I was disappointed to read a number of articles that claimed 97 per cent of terminal cancer patients have had root canal treatment in the past. This upset me on a number of different levels, not only because of the implied causal link between root canal treatment and cancer, but also the fact that this alarmist nonsense can be pedalled out so convincingly by and to apparently intelligent people.
It is worrying that in the 21st century there are still people out there regurgitating the work of Dr Weston Price and his ilk. Even more concerning is the thought that articles such as these may well be putting patients off root canal treatment based on this misguided ‘science’.
An awful lot of the pseudoscience that can be found on endodontics can be linked back to Focal Infection Theory (FIT) that was popular for the early part of the last century. According to the theory a localised infection will disseminate micro-organisms or their products to a distant site in the body. As a result of focal infection theory conservative dental treatment was avoided for many years and extraction was recommended instead.
This continued right up until the 1950s when advances in endodontics coupled with advances in biology and epidemiology start to bring about the theory’s demise. However, this is not to say that FIT has completely gone away. Despite a lack of real scientific evidence, FIT and similar theories are still very much with us, and are being used to undermine scientifically sound treatments that save teeth and improve patients’ quality of life.
The dental conspiracy
Pseudoscience seems to be everywhere these days. The internet has certainly given the pseudoscientists a new platform to reach out and share scare stories for their own financial gain. It astounds me that they act as if there’s some major conspiracy going on; that doctors and dentists are somehow working to hide the fact that they are secretly poisoning patients – for what reason I couldn’t begin to imagine.
In the past it was silver amalgam fillings that were part of the conspiracy, but now it seems to be endodontics. While we endodontists are apparently the villains, the heroes are those nice ‘biological’ dentists - you know, the ones who really understand and care for their patients. Influenced by the ‘visionary’ Hal Huggins, biological dentists are concerned with how dentistry affects the entire body. Of course our biological friends are aware that root canals are difficult, and that we can never absolutely sterilise a canal. But then they take this argument further and claim that pockets of bacteria that are left untreated are leaching out, causing organs to fail. That is why biological dentists recommend extraction, plus removal of the periodontal ligament and the surrounding area of dead bone. Personally I think I would prefer a root canal.
Teeth as causative agents
The problem with our friends is that they have a great ability to take a grain of truth and extrapolate it and draw conclusions that the science just doesn’t suggest, but with quite a seductive and reasonable-sounding tone. They are of course quite right that bacteria from oral sources can enter the bloodstream (though let’s not forget bacteraemias also occur naturally through normal everyday processes such as chewing and even brushing our teeth). They are also quite correct that bacteria can enter the bloodstream due to endodontic sources such as acute dental abscesses and instrumentation during canal preparation. Furthermore, they are also correct that it is virtually impossible to full clean out a root canal system and that some bacteria will inevitably be left behind. So far so good, however there is no evidence that these bacteria are constantly leaking out of the tooth causing bacteraemias. And even if they were we would need a number of factors to combine to cause a problem: we would need a large number of viable bacteria that can survive host responses; these bacteria would then have to encounter predisposing conditions for attachment, reach sufficient numbers for disease, and have virulence to actually cause disease. There is so far zero evidence for this.
Trust in science
If pseudoscience teaches us anything, it is that it is very easy to be selective or deliberately misleading with facts. While pseudoscience may not bring about the death of endodontics per se, it is still certainly influencing a great many people into making decisions based on hearsay and outdated ‘science’ that has no grounding in the modern day world.
As dentists we are fully aware of just how intricate and difficult to prepare a root canal system can be. However with the latest equipment, irrigants and three-dimensional filling we can really cut down on the number of bacteria in a tooth and entomb any survivors so that they wither and die. We are also aware of the need of a coronal seal to prevent further ingress of bacteria and know that the inflamed teeth that we treat never had an infected root canal system to start off with.
If pseudoscientists had their way I am sure we would return to the 1920s and extract every single infected tooth, but thankfully we’ve moved on since then. With the latest advances in endodontics, root canal treatments are safer and more successful than ever before, and an option we can offer patients with complete clinical confidence.