth with its associated organs, glands, and anatomical structures on the same meridian. Infected or diseased teeth as well as dental implants block electrical conductivity on meridians and so can alter the health of other organs located on the same meridian and vice versa.
Perhaps you have decided you must extract your root canal treated teeth to maintain or regain health against the clear position stated by the American Academy of Endodontists above. You chose a biological dentist who can help you avoid cavitations and boosted your immune system. How should you replace the space? Interestingly, the more complex and biologically incompatible the option, the more costly it is. Costs vary widely as do longevity estimates.
Replacing a Lost Tooth
Implant/Root Canal Bridge
Titanium Implant with Crown
Implants are essentially an artificial root screwed into the jawbone and topped with an artificial tooth or used as an anchor for a bridge or partial denture. Implants are displacing root canals because they look, feel, and function very much like a natural tooth and do not interfere with normal oral activities. They help maintain bone that normally dissolves over time after a tooth is extracted. They can last a long time and do not require grinding down adjacent teeth, as a bridge would require.
The dark side of implants.
We have to remember success is not measured only by tooth function, but function within the body as a whole. Here are a few important aspects of dental implants you must seriously consider before making the decision to go forward with this major investment.
Dead tissues do not conduct energy; implants, whether titanium or zirconium, slow energy flow along meridians. Your body must constantly compensate for this. As with root canals, your associated organs, glands, or anatomical structures may functionally decline. Most people with a dental implant have other metallic dental repairs present, such as gold, mercury amalgam fillings, or nickel-based crowns. This only exacerbates energetic chaos. In fact, the implant, abutment screw, and replacement tooth are also usually different metals. Two dissimilar metals within an electrolyte (saliva) wind up making your mouth a battery.
Most implants used today are make of titanium. So when your mouth is functioning as a battery from having dissimilar metals in it, the resulting chaotic galvanic currents drive ions from the titanium or its alloys, which include small amounts of vanadium or aluminum 24/7. These metallic ions are then transported around your body where they bind to proteins and can wreak havoc. Some people are more susceptible to the resulting inflammatory, allergy, and autoimmune problems than others. There is a blood test to help determine this sensitivity.
Though we are exposed to fluoride through many avenues, tap water and dental products remain our most significant sources. If you drink tap water or use fluoridated dental products, it is important to know fluoride accelerates titanium corrosion in the extreme (up to 500 microg/(cm2 x d)). Low pH values (acidity in the mouth or a dry mouth) accelerate this effect profoundly. Of course corrosion of the other metals also accelerates ion release.
Previous research has documented “The amounts of tin released by the enhanced corrosion of amalgam [in the presence of titanium] might contribute measurably to the daily intake of this element; the corrosion current generated reached values known to cause taste sensations. If the buffer systems of adjacent tissues … are not able to cope with the high pH generated around the titanium, local tissue damage may ensue; this relationship is liable to be overlooked, as it leaves no evidence in the form of corrosion products.”
While most people do not notice galvanic currents, others experience unexplained nerve shocks, ulcerations, a salty or metallic taste or a burning sensation. Noticeable or not, oral galvanic currents are commonly as high as 100 micro-amps yet the brain operates on 7 to 9 nano-amps, a current more than 1000 times weaker. Given the brain’s proximity to the mouth, biological dentists are concerned the constant high and chaotic electrical activity misdirects brain impulses. These currents can contribute to insomnia, brain fog, ear-ringing, epilepsy, and dizziness.
As Dr. Douglas Swartzendruber, a professor at the University of Colorado has said, “Anything implanted in bone will create an autoimmune response. The only difference is the length of time it takes.”Titanium implants are known to suppress important immune cells such as your T-cells, white blood cells critical to immune system function, and create oxidative stress as measured by rH2 values. Diseases associated with implants are not all that different than those associated with root canals: cancer, multiple sclerosis (MS), Alzheimer’s, Parkinson’s, chronic fatigue (CFS), fibromyalgia and other autoimmune and neurological disorders. Other complications include occasional facial or whole body eczema as skin tries to detoxify the titanium ions.
Implanted titanium can induce neoplasia, the abnormal proliferation of cells, which could be a precursor to developing malignant tumors. In August 2008, two articles appeared in the Journal of the American Dental Association that discussed two different types of oral cancer. Both articles indicated that dental implants caused or exacerbated the malignant condition.
Dental implants have no fibrous “seal” to prevent microbial invasion. If you make the decision to get dental implants, I recommend using floss impregnated with ozonated oil around the neck of each implant daily.
Alternatives to Titanium Implants
- Zirconium implants are a newer innovation in dentistry and many biological dentists are now using them. These implants bypass some of the problems with titanium mentioned above. They still block energy flow, but at least they are electrically neutral, so don’t have the potential to interfere with your brain impulses and the implant itself does not contribute to electrical galvanic currents. But you still need to be careful as the artificial tooth may have a metal base. Zirconium implants also release ions, but at a much slower rate than titanium implants.
Implants seem to last quite a long time as one systematic review showed that over the 10-30 year period studied, there was only a 1.3% to 5% loss of implanted teeth in clinically well-maintained mouths. For those with less optimal maintenance, it was more like a 14-20% loss of implanted teeth over that time. Don’t even think about smoking! Endodontic literature has a very different slant on the benefits and drawbacks of implants, of course.
Bridging the Gap
Traditional Bridge Can Be Costly and Relatively Impermanent
First off, bridges do not last all that long. The average bridge lasts 8 years with the range from 5-15 years. For this reason, “permanent bridges” are no longer considered “permanent.” A traditional bridge is comprised of several units – the artificial teeth and the abutments. Abutments are the crowns (caps) made to cover the anchor teeth. The bridge is permanently bonded in place to span a gap that replaces at least one missing tooth. Broken down or completely intact, the abutment teeth to each side of the gap are aggressively cut away to accept the covering crown.
Or should I say smothering crown? Remember my analogy of a healthy tooth to a fountain? A crown stifles the natural nutritive, cleansing, hydrating flow of lymph. It can no longer “breathe.” Why do this to two good teeth that need no dental work for the sake of one (or two) missing teeth? Some biological doctors think these should be removed periodically so the underlying teeth can be cleaned up.
If one of the supporting crowned teeth breaks or develops decay or nerve damage, the bridge and its three or more crowns must be removed and replaced. As a hygienist, I can tell you most people are terrible about cleaning around the abutment teeth and under the artificial tooth. Margins are very susceptible to decay. Again, I council my clients to use ozonated oil around all crown margins as an extra degree of caution. Good personal care is one key to longevity. Don’t even think about smoking!
I am no fan of crowns as I explain in an interview with Dr. Mercola. The more a tooth is destroyed during restoration, the less able it is to withstand chewing forces. And forces which once could transfer through the organic, flexible bulk of the tooth to the root now must travel along the outside of a stiff crown to concentrate at the gum margin – hardly a recipe for longevity of either the underlying tooth or the crown itself.
There are other biomimetic considerations. Biomimetic means mimicking nature. In choosing dental materials, a dentist must weigh the ability of the body’s immune system to ignore dental materials after recognition, called biocompatibility, with the beauty and function patients demand. They must find materials that match the flexibility of teeth so they can absorb daily chewing and clenching stresses. They should expand and contract at the same rate as teeth do when exposed to oral temperature fluctuations and they must resist wear and fracture.
Porcelain crowns are about four times harder than natural teeth and tend to accelerate wear on opposing teeth. They fracture more easily than zirconia based ceramic crowns, which are biocompatible, beautiful, strong and they resist fracture. These benefits come at the cost of stiffness – they are poor shock absorbers, which can be hard on the bones that anchor teeth and the jaw joint. A new material, poly-ceramic DiamondCrown, comes very close to meeting all these requirements and is biocompatible for about eighty percent of people tested. More biocompatible and biomimetic dental materials will emerge as these principals are more widely recognized.
Your cranial (head) bones rhythmically move. Their gentle movements are thought to help drain your sinuses, aid nasal breathing, and influence your nervous system via movement of the cerebrospinal fluid – the fluid that bathes your brain and nerves in your spinal cord.
This rhythmic pumping of cranial bones is particularly important at night because it helps the glymphatic system flush waste products from your brain that have built up during the day. Think of the glymphatic system as your brain’s garbage truck; glial cells create high pressure channels for cerebrospinal fluid that dilate and flow during sleep as blood pumps through arteries and as cranial bones “breathe”. They close during wakefulness. When movement is restricted, migraines or a build-up of the amyloid plaques associated with Alzheimers disease can occur. The glymphatic system may be one of the most important reasons you sleep.
TMJ (jaw joint) specialists, osteopaths and craniosacral therapists recognize the need to maintain cranial bone motion. These clinicians suggest no fixed metal dentistry, whether “permanent” bridgework, metal partial or metal retainer, cross the midline of the upper jaw, the maxilla.
If you choose to have a permanent bridge, biological dentists often recommend all porcelain bridges, not porcelain fused to metal, since most of these metals contain nickel. Some dentists will assure you that they would never use a nickel-based metal; they use stainless steel! Stainless steel contains at least 10% chromium, vanadium, and nickel and/or manganese. Go metal-free! Zirconium, bridges are a newer and better option with many of the advantages discussed in the previous section on dental implants.
Fixed bridges were once considered premium care, since they, like implants, look, feel and function much like permanent teeth. In my experience, both require about the same amount of extra personal and clinical care. Incidentally, dentists will occasionally recommend a cantilever bridge, anchoring a false tooth to just one neighbor instead of two. These are less costly, but can certainly put torque on the anchor tooth, which it cannot always withstand.
Resin Bonded Bridge: Less Costly But just as Impermanent
Resin bonded bridges (Maryland bridges) are a minimally invasive option for replacing missing teeth in certain situations. They are generally only considered for anterior tooth replacement Design, materials, skill, and patient selection largely dictate longevity and satisfaction. Design and materials have significantly evolved.
Unlike traditional bridges, resin bonded bridges require much less reduction of supporting teeth. Instead, the dentist slightly reduces the backs of the neighboring teeth onto which “wings” attached to the artificial tooth are bonded. Materials can be all resin, porcelain, porcelain bonded to metal, or zirconium. Most doctors still fabricate these bridges with a wing to either side of the artificial tooth, though the literature seems to suggest it is better to just have one – to cantilever the missing tooth off one supporting tooth.
Interestingly, this is because it is recognized that cranial bones and teeth move and that the anchoring teeth do not move equally. This puts stress on the bonds, leading to failure. Also, since it is unlikely that both bonds break at the same time, the debonding often goes unnoticed and decay can set in under the debonded wing. RBBs are a good option for adolescents with missing teeth when well designed. Most replacement options cannot be considered until one has finished maturing physically. These bridges help maintain space and are fairly easy to care for.
If you have teeth that have loosened due to gum disease, some would add another advantage of resin bonded bridges – they help splint them together. True, but unless gums are disease-free and easily cleaned on a daily basis at home, it might be time to remove the resin bonded bridge, because in this case, it might be extremely difficult to self-cleanse daily at home. We are not just looking at longevity of the teeth, but longevity of the host.
Downsides? They are somewhat fragile. If made with metals, the usual caveats apply: mixed metals lead to galvanic currents and a panoply of problems already addressed. Again, 100% zirconium would avoid this. Remember, biological dentists try to be metal free and avoid metal-based crowns and bridges. It isn’t just the galvanic currents these set up, but the release of nickel/chromium/manganese ions.
A better RSS option might be the Carlson Bridge – a resin bonded bridge that requires no drilling into adjacent teeth. Placed in one appointment, these economical, prefabricated, “winged” replacement teeth can last many years. An advantage is that the bond to adjacent teeth is less rigid, so cranial bones can shift as they should.
Partials: The Least Expensive Option
The intentional exposed palate design in this partial means the wearer can continue good oral posture, which means properly keep the tongue in contact with the palate.
Going back in time, removable partials were all dentistry offered to replace missing teeth. Our current culture values looking young, so partials – associated with our grandparents – are a difficult aesthetic choice. They may however be the choice that offers the best chance for aging well.
Partials are designed based on how many teeth need replacing. Metal frameworks were once the norm, but the future lies in non-metal dental repairs. New materials:
- Are less obvious
- Avoid the adverse properties of metal restorations already discussed
- Are able to distribute chewing forces over a greater area compared to metal framework partials so are more comfortable
- Relines are less frequent
- Per the Clifford Biocompatibility Test, Flexite and Valplast (light, flexible, yet strong nylon resins) are biocompatible for 99% of the population. Lucitone FRS is a very similar biocompatible nylon resin. None of these uses a heavy metal (cadmium) as a pink colorant as some other dental materials do. Many patients choose a clear framework to avoid any possible reaction to the colorant. Nylon materials can draw in water and with it, odors and stain, though good hygiene can mitigate this problem.
- VisiClear is a nylon-free biocompatible partial material.
For best aesthetics, biocompatibility and biomimetic function, choose DiamondCrown or zirconia teeth in your partial rather than the default acrylic teeth most often used. If you must add another tooth to any of the above partials, it is possible. The lab simply reuses the artificial teeth, the most valuable component, and remakes the framework with the new tooth!
Biocomp Labs and The Clifford Consulting and Research Lab offers individualized dental materials testing, recommended especially for those with multiple chemical sensitivities or anyone who needs dental work and feels their health could be challenged by the wide range of dental materials available.
Most patients tell me they consider these newer lightweight partials are comfortable and aesthetically unnoticeable, though they are annoyed that foods tend to trap under them. People with spider partials tell me they often take them out to eat, but wear them the rest of the time to maintain the space until dentistry offers them more biocompatible “fixed” choices.
At least one reader will likely think that if only people adopted a certain lifestyle, these kinds of advanced dentistry would be unnecessary. I couldn’t agree more and is one of the main foci of Mouth Matters; the reality is that most people’s mouths are in deplorable shape.
I try not to spend much time thinking about the rescue dentistry presented here. Most of my advocacy work centers around changing how all of us approach dentistry so your children or their children can avoid these compromising options. Ultimately, the answers to better oral and general health start in infancy and include a radically different model of dentistry and definition of health. The answers are out there now along with a few clinicians who know them. Seek them out and if you can’t find someone who does the kind of dentistry you want in your area, be ready to ask them to learn it.
Limited Availability: apologies in advance for the impossibility of answering/researching all personal e-mail queries or comments posted to various blogs. I will however selectively answer those of a general nature so readers can benefit from other’s questions. Please note: Carol Vander Stoep is a dental hygienist. Just as a dentist may not legally diagnose or offer personalized dental treatment advice via the Internet, neither may she. Carol will not dispense dental/medical advice via email – if you have dental concerns, please schedule a consultation with a dental professional whose philosophy most closely aligns with yours. Mouth Matters and Primal Dentistry books and database as well as this website is an offering to help enlighten you about possible considerations and choices.
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