Root-Canal Treatment … holistically… an “alternative alternative” viewpoint ! by Michael C. Goldman, DDS
27.02.2006

I am neither FOR nor AGAINST root canals…. My position is that there is NO PERFECT SOLUTION at this time to a root canal problem and so taking a black or white position for or against root canal treatment seems to me to be a mistake in judgement. My feeling is that each situation needs to be seen and evaluated on its own merits.

If extraction makes sense in a specific situation, fine. If not, then perhaps there are some things that could be done – perhaps just a little differently – to make the root canal treatment less likely to become a problem later.

As Paul Harvey used to say on the radio:
And now for the rest of the story…

FAQ 1: My dentist says I need a root-canal. Should I have it done or Extract the tooth?…and What are the consequences?

FAQ 2: I have been told it’s dangerous to keep my old root-canal treated tooth. Is that true? What should I do?

There is a line of thinking among many dentists in the holistic community that root canals are necessarily “bad” and should be removed if you have them and never done if you need one… Well, that’s fine if there’s some reasonable alternative. Sometimes there is…. and sometimes there is not !

Before you let any dentist remove any of your teeth – possibly making you a dental cripple – check out what treatment options are being offered following the tooth (or teeth) removal and see if what is offered makes sense to you…..Always remember, it’s YOUR body, and only YOU can decide what’s right for it !

Get a good understanding of the issues so you can make an informed decision about your body !!!!!

Note [this really just happened ! ] :-(
As I’m in my office writing this section, the phone rang. A young woman wanted an appointment for a consultation about getting a partial denture (removable bridgework…”like her grandparents wore”…). She had all the molars extracted on the lower jaw on one side….

Her “holistic” dentist had told her she had infections and cavitations…and the teeth had to come out. No options were offered. He scared the h…. out of her. And so…as often happens … she went along. She never thought about “…then what?”.
………Never having experienced several missing teeth before, she had no idea how devastating it might be or feel. I felt very, very sad for her.
She was now in touch with her anger about having been told to take out those teeth. She said she would never have done it if she really understood the implications…

She said she had no intention of going back “to him” to have the rest of the treatment finished. She was sick about it….and so was I. I’m not totally 100% convinced about how big a problem she might have had with the infections and cavitations she was told she had…, but I am 100% certain she’s really got a problem now for sure !!!!

Please understand, her decision was neither right nor wrong…it’s just that she was not given enough information to make that decision from a position of mental comfort and balance. It’s what is legally called “informed consent”. Don’t ever allow yourself to be pressured or intimidated into a course of treatment!

Some of the frequent questions that I get asked are about root canals…. What to do about old ones?… What to do if one is now needed? While a lot has been said about potential problems with root canals – and I agree with much of that – little has been offered for patients who need to make real-world, hard, practical choices, not in the abstract, but about their own bodies.

I recently had this discussion with a very aware woman who was concerned about issues raised in Dr. Geoge Meinig’s excellent book discussing Dr Price’s research of root canal problems and treatment. That book , of course is “Root Canal Cover-up Exposed!”.

Let me set the groundwork this way. I do many root canals in my practice, which I like to characterize as a holistic, mercury-free, caring practice, centered in what I like to think of as a “healing environment”. I have read an am familiar with the controversies regarding root canals as raised by Dr. Price, Dr. Meinig and others. I agree with them!….. Nevertheless, I feel there is more to the story and when it comes to making practical decisions, people need practical options.

Here’s how I have reasoned through this difficult and very confusing issue.

First, to re-familiarize readers with the issues raised against root canal treatment let me do a quick review. Recently, a book, Root Canal Cover-up Exposed was published by a dentist named George Meinig centering on the research done about the turn of the century by another remarkable dentist named Weston Price. Dr Price did a lot of very interesting research relating to root canal infection and treatment spanning a period of about twenty-five years with some amazing results.

The basic notion behind his work was the idea of focal infections which was a very big deal in medical thinking at that time. It is the idea that an infection someplace in the body – tonsil, gums, toenail, ear, or root canal – might be able to spread to another perhaps far remote part of the body. There was the feeling that was largely accepted that a gum infection, for example, might be able to end up somehow in the heart or other part of the body,and result in a dangerous or even life-threatening infection there. That idea, while never disproved, just sort of faded away by and large (although it keeps making small and sporadic comebacks ).

What happened was that with the advent of penicillin and other wonder-drugs to combat infection, concern for where the infection was coming from was suddenly less important than just which particular germ the infection was. The identity of the germ bacteria dictated which particular wonder-drug antibiotic was needed and that, in a nutshell, was that! “…Next patient!” We got away from treating the cause to treating the symptom .

If the way Dr. Meinig describes it in his book is accurate, the political debate among medical/dental leaders at the time must have been pretty hot and heavy! No doubt the pharmaceutical companies had their input, too… As with any new wave of thought, those that held to old ways were labelled old-fashioned and reactionary, whereas those that promoted the new were seen as modern and with it. The new way won the day. Some ground was gained, no doubt, but something may have been lost in the process.

Re-enter Dr. Weston Price. He took infected teeth or extracts of them from patients suffering from a wide range of serious “medical” problems. He implanted these under the skin of laboratory animals….Guess what happened? The laboratory animal quickly came down with the very same disease ! I might have expected that an infection from a tooth might go somewhere. Like if ten animals had parts of an infected tooth implanted, that one might get an infection in the brain, another in the heart, and another somewhere else and so on…that seems reasonable. But that’s not what he (and others) found at all! What was seen was that if the patient had infected kidneys and his infected tooth was implanted in several lab animals, essentially all the animals quickly developed infected kidneys! I don’t think contemporary medical wisdom can explain that.

Moreover, Dr. Price claimed to have found that 95% of focal infections started in the teeth and tonsils! Part and parcel in with this is the idea that harmless bacteria normally found in the mouth get trapped in infected teeth (and tonsils) and somehow mutate into a dangerous form. The new mutated bacteria and /or the toxic poisons they create travel through the blood stream and lymphatic system to remote body parts and cause damage.

As if that were not bad enough, Dr. Price goes on to show that even when root canal treatment is done according to accepted modern principles…and even when the followup x-rays show good healing of the bone around the root (which has been thought to prove that the infection is gone) – that even then, the mutant bacteria and their toxins are often still there spreading their poison! This is a very different scenerio from what I was told in dental school and in all the years up to now! All I can say is that I read the book with an open mind and with the ability to challenge allegations by virtue of my training and 25 years or so of experience and I have to say it was compelling.

The anatomy of a tooth is like this. There is a hollow space running down the center of each root. That is the nerve canal. It can have curves and small offshutes or branches to make it more complex than a straight “tube”, but in all, that total space is the nerve- or root-canal space. In a healthy tooth the nerve and small blood vessels mainly occupy that space. When root-canal treatment is done, that canal is cleaned out to render it empty. Medications are usually used to “sterilize” that space…to kill any bacteria that might be remaining after physically cleaning it out. Then it is filled up with various techniques and materials to obliterate the space.

What Dr. Price and Dr. Meinig showed is that it is more complex than that. Not only is there this large central nerve-canal space to worry about, but, rather, that there are millions of little tunnels coming off the central nerve-canal space radiating through the body of the tooth root to the exterior surface of the tooth root. The tooth root surface is in contact with the blood stream and then bone. The “little tunnels” or dentinal tubules, as they are correctly called comprise literally miles of tunnels into which bacteria from the nerve-canal space can go and hide, well away from the physical and chemical efforts of the dentist. This has been shown more recently and confirmed by the electron-microscope!

What does all this mean? What are the implications? Well it seems to me there are several. First, it seems ever more important to do the root-canal treatment as early as possible. In addition to making the treatment easier for you, it minimizes the opportunity for infection to develop inside the tooth which might be able to subsequently hide in the tubules and from there spread havoc around your body.

Second, there is only one medication which is generally agreed to be found capable of really killing even the most resistant bacteria inside the tooth, calcium hydroxide. [ See page 197 of Meinig’s book, 1993 edition ] Calcium hydroxide (Note: This is NOT…NOT…not Biocalex, which is now sold under a new name which I believe is Endo-Cal) is recognized to be more effective than other more “modern” medications, but is only infrequently used by the root canal specialists and usually only for special situations, not consciously related to the issues raised here. There is no reason why it should not be routinely used and for a long enough time period to do the job (about a month). The norm today among general dentists as well as root canal specialists is to either finish the treatment in one appointment or perhaps in two appointments a week apart. Little real effort is apparent to sterilize the canal, probably again because of the “modern” thinking that if an infection is still there, we’ll just knock it out with one or another antibiotic later.

****************

So with all that having been said, why on earth would I ever recommend doing root canal treatment? It really hinges on the question of what are you going to do if you already have root canal treated teeth or if you have a tooth in need of root canal treatment?

If you just take out a tooth or teeth how are you going to replace it? Well, you may just say “I won’t replace it.” That’s ok, how about if it’s a front tooth? You could choose to not replace it, but realistically most people would want to replace it.

Back teeth that “don’t show”? If you leave missing teeth missing, you may develop problems with your gums, problems with your bite (TMJ), and / or sacro-cranial problems, not to mention lowered chewing ability. I should add that in some situations, teeth can be left not replaced and everything may be fine. But that’s the exception to the rule. The fact is that most of us will want the teeth replaced for a variety of reasons.

Teeth can be replaced with removable, “clip-in” partial dentures – bridges you take in and out. Most people find them unesthetic and unhygienic. Workable, but not very satisfactory….. Dentally, they work… but not well. Usually patients want teeth replaced in a way that is close to “natural”.

That means the teeth must be replaced with an implant or a fixed bridge with caps. Implants are metallic posts implanted into the jawbone to mimic lost tooth roots. They are complicated and expensive and require a surgical procedure. Mostly (but certainly not always) they work pretty well. But what of having a metal plug directly in the bone ? Is it a problem? We really don’t know.

From a regular western dental point of view they seem ok, but from a more subtle holistic point of view, who knows! Maybe after years of observation we’ll have some idea, but I don’t think anybody really knows for sure at this time. I wonder if the metal of the implant interferes with accupuncture meridiens which flow through the bone where the implant has been placed. We know each tooth is normally related to meridiens.

If implants are out, then the other possiblility may be to cap the teeth on either side of the space and have a “dummy cap” attached to those caps so the “real” caps hold the “dummy cap” in the space. That’s good old dentistry as it’s been done for years. While we have some options now about what the caps can be made of so that it is possible to make caps without metal in them, that is not always an option. It depends on the specifics of you and your mouth. But, what if you don’t have teeth on either side of the space to hold a “fixed bridge”, or if the teeth are not suitable for use?

And what if capping these other teeth causes so much trauma to those teeth that the nerve breaks down in them …and then they need root canals? That probably won’t happen, but be aware that it can and does happen! And not necessarily through any fault of the dentist, either. Finding a really good dentist will minimize that possibility, but it will not eliminate it….

So then what do you do? That’s the problem. If there were a perfect solution, I’d be first in line for it…but, unfortunately, there is not a perfect solution.

Given that, then, what can be done to respect and acknowledge the kinds of issues raised by Drs. Price and Meinig (and others), and yet treat diseased teeth?

Apparently Dr. Price did not work with all the root canal medications we have today. Cacium hydroxide is a simple salt used to make lime water. It was around in Dr. Price’s time, but it seems from Meinig’s writings (page 197) that it was not used in root canal treatment then as it has been used subsequently. Today calcium hydroxide is recognized by root canal specialists as being one of the most – if not the most – potent sterilizing agents that can be placed in the root canal space. Also, it is non-toxic and it stimulates the bone to repair around the infected root. (Note: Calcium Hydroxide is NOT…NOT…not Biocalex, which is now sold under a new name which I believe is Endo-Cal)

Root canal specialists all use calcium hydroxide, but only occasionally, for special and difficult situations. Their thinking has little to do with the issues raised here, however. Dr. Meinig discusses calcium hydroxide in his book on page 197, acknowledging its potency. He comments that it kills even the most resistant bacteria in about a minute.

Dr. Price was skeptical that anything would be able to sterilize the tiny tubules especially as they go further and further away from the main large nerve canal space outward toward the outside surface of the root. He said (as reported by Dr. Meinig on page 111, 1993 edition) that “It is practically, if not entirely, a physical impossibility to sterilize infected cementum [ the outside surface of the root ] by treating through the dentin [ that is, by placing a disinfectant inside the main nerve canal space in the center of the root structure ]. It is like trying to sterilize infection in the label on the bottle by putting disinfectants in the bottle.”

There has been some very interesting research in the use of calcium hydroxide. We have learned that when calcium hydroxide is placed inside the tooth, the cementum [outside root surface] can be monitored to see the change in pH. The pH measures acidity or alkalinity, where 0=strongly acidic, 7=neutral, and 14=strongly alkaline . Calcium hydroxide is a strong alkaline and within 3 days of filling the root canal space with it, the pH measured out at the outside root cementum surface goes from about pH=7 (neutral) to pH=9. After about 18 days the pH is 10 and that pH will be maintained up to at least 120 days, which is as long as the research continued to measure it. It was found that this change in pH was observed everywhere on the root outside surface which would suggest that all the tooth structure was affected by the calcium hydroxide.

Does this guarantee that every single tubule in the tooth was affected and that every single bacteria cell in the tooth was definitely killed stone dead? No, it doesn’t, but it suggests very strongly that it probably is so.

There are other significant benefits to calcium hydroxide. It will dissolve any tissue remaining in the root canal space. That’s important because the mechanical technique used by dentists to clean out the nerve canal space leaves lots of bits of tissue behind, especially in the little offshutes and accessory canals which usually cannot be reached with dental instruments. So the calcium hydroxide dissolves it out chemically, provided it is left in there for a long enough time.

Additionally, the calcium hydroxide stimulates bone repair which is usually damaged if the root canal problem has been going on for more than a short time. In the mouth the calcium hydroxide dispurses not only out from the nerve canal space to the surface of the root, as in the research experiment mentioned above, it continues out and goes into the ligament that holds the tooth to the bone socket, and further out into the bone itself, helping to decrease inflammation, ease pain, counteract the altered chemistry from infection, stimulate the bone repair processes and kill bacteria along the way.

So, if a patient of mine has a root canal problem, I almost always recommend doing the root canal. When I do the root canal treatment, I use calcium hydroxide as the medication inside the tooth and I leave it there for a full month. Not a week, not 10 or 14 days, a full month. In severe cases I have re-medicated for one to several months after that before finalizing the treatment.

Often when patients have been concerned about old root canals, I have re-treated them by starting over and using the calcium hydroxide technique.

Again, I cannot guarantee this is a perfect solution…

but neither can any other dentist guarantee that this or that “holistic” or “conventional” treatment is going to be perfect either!!!!
*****

So what’s the problem if I use calcium hydroxide?
The big question remaining about what I have suggested here is even if the canals and tiny tubules can be make totally bacteria free…which may or may not be the case…. what happens after a period of time. A week, year…ten years? Do bacteria come in from the outside and rehabitate the tubules? We know it is possible, because it happens in gum disease. If it happens that way, is it a problem? Is it the same as when bacteria are left in there when root canal treatment is done? It may seem logical to think “yes”…but we just simply don’t know.

Can root canals be tested somehow?
Perhaps…..There have been dentists that “test” teeth using kinesiology, or acupunture, …or electrical acupuncture spinoffs like computerized “Voll testing”. Are they valid? perhaps….perhaps not…. We don’t know for sure. Am I against these techniques? No, definitely not. Any indicator is helpful. But would I take out a tooth of mine based on them?….NO way!!!

Is there hope in this mess?
I think so… testing techniques are developing as more interest [and money] are beginning to surround these issues. At present a very interesting test has been developed by some very clever people at Affinity Labelling Corp. out of University of Kentucky.

They have developed a very sophisticated test for toxins around teeth either from the gums or from the root canals. Is it valid? Maybe… But to me it looks like the best and most valid and most scientifically based way to test teeth at this time. And that’s a lot ! They have a very good website with lots of good info at http://www.altcorp.com. If you’ve read all this stuff up to here, you definitely should check them out.

Biocalex….

They have tried to get results about what happens over time with root canal teeth that are treated by conventional means and by using the Biocalex technique. In my persomal experience with Biocalex I feel it is NOT THE WAY TO GO. There are many well-documented problems with Biocalex including splitting of teeth (preventing them from ever being saved) , post-operative pain and strange discomforts, inability to re-treat the tooth again if needed later, and inability to see the results on xrays aftera period of time. I HAVE USED BIOCALEX SEVERAL TIMES AND WILL NEVER USE IT AGAIN ON MY PATIENTS. Calcium Hydroxide has been dependable and comfortable for many years in my hands with my patients and I continue to use it as described above. CALCIUM HYDROXIDE IS NOT THE SAME THING AS BIOCALEX. CALCIUM HYDROXIDE IS NOT THE SAME THING AS BIOCALEX.CALCIUM HYDROXIDE IS NOT THE SAME THING AS BIOCALEX. Have I made my point clear enough?

It is my hope that this article helps readers reach reasonable and rational decisions about their dental health.

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