Book Review: The Roots of Disease
Connecting Dentistry & Medicine by Robert Kulacz DDS and Thomas E Levy MD JD, Xlibris Corp. 2002
This book has been written jointly by Dr Thomas Levy, a US doctor, attorney and author and Dr Robert Kulacz, a dentist with a special interest in root canal treatments and the treatment of cavitations. This book addresses the many problems posed by current routine dental treatment which the authors firmly believe may account for the explosive increase in the numbers of people suffering from chronic, serious and degenerative diseases that appear to be peculiar to the developed world.
The dental profession is either oblivious to or in denial about the harm it is inflicting, and for understandable reasons, they are not likely to conduct research implicating their procedures in the causation of ill-health. And the medical profession by-and-large does not consider the mouth to be a part of the body, so they are looking the other way too! This schism means that, in the words of the authors, "No one is minding the shop!" (ie: the health of the body).
As an aside, I notice time and time again that the possibility of a dental cause for a variety of illnesses is almost completely overlooked by researchers. I remember a study into the stratospheric rise in rates of asthma on a particular Pacific island where those involved had exhaustively analysed the environment and diet but had completely neglected to look at what dental treatment(s) and materials may have been introduced to the island in recent times.
Although the book addresses the topics of the toxicity of dental materials and particularly the use of mercury-containing amalgam, and the problems posed by jaw cavitations and some other topics, this review will concentrate upon the dangers posed by root canal treatments as these other topics have been covered in previous articles available on this site.
The authors argue that the hidden infections found in all root canal treated teeth may be one of the largest contributory factors to the causation of diseases such as cancer and heart disease and that many - if not most - medical conditions get their start in the dentist's chair. They maintain that routine procedures that are performed every day either initiate or may worsen most medical conditions.
Whilst infected root filled teeth are not the only source of dental infections, which may also arise from periodontal or gum disease, cavitations (holes which may form in the jaw bone further to tooth extraction), abscesses and dental implants, they have been consistently linked with serious medical consequences. The link between gum disease and a variety of disorders including heart disease, strokes and preeclampsia in pregnant women is now well established, but this has only been relatively recently accepted. However, at present, the dangers posed by root canal treated teeth remain either unacknowledged or actively rejected by the majority of the dental profession.
The authors counsel us to appreciate the money trail when understanding why things work the way that they do. If dentists in general and endodontists (who are dentists that have specialised in root canal treatments) in particular acknowledged the problems posed by root canal treatments they would have to stop doing them. This would have massive repercussions and consequences upon their livelihoods and dental practice. It is also very difficult medico-legally not to offer what is widely accepted best practice and certainly takes a lot of one-to-one explaining of why you adopt a different approach. I wonder if the medieval barber surgeons who refused to bleed their patients had the same problem.
In the 1960s US dentists performed nearly 3 million root treatments per year, by 1990 that figure had risen to 40 million per year and in 2002 there were estimated to be more than 50 million per year. Other similar increases have occurred and continue to occur throughout the rest of the world with a slight time lag. This has coincided with chronic and degenerative diseases that used to be the province of old age appearing earlier and earlier in life and the advent of many illnesses which appear to be 'mysterious' in that they have no clear diagnosis or cause.
In order to understand the problems posed by root canal treatments you need first to understand a little about the structure of the tooth and what a root treatment is.
The structure of the tooth
The bulk of the tooth is composed of a tubular structure known as dentine. In the visible part of the tooth (the crown) this dentine is covered in a heavily mineralised layer of enamel. Below the gum, the dentine is covered in cementum which anchors the periodontal ligament fibres that suspend the tooth roots within the jaw bone. The dentine encases the pulp of the tooth which comprises the blood, lymphatic and nervous supply to the tooth as shown below.
The dentine is composed of millions of tiny tubules that radiate outward from the pulp to the enamel or cementum junction. In health, each of these dentinal tubules is occupied by an odontoblast which originally formed the tooth and some believe continues to maintain the tooth structure thereafter. The processes of the odontoblasts may extend through some or most of the thickness of the dentine.
In fact, dentists use the tubular nature of dentine to be able to bond plastic materials on to the tooth by chemically cleaning the surface and then applying a fluid resin which locks into the tubules when set with a light.
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What is a root canal treatment?
Root canal treatments are usually performed in response to an irreversible inflammatory process that takes part within the pulp of the tooth. This is most often caused by the bacteria and toxins that cause dental decay, but may also be caused by trauma or by a cracked tooth.
A cracked tooth is a tooth that has a hairline crack (often in turn caused by a dental amalgam fillings swelling) but has not broken. They can be painful to bite on at certain angles but the pain can be relieved when the teeth are not in contact. In such circumstances, bacteria from the mouth along with other substances can leach into the pulp of the tooth and the crack itself can also cause mechanical trauma.
Alternatively, the patient may present with an abscess (an infection around the tip of the root of the tooth) or a chronic infection may become apparent on an x-ray (often a granuloma ie: an area of fibrous, infected and inflammatory tissue) and this may be asymptomatic.
Whatever the cause, the inflammatory process within the pulp of the tooth effectively strangles the blood supply creating a necrotic pulp which can then act as a breeding ground for the bacteria which may have caused the pulp to die in the first place. Within the pulp which now has no circulation, bacteria can multiply and leach toxins and microbes from the ends of the roots.
When a dentist performs a root canal treatment they clean out the decay and create access to the pulp through the top (in the case of a molar or bicuspid/premolar tooth) or back of the tooth (in the case of an incisor or canine tooth). They then use either hand instruments or various ultrasonic or rotary devices to mechanically clean out the necrotic tissue and they ream the canals to create a uniform canal that they can then fill.
They use irrigation to flush and clean the canal system and wash away debris created by filing the canals. They may place an antiseptic paste within the canal system in the hopes of sterilising the inside of the tooth and place a temporary filling and complete the treatment at a later appointment or complete it in one visit.
The canals are then filled with a rubber-like material called gutta percha which is usually used along with a sealing material. This can be achieved by means of manually condensing points into the canal with a long probe-like instrument, or by heating and injecting the gutta percha with the goal of having it flow within the root canal system.
Problems with root canal treatments
The first problem which is well recognised by endodontists and most dentists is that most teeth are not like the idealised version represented above in that each root may have more than one canal. In addition these canals may intercommunicate in a complex way so that the preferred term is root canal system these days.
Frequently, one or more of the canals may also have become occluded by the formation of secondary dentine within the pulp in response to irritation from advancing decay or in an attempt to repair. This can make it difficult or impossible to locate, access and instrument all the canals.
In addition to the main canals, there are also many minor lateral canals which carry collateral blood and nervous supplies which perforate the tips of the roots of the teeth. These lateral canals are impossible to clean out by even the most diligent and skilled endodontist and may ultimately act as a reservoir of necrotic and/or infected material.
These problematic factors are all well acknowledged and root canal fillings although apparently successful much of the time still carry a significant failure rate depending upon whether the tooth is being re-treated and the skill of the operator.
However, the big problem with the whole concept of root canal treatments is that the dentine is not solid, but tubular in structure. In fact, the tubules within an incisor tooth would stretch 3 miles end-to-end and those in molars would cover 12 miles. Although tiny, these tubules are big enough to house many different species of microbe including bacteria and fungi as shown in the illustration below. This means that the dentine of the tooth can act as a reservoir for millions of bacteria.
The problem is that no amount of instrumenting or irrigating can remove all the organic material within the tooth and almost all root canal treated teeth have been shown to harbour bacteria from the moment the procedure is completed. Bacteria are then able to migrate into and be harboured by the root canal treated tooth which has no circulation and therefore no immune system serving it. So that although the procedure frequently results in the elimination of pain it does not result in the elimination of infection.
The very indication for doing a root canal treatment is often a necrotic and possibly heavily infected and abscessed tooth that is spewing bacteria and necrotic material. What endodontists believe is that they can reduce the number of microorganisms present with diligent cleaning, seal any residual microbes within the the body of the tooth and that the immune system will then be able to control any bacteria that remain.
The problem being that, once the bacteria are sealed within the dentine of the tooth and deprived of circulating oxygen they change into their anaerobic forms. This is the way normally harmless bacteria can change into highly toxic forms as in the case of which can grow within foods to produce the incredibly potent toxins that cause botulism.
This means that root canal treatments are a fundamentally fatally flawed procedure in the eyes of the authors and that there can be no such thing as a 'safe' or biological root canal treatment. Although many root treatments appear to be successful from x-ray assessments, they can produce both chronic and acute threats to the health of the individuals involved.
Dr Robert Kulacz cites an example of a local doctor who had to be admitted to intensive care with life-threatening toxic shock after initial treatment of a tooth by an endodontist. In spite of nearly dying the patient still chose to complete the root canal treatment with encouragement from both the endodontist and another dentist. His feeling however is that the tooth is a ticking time-bomb waiting to undermine the health of the physician concerned.
For many others the cause is less clear-cut and the problem less acute, but no less serious. The idea is that root-filled teeth provide a constant challenge to the immune system and that this can result over time in the development of cancer, heart disease or an autoimmune disease. And Dr Robert Kulacz gives real life examples from his practice of people who have managed to recover from seemingly hopeless illnesses after extraction of their root canal filled teeth.
The fact is that the dental profession already acknowledges that bacteria from the mouth can spread throughout the body during routine cleaning or invasive dental treatment. In certain vulnerable groups this has historically required the use of prophylactic 'antibiotic cover' to prevent these bacteria attaching to the heart valves and causing infective endocarditis. However, the profession at large somehow fail to make the connection that the same process is at work in everyone, albeit with less immediately life-threatening consequences.
Focal infections and root filled teeth
Focal infections act as reservoirs of microbes that can be seeded throughout the body and which can produce incredibly potent toxins that can also have a detrimental effect upon general health.
The authors liken the problem posed by root canal treated teeth as being akin to that of toxic shock syndrome caused by the use of super-absorbent tampons. This issue first came to prominence a couple of decades ago when these products were introduced. These tampons occupy a body cavity (the vagina) and become saturated with body fluids and blood in an oxygen deprived atmosphere whilst being incubated at body temperature and this leads the bacteria within to multiply and mutate into their anaerobic forms.
In the case of toxic shock syndrome induced by super-absorbent tampons, Staphylococcus bacteria from the skin which are normally harmless transform in the oxygen deprived environment of the tampon into pathogenic forms producing a very potent toxin. And both the immune system and antibiotics are helpless to defend the body since there is no effective circulation to the source of infection.
Specific microorganisms seek out and flourish within certain microenvironments in the body. This means that the herpes simplex virus, for example, is frequently highly specific to the roots of the nerves serving the mouth occasionally reactivating and producing cold sores. The particular microenvironment on offer will also vary from person to person according to genetics, diet, race, and so on. And so different people have individual vulnerabilities and the same toxins and microorganisms may manifest as a variety of seemingly different diseases.
Analysis of root canal treated teeth has revealed the presence of at least 400 different species of bacteria. Focal infections associated with the teeth have been shown to be able to spread to the:
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Head, neck and heart cavity (mediastinum) along fascial (tissue) planes
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Eye
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Brain (forming abscesses)
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Brain meninges causing meningitis and osteomyelitis
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Respiratory system
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Cardiovascular system
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Gastrointestinal tract and
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Reproductive system causing fertility problems and miscarriage in women.
All root canal treated teeth are infected. The nutritionist and dentist, Dr Weston Price, demonstrated that transplanting an extracted root canal treated tooth from a patient with a severe disease of the central nervous system into a succession of 31 rabbits caused them all to develop neurological problems similar to those of the patient. He ruled out the possibility that this reaction was due to a foreign body reaction by also implanting other objects including coins. The implication being that either the toxins or microorganisms the tooth was producing were responsible for the neurological disorder.
"A devitalised tooth (root canal treated tooth) is like a sea of sepsis (infection) under a mausoleum of gold."
Dr John Hunter, physician
Bacteria in root canal filled teeth release chemicals which block the process of chemotaxis which attracts white blood cells to the area alerting the immune system that there is a problem. The bacteria also build a 'fortress' within the bone where they can 'hide' from the immune system. From such a base they can invade capillaries, multiplying along the inside of the vessel walls as a biofilm and producing substances that enable them to attach to the capillary walls.
They can multiply within the capillaries and effectively block the circulation so that no blood reaches the region and the bone cells served die. The bacteria then adapt to the reduced oxygen environment and are effectively shielded from the immune system.
Counter-intuitively, when an abscess creates a large amount of swelling, pus and inflammation this is an indication that the immune response of the individual is vigorous and effective; whereas, a diminished response may be due to a compromised or weak immune system. Indeed one of the naturopathic principles is that "Strong systems react strongly and weak systems react weakly."
This means that you cannot rely upon local signs to give an indication of the toxicity of the tooth.
The other issue is that many of the energy meridians pass through the teeth. These dead, root filled teeth invariably compromise the meridian energy flows by blocking the flow of chi as assessed by electroacupuncture. The toxins produced can also compromise the circulation elsewhere and this may occur in the organ or system that corresponds with the particular meridian.
Some holistic dentists are of the opinion that some root canal treated teeth can be tolerated if the immune system of the individual is robust, but others feel that all root filled teeth should be extracted.
Various tests to assess the toxicity of a root canal treated tooth have been devised. Dr Boyd Haley and Dr Curt Pendergrass of the University of Kentucky have developed a test that analyses the enzyme function in a sample of gingival fluid collected adjacent to the tooth. This gives an indication of the toxins being produced by the tooth.
However, it is not clear how reliable these tests are since the toxicity may manifest deep within the bone. Other dentists have suggested using various different materials which they regard as more biologically compatible, but the fundamental problem of the reservoir created within the porous dentine still remains.
Nearly half the book provides an appendix giving research articles for the interested professional and a common 'Questions and Answers' section giving answers to the most common questions that arise around this issue.
Health, disease and allopathic medicine
Human bodies are complex and they are all different. This means that the 'cookbook' approach to illness with which the allopathic medical world is currently so enamoured does not work. As the authors point out, we can't even devise a mathematical model to predict when something as simple as a drop of water will fall from a tap, so what chance do we stand when predicting and diagnosing illness in the human body?
They draw the analogy of healthy body being like symphony orchestra with every instrument playing in time and in tune. As health starts to deteriorate some of the instruments start to play out of key and this may not be detectable to anything other than the most finely tuned ear. However as the symphony becomes progressively discordant timing and tuning is systematically lost until the symphony becomes unidentifiable. And so it is with health - except our bodies are infinitely more complex than a symphony.
Allopathic medicine is very bad at detecting the early stages of disease when the individual just doesn't feel well and knows that there is something wrong - that their symphony is out of tune. Often the response from a physician is either reassurance or outright rejection (it's all in your head/neurosis/hypochondria) until the individual's health has deteriorated further and they eventually present with the signs and symptoms of an identifiable condition.
Not only are we all different but our own system varies over time according to factors such as diet and stress. This means that a system that appears to be coping can be undermined by a change in circumstances that may be the proverbial 'straw that breaks the camel's back'. So that even in those who appear to be tolerating root canal treated teeth, circumstances can change rapidly due to stress and other factors.
What to do about root canal treatments
Needless to say, the official position of the American Association of Endodontists (AAE) is that root canal treatments are "safe and effective".
The whole thrust of current dental school teaching is to save every restorable tooth that the patient can afford to, or wants, saved. Indeed, for many years I prided myself on this.
This information can be difficult to take on board. I certainly know it was for me as someone who has multiple root canal treatments and who spent approximately one-third of my professional career doing root canal treatments on others.
There is, though, I think, a world of difference between being denied this information and being able to consider the possibility that the cause of your chronic, serious or degenerative disease might have started in your mouth. And many experts now agree that 85% of all illness can be laid at the door of one dental practice or another.
I didn't know and couldn't possibly have known when I gave up my dental practice on my own quest for health and retrained as a naturopath how the routine practices embraced by my former profession are inextricably linked to the causation of illness. I still feel enormous guilt that the techniques I practiced and tried diligently to perfect were, in fact, causing untold harm to my trusting patients.
"The acquisition of a new truth is like the acquisition of a new sense, which renders the man capable of perceiving and recognising a large number of phenomena that are invisible and hidden from another, as they were from him originally."
Leiberg as quoted by Dr Weston Price DDS
Just a word of warning, if you do decide to have any offending root filled teeth extracted, please make sure you are informed about the possibility of developing a cavitation and that you see a dentist conversant with the proper extraction technique. Also consider the possibility that any replacement is likely to involve the use of a variety of metals which may create their own problems as documented elsewhere on this site and in the book Chronic Fatigue, ME and Fibromyalgia: The Natural Recovery Plan.
"The acquisition of a new truth is like the acquisition of a new sense, which renders the man capable of perceiving and recognising a large number of phenomena that are invisible and hidden from another, as they were from him originally."
Leiberg as quoted by Dr Weston Price DDS
Further resources
To buy The Roots of Disease click for UK Amazon or US Amazon.
Click the link for Dr Thomas Levy's website which addresses the topic of dental toxins.
"I am so impressed by your comprehensive knowledge and explanations on the subject of mercury toxicity that I have today downloaded the Kindle version of your book and have just finished reading chapter 4. I heartily commend your brave attempts to bring your painfully acquired challenging knowledge to the attention of the professions. Well done!"
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