Dr Ron Ehrlich [00:00:07] Hello and welcome to Unstress. My name is Dr Ron Ehrlich. Well, today’s topic is one of focus on oral health. Yeah, I have to remind myself that I’m also a dentist. And there is a subject which seems to cause a lot of controversy in the dental and the health world and seems to be poorly understood by the public and by many health practitioners.
Dr Ron Ehrlich [00:00:33] So the subject is root canal treatment. And I thought I would just cover some of the issues around it. Firstly about what it is. Secondly, about how you define a clinically well-done root canal treatment, what some of the complications are, what some of the alternatives are. But firstly, a little bit of background. And this is for those that don’t know me and maybe listening to this for the first time; I have been in clinical practice as a holistic dentist for almost 40 years. In my own practice, we stopped using mercury amalgam fillings in 1985. We’ve been very careful about how we remove it. We do not use fluoride or we use it very sparingly in our practice. I don’t recommend it. I don’t like it, particularly in the water supply. That’s a whole other story. There’s good scientific evidence to support some topical application of it on susceptible tooth structure. So that’s kind of putting that into perspective. In our practice, we do some root canal treatments, and we remove some root canal treatments. And this is an issue we have been grappling with and constantly being asked about for the last 35 or so years. So I’m not coming at this from some “oh, that’s a whole lot of crap, it doesn’t really matter” or “no that sort of root canal treatment can’t cause a problem”. I’m coming at it from a very critical perspective and one that is very aware of the issues. I’ve read the “Root canal cover-up” book, which people reference. I’ve seen the video on Netflix “Root Cause” I have seen the Joseph Mercola website, which said, “97 per cent of terminal cancer patients have this treatment done”. And I’ll go into that a bit with you. So I’m familiar with all of it. And I’ve explored the pluses and minuses of doing root canal treatment. In fact, many years ago, twenty or more years ago, when I started to really question this procedure more critically, I rang up my endodontist who is a root canal specialist. So if you think dentistry is specialised, which it is focussing on the mouth, there isn’t even a subspecialty of that speciality called Endodontics, whereby the practitioner focuses on the root canal system of a tooth, and that is extremely specialised. So. So I rang up my endodontist, and I said, can you please send me all of the references to support that root canal treatment is a safe and effective treatment option. So I’m going to share with you where how we approach this. My own practice in the centre of the city of Sydney is called the Sydney Holistic Dental Centre. You can go online to www.shdc.com.au, which stands for Sydney Holistic Dental Centre. There will be an attachment, a brochure that we use in our practice attached to the show notes. And I’m very happy to take any questions if there are any. But and I want to remind you also that this isn’t just an audio show, but it is available on YouTube. And there are some very good, I think, visuals attached to this. So but I think it will work. I’ll make sure that this works as an audio file. So here we go.
Dr Ron Ehrlich [00:04:10] Look, first, the first thing you have to know is what is a root canal treatment? And the first thing you have to know is what is a healthy tooth? And a healthy tooth is covered by enamel, which is crystalline. It’s the hardest structure in the body. It’s much harder than bone. So crystalline structure underneath the enamel is the dentin, which is a softer, more organic structure. And the dentine contains millions of little tubules which are filled with fluid. And underneath and below that is the pulp of the tooth, which is how the tooth grows. And it contains nerves and blood vessels. And what separates the tooth from the jawbone is a ligament called the periodontal ligament. It’s a very thin and fine ligament, and that’s particularly important when we come to diagnosing infections in teeth, which is relevant to this. So what happens when something goes wrong, well, when something goes wrong, a decay starts a little pinhole that goes through the enamel, and when it hits the underlying dentin, it spreads. And if it’s allowed to go any further, it will spread into the nerve of the tooth. And if it’s left for long enough, eventually the nerve in the tooth will die or become gangrenous. Now, that may occur with a tooth, with pain, but it often surprises my colleagues and me how often this happens without any pain associated at all. And so pain is a very poor barometer of whether you have decay in a tooth. I mean, it is an indicator, but there are so many instances where it’s just not you can have decay, deep decay. I’ve even seen teeth rotted down to the gum, horrible as that may sound. And there’s never been a day’s pain. So pain, a very bad barometer. When that gangrenous tissue is left inside the tooth and the no longer any blood supply within the tooth, then that rots literally, and an infection starts to develop at the tip of the root, at the periapical, at the tip of the at the apex of the root. And so the bone is lost. That thin periodontal ligament which surrounds a tooth separates it from the bone, becomes thickened, and it’s filled with pus or granulation tissue. But it shows up on an X-ray as a shadow. So essentially, what a root canal treatment is, is when there is this infection, an opening is made, and you can take an X-ray and see the shadow at the tip of the root. The tooth is opened up. The canals are located now in front teeth there’s usually one root canal as we move further back in the mouth into the premolars area sometimes there are one or two canals. And as we go further back in the mouth, the root canal anatomy becomes far more complex. And it could be three or four or more. And there are also branches of the canal. But let’s look at the theory behind what a root canal is. Essentially, you open the tooth up; you locate the canal, you measure the length of the tooth to the nearest millimetre. You then use small hand files or other files that slightly enlarge the canal, remove the dead tissue and slightly enlarge the canal so that you can get antiseptics in there. And little vibration is used to make sure it goes through the tooth and and and penetrates into those millions of tubules which are contained within the dentin. And once the system is cleaned and washed out with antiseptic, it’s usually then dressed with the calcium hydroxide dressing. Now, calcium hydroxide is really alkaline. It’s got alkalinity of about 12, so it’s it’s P.H. of about 12. So it’s very alkaline, very bactericidal. And the work of Weston A Price is often quoted here. And it’s worth mentioning, and George Meinig mentioned this in his book, “Root Canal Cover-Up”. If you bothered to read to the end of the book, you will note that Weston A Price never had calcium hydroxide or some of the other medicaments in his armamentarium when he did all his research in the 1920s and 30s. But I’ll come back to that in a moment. So the canals are cleaned out, washed out, put a dressing in, it’s sealed off for a week or two. It could be longer. You get to come back for the second appointment. The temporary filling is removed from the top of the tooth. And then the antiseptic is washed, the dressing is washed out, more cleaning is undertaken, more antiseptics are placed. And then the tool, the other tooth is sealed off with cement. It could be a calcium hydroxide or a zinc oxide cement and something an inert plastic called gutta perca. And it is sealed off, very importantly, sealed off to the tip of the tooth. Now, if it’s not sealed off to the tip of the tooth, you’ve got a real problem there right away. There are other challenges. There could be branches. But this, in theory, is what constitutes a well-done root canal treatment.
Dr Ron Ehrlich [00:09:41] And I should mention here; I should have mentioned at the very beginning, root canal treatment is without a doubt one of the most technically challenging procedures in dentistry, which in itself is technically very challenging to do really fine work inside a person’s mouth while they’re awake, while they’re breathing, while the swallowing, you know, very moist environment because of the saliva is technically very challenging and of all things we do in dentistry to do a technically excellent, clinically excellent root canal treatment is very challenging. And it is easy to do a root canal treatment, but it’s not easy to do a root canal treatment well, and there is a very big difference in that. And if getting rid of pain is your only measure of success, anybody could do a root canal treatment, more or less. Pretty much any dentist could do a root canal treatment to that degree. But to do it well enough for an infection to resolve the tip of the root is technically challenging. So for those that say all root canals must come out, I often say to my patients, I wish we were more dogmatic because something like saying something like that rolls off the tongue so easily. It’s so easy to say. It eliminates one of the most technically challenging procedures in my practice. So I don’t have to stress out about doing root canals if I say all root canals must come out. And when you look at the alternative, the alternative is either to do implants, place a titanium or zirconium implant into the jaw to replace the missing tooth or to do a bridge to replace the missing tooth. Because if you remove a tooth because it’s infected or because of the root canal, you have to replace the tooth. And that’s a very important thing in maintaining bite, maintaining a balance so that you use both the left and the right side of your jaw. It’s like jumping up and down all day on one foot. Eventually, that foot will suffer, and so will all the muscles that compensate around you using that. So establishing a balance is really important. So when a root canal is removed, you have to do more dentistry, and that dentistry is more expensive. So there’s the double if you like, not only by saying all root canals must come out, you’ve eliminated the most difficult procedure, but you’ve also introduced far more lucrative, expensive dentistry into your practice.
Dr Ron Ehrlich [00:12:28] And I think there’s a place for bridgework. There’s a place for implants. There’s no question about that. And some root canal treatment should come out. I’m not saying that. But what we’re establishing here is, should all root canal treatments come out? Should you never have one done? Well, my advice is it depends. And you’ll see why. Let’s push on because while this diagram, which I’m looking at now, which shows a well-filled root canal system in a diagram, mind you, not in real life, there are things that can go wrong. For example, there can be a little side canal, which makes it very difficult, if not impossible, to get into and cleanout. So you have a residual infection there is an accessory or side canal. It could be that the canal, the root canal system is so convoluted being curved and difficult to access that you actually can’t get down there. And again, an area which you just couldn’t get into remains infected and unfiled canal just simply wasn’t prepared well enough. And again, an X-ray will show infection at the tip of the route. And here we go into an X-ray where while on the left of the screen to those looking; there is a diagram of what is going on. On the right is the is an actual X-ray, which shows a shadow at the tip of the route and shows the tent at the root canal fillings which don’t go all the way to the tip. And so that shadow indicates a residual infection. Now, when this tooth was re-treated, the old root canal was removed. The tooth, the canals were measured, cleaned out, antiseptic dressings placed, etc., etc. 12 months later, we come back and take an x-ray and bone has regenerated. It is still regenerating in this x-ray, but the bone has regenerated. So the question I always ask a dentist who questions root canal treatment is how do you diagnose a tooth needs a root canal treatment. And invariably they will say, well, you take an x-ray and you look for the shadow at the tip of the root, which indicates infection. I go, OK, I accept that. What about the regeneration of bone? Is that a good thing or not? It’s a rhetorical question, really, because for the bone to grow back, something positive must have gone on. And they will point out, well, that doesn’t tell us there’s no infection there. And I agree. I agree with that. But what I’m asking is, has something positive gone on for bone to be regenerated? And the answer is obviously yes. Now, is that the end of the story? No, not necessarily. But is that a good sign? It’s an encouraging one. And so. That’s a good thing, and doing root canal treatments, as I said, are technically challenging, and I’m looking at an X-ray now where the canal has been filled and that accessory canal has also been filled by a very good procedure by somebody who has known what they were doing in this root canal treatment. And that is a good root canal. And you can look at the tip of the root and see that even some of the cement has spread out into what is probably little branches at the tip of the root. So not all root canal treatments are the same. Far from it. They have these branches, which we need to take into consideration. And even if they don’t have branches, dentin is made up of millions of tubules which can harbour bacteria. That’s why in the washing out of a root canal, often a chelating agent is used which cleans out and opens up those canals. Often it’s called EDTA, which is a chelating agent, which just opens up the tubules and allows the antiseptic to penetrate through the tooth. And here’s another X-ray of a very convoluted root canal system, which has been technically done to a very, very high standard. And it just shows that, yes, there are accessory canals, but with a good technique, they can be at least got into. And does that resolve the infection? Not always. Not always. That’s why I say it depends and it depends on a lot of factors. Now, this book, “Root Canal Cover-Up”. The founder of the Association of Root Canal Specialists, The American Endodontic Society, discovers evidence that root canals damage your health. Learn what to do with George Meinig wrote this book. At the end of his career. He’d been an endodontist, presumably done thousands and thousands of root canals and in retirement decided to explore the subject further and discovered the work of Weston A Price. Who was a dentist that worked in the 1920s and 30s and as I said, in those days, even Price found that 25 per cent of those people and this is quoted from George Meinig’s book, 25 per cent of people had an immune system that would probably deal with root canal treatments. Okay, that was Weston A Price’s conclusion. And it’s also worth noting that medications, antiseptics like calcium hydroxide, that strong alkaline antiseptic, that is very bacteriocidal were not available at Weston A Price’s time. And George Meinig acknowledges this. But you have to read the end of the book to come to that conclusion. Now, another thing that came about that a lot of people saw was Mercola. And I like Joseph Mercola’s site. I mean, I mean, I did until I saw this 97 per cent of terminal cancer patients previously had a root canal procedure. And this was a huge statement. I mean, I took this screenshot in 2012 and there had already been two and a half million views. And I can tell you, this site is, I don’t think, any longer available or live. I think it went offline about five years ago, but it literally had four or five more million views. So people read this and were rightfully concerned and they should be concerned. But this statement of 97 per cent of terminal cancer patients, I’m about to do a research to actually look into this in a little more detail. But I did look at the evidence and the evidence that was provided. The references that were provided was ten references or eleven references. And I went and read every single one of them. And actually not one of them actually said this. So I do have a little bit of a concern with this statement, however.
Dr Ron Ehrlich [00:19:25] And then, of course, the “Root Cause” came along. And this is the conclusion of that was, was that a new film claims root canal treatments cause cancer. Don’t believe it, dentists say. Now that root canal root causes came off air as well because it caused so much controversy. My position on this is this. If there is a chronic infection present, irrespective of whether there’s pain or not, that is relevant to an immune system. And if you are trying to bolster your immune system through being as healthy as you can, having a chronic infection in your jawbone does not do your immune system any favours. And I do believe you should address that issue and should deal with it. And remember, pain does not indicate whether you have an infection or not. 3D X-rays typically do that. 3D X-rays are an absolute must in diagnosing accurately what is going on. And even they are not perfect. Okay. But they give us a huge amount of more information than we ever had. But even they are not perfect. Okay, but this film also raised that issue. And I you know, we could review the film. And I thought it was very interesting that the main commentator there had explored a whole range of other things, as well as having his root canals removed or his teeth cleaned up. And I think, you know, if you’re a regular listener in my podcast and you know, the model of health that I have used in my practice and in my life and in my podcast, in my book, to say that our health is affected by stress, which compromises your immune system or causes chronic inflammation. And you need to look at that stress from a five stressor model, I believe, emotional, environmental, postural, nutritional and dental stress. And this is one of the reasons why we include dental stress in that model and at the same time try to build resilience by focussing on the five pillars of health, sleep, breathe, nourish, move and think. And pivoting on all of that is our genes and how our genes express themselves, which is referred to as epigenetics. So so the whole idea that having your root canals removed is the answer to all health problems. I’m I’m sorry. I’ve been in practice for 40 years and I agree that it’s an important part of the picture. But you need to look at the whole picture at the same time. And again, I come back to not all root canals are the same. Not all people are the same. And even if even within one person, being having the same immune system isn’t always the same, at one stage in your life, your immune system could be really strong and yet another time in your life it may be really compromised. So this is a constant state of assessment. So, as I said, calcium hydroxide is the ability to kill bacteria that infects root canals in this medicament was not used or mentioned by Price in over the 100 medicaments that he studied. And there’s some good research to support that. And here’s some examples of X-rays where you take an X-ray of a tooth and there’s a shadow around the tooth, the thin line that separates the tooth from the bone, which is actually the periodontal ligament, can become thickened as the bone is infected. And so in this particular X-ray that I’m showing, the red arrows indicate that. And then on the X-ray, on the right, 12 months later, an x rays taken. The ligament has healed, the bone has regenerated. And the question is, has something positive occurred? And the answer is yes. And the patient did not require the seven or eight thousand dollars that would have been involved in removing the tooth, curetting it out, putting a temporary denture in, then placing an implant, then six months later putting the abutment and the crown on, all of which cost somewhere between seven and nine thousand dollars. But importantly, even more, important than the cost, the infection cleared up and that was positive for a patient with a healthy immune system. Here’s another example of on the left, the arrows indicating shadowing, which is the loss of bone and the thickening of that periodontal ligament, the thin line that separates the tooth from the bone filled by a ligament. And when that thickens, you know, you’ve got an infection. And on the right, a root canal is well done. By technical standards, the canals filled to their length and the bone has regenerated. So something positive has occurred. Here’s another example on a front tooth, and you’ll notice that the cement, the filling goes right to the end of the tooth and the bone has regenerated. So these are all good things. And these are all things that give us an indication as to has a root canal been well done or not. And we’ve looked at that. So it’s interesting to look at what defines a good a successful root canal treatment and it involves and this is an animation for those that are watching it, but it involves going in and cleaning out the decay and then going into the infected nerve and with files, cleaning out the infected and decayed nerve and then cleaning out the canal and eventually filling it and then watching the bone at the tip of the root, that little ball of infection healing up. And that is what constitutes a successful root canal treatment. So that let’s move on. So the key points about root canal treatment of this, not all root canal treatments are the same, technically very challenging to do it well. And it’s much easier to say either all root canals must come out or refer them to a specialist or in my own practice, my partners, Dr Lewis Ehrlich, Dr Craig Wilson, do them to an extremely high standard using all the latest technology, including 3-D, X-ray and microscopes, which enlarge the space to, you know, you can see under 20 or 30 times magnification. So this is a technically challenging procedure. Not all immune systems are the same. That’s important to note. Everybody’s immune system is different. And even within the one person, the immune system varies from time to time. So this is a constant conversation, a constant assessment. When there is complex dental work in people’s mouths, we need to be sure that the nerves have not died in the tooth. And if they’re an infection spread into the jawbone with or without pain, and if there are existing root canal treatments, we routinely use 3-D X-ray to explore whether there is still residual infection present. So in answer to the question are should you do a root canal treatment or not? The answer, after 42 years of clinical practice can be summarised in these two words. It depends. It depends and it depends on those factors. I hope that’s been of some use to you. Obviously, it’s a very complex issue and the whole dental stress issue is a complex one if you have any questions. By all means, send me an email if you are interested in consultations. Well, obviously, the clinics there for that, we may even explore doing online consultations, but these are some of the issues to consider. I hope this finds you. Well, don’t forget to go onto iTunes and leave us a five-star review because that just pushes the ratings up. We cover a wide range of topics on our podcast. Just have a look at the list of topics we’ve covered just this year alone. I hope this finds you well until next time. This is Dr Ron Ehrlich, be well.
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