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Agustus 15, 2008 pukul 3:49 am | Ditulis dalam gigi dan mulut | 2 Komentar
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The aim of Root Canal Therapy is to ‘save’ a tooth which has become infected or dead, in an attempt to make it functional and pain free.

There are many presumptions about Root Canal Therapy which are based in myth rather than science. The philosophy underlying the teaching of dentistry limits it’s practice to mechanics, pain control and aesthetics. The systemic effects of dental treatment are rarely considered.

Dr. Weston Price was the leading dental researcher at the turn of the century. He was the head of the American Dental Association and wrote numerous papers on subjects as diverse as the role of nutrition on dental health to the effects of dead teeth and root canal therapy on systemic health. Dr. Price researched the effects of Root Canal Therapy for over twenty years. He was able to correlate different disease states with the types of pathology seen around dead teeth. He demonstrated thousands of times, the creation of diseases from non-vital teeth. He demonstrated how every belief about Root Canal Therapy, held by the dental community at the time, was based on a complete lack of scientific research. They were myths which developed and were then believed. These beliefs have now become set in concrete as truths by the current dental communities.

If you think that the research is out of date, you should realise that the techniques, most of the materials, and some of the instruments that were used then are identical to those used today. The medicaments used to ‘sterilize’ teeth then, are still being used today – Camphor, Phenol, Formaldehyde, Menthol.
Recently published research, completely supports that done by Dr Price. Specially that of Dr. Patrick Störtebeker, Assoc. Professor of Neural Surgery at Karolinska University in Sweden [2,3 4,5] , and the work of Dr. Eugene Ratner [6,7] in the United States.


Some of the myths that are still perpetuated include:

1. You can see infection on an x-ray
FALSE! Only if the angle is correct you may see some bone loss on an x-ray. It is impossible to demonstrate infection with an x-ray as dental radiographs only ‘see’ hard tissue. They do not see soft tissue or infections. Due to the shadow cast by the root it may also be impossible to see the bone loss.

2. You can gauge the extent of infection by the amount of bone loss on an x-ray.
FALSE! It is assumed in dentistry that the extent of bone loss is a direct indication of the amount of infection present. This is a false assumption because the bone loss may take time to develop. The extent of the bone loss about the end of the root is also a function of the body’s immune system being able to isolate the infection process. It has little to do with the degree of infection.[8]

Sometimes there is no bone loss, but instead, a condensation of bone about the end of a dead tooth. We are taught in dentistry that this indicates a lack of infection. The reality is that teeth showing a ‘Condensing Osteitis’ are demonstrating that the body’s immune system is incapable of quarantining the infection locally.19 These are often the teeth which cause the greatest systemic effects. This is put neatly by Dr Josef Issels 1995 (translated direct from German):

“If the local resistance is already so weakened that the inflammatory focus no longer can become encapsulated, the inflammatory toxins will infiltrate without hindrance into the pulpa and the whole organism.

If an inflammatory process can no longer be localised and encapsulated, it proves, as emphasised by Pischinger and Kellner that the organism has become largely non reactive. On an X-ray, these teeth normally show no translucence. This is characterised as X-ray negative .

In our cancer patients, such non-encapsulated focus, and therefore X-ray negative teeth, do frequently exist. This indicates the enormity of low resistance of these patients.” [9]

3. You can determine the length of a tooth by x-ray.
FALSE! Dentistry teaches that a root canal must be filled to within 1mm of the root apex. The apex of a root canal is only rarely determinable by X-ray. Thus most root canals are worked too short, or so long that the root filling will protrude through the end of the tooth and into the bone. This is born out by research published in the dental literature:

“Thirty two canals in four mongrel dogs were treated endodontically. The mandibular third and fourth premolars were selected for study because their apices were widely spaced and could be studied individually without danger of confusion”

“Examination of the histologic sections revealed that in some cases root canal instrumentation had been terminated slightly short of the anatomic apex. Moreover some canals which appeared reontgenographically to be filled slightly short of the apex actually were associated with extrusion of some particles of sealer into the periodontal ligament space”
Five canals were accidentally overfilled. Of the 32 tested, 4 were overfilled. Therefore 5 out of 28 canals which were radiographically under-filled were in fact overfilled. This is a failure rate of 17% in terms of basic endodontic procedure.

“In the canals which were overfilled, the extruded materials were always associated with advanced destruction of the surrounding tissue and liquification necrosis” [10]

It is not possible with an x-ray to see:

* the end of the root canal,
* the angle of the root canal,
* the number of canals or
* the various branches of each canal

4. It is possible to actually treat all of the hollow areas of the tooth. This is assumed to be limited to the actual root canals.

False! It is assumed that the only part of the tooth which contains soft tissue is the actual root canal. Even in the latest Australian Dental Association handout on root therapy they state “All root canals in the effected tooth must be treated”[11]. Unfortunately the root canals are the smallest area of the tooth which contains nerves, blood vessels and connective tissue.

The root canals are really like the tap root of a tree – one main root with hundreds of branches coming off it and opening to the edge of the root all the way along its length. It is impossible to treat these accessory canals.
As well, the dentine is not a solid structure. It is made of tubules which extend from the surface of the root canal to the enamel of the crown and to the cementum on the root surface. Each tubule is estimated to be able to contain 8 bacteria across its diameter. In a front tooth which has only one root there is over three kilometers of tubing. This equates to billions of microorganisms in just one tooth.

In comparison to the volume contained in the accessory canals and the dentine tubules, that of the root canal is actually quite small. It is not possible to remove dead infected soft tissue from whole of the tooth. When only the root canals are treated there remains a massive amount of gangrenous tissue which is infected by anaerobic microorganisms.

Dr Issels puts it this way; (note that this is a translation from German and directly quoted) [9]

“Altmann, Doepke and Pritz, as well as Fischer, Hess and other researchers have become involved with the fine structure of the tooth. They have found that the hard substance of the tooth in no way resembles an avital structure but maintains an active metabolic process with pulpa and dental periosteum. The pulper cavity and the external surface of the root are connected with each other via very fine canals. They are again connected via the mesenchymal fissures and capillars of the central periosteum with the canal system of the jaw bone and its pulper spaces and therefore with the general organism. This knowledge has refuted the concept, which had existed for decades, that the tooth, after removal and sealing off the pulper cavity, would be an isolated, avital structure no longer maintaining further exchange transactions. Even the most perfect preservation will only reach the most vertical intermediary trunk of the root canal system. In no way will it reach the lateral branches or the numerous dental canalculi, which likewise takes its exit from the root canal. Even after the most precise preparation of the root canal, there will always remain protein in the adjoining areas. This protein is usually infected and denaturated by filling materials, whereby toxic decomposition products will be formed. It was demonstrated by MEYER (Goettingen), that the dental canaliculi exhibits an exuberant bacterial flora. The decomposition toxins produced by these microbes can, with a dental root filling, no longer empty into the oral cavity. They can only be derived via the cross connection and the unsealed branches of the root canal finally reaching the pulper spaces of the jaw and thereby the flowing systems of the organism. Because of the devitalising and preservation procedures, the tooth has become a “toxin factory” by which the organism will be continually damaged.”

It is claimed by most dental authorities that the bodies immune system will take care of what is left over. This is an assumption based in fantasy. If the blood supply of the tooth has been removed (which is what happens when the root canal is ‘cleaned out’) the cells of the immune system cannot get there.

Often during or before root therapy is started the dentist will administer antibiotics. This may lead to a rapid reduction in pain. Unfortunately both the dentist and the patient assume that the infection has been eradicated. The reason that the pain disappears is only because there is a reduction in pressure from around the end of the root. The antibiotics do not effect the organisms which reside within the tooth which are the original and continuing source of microorganisms and their toxins. As there is no blood supply to the tooth it is impossible to get the antibiotics in there either. [12]

” In the case of an acutely infected tooth there is no natural process of drainage and there is no mechanism by which the antibiotics which have been administered can reach the bacteria inside the tooth” [1]

5. It is possible to sterilize the canal by using medicaments placed inside the canal.

FALSE! It is impossible to sterilize the canals. The medicaments and antibiotics used do not penetrate the dentine tubules. Dr. Price was even able to culture bacteria from teeth through which he had poured fuming formaldehyde. Even the recent dental literature reflects this:

“It is now known that complete sterilization of an infected root canal is very difficult to achieve and complete removal of all pulp tissue remnants frequently is not possible.” [13]

6. Bacteria that penetrate the canals and tubules are usually the ‘aerobic’ type found in the mouth. When the canal is sealed and the oxygen supply cut of, these bacteria die.

FALSE! The bacteria, yeasts and other organisms which enter the tooth do not die when the oxygen supply is reduced (as happens inside the root canal system). They undergo what is called a pleomorphic change[14,15] and become ‘anaerobic’ bacteria. They literally change form and become bacteria that do not need oxygen to live. It is now known that dead teeth are usually heavily infected with gram negative anaerobic bacteria.[16] Sundqvist, in 1976 isolated 88 species of bacteria out of 32 root canals with periapical disease.[17] “Only 5 of those bacteria could grow in air. Strict anaerobic bacteria must have played a decisive pathological role although a limited number of facultative species have been show to induce periapical lesions………………..”

Long standing populations of infected root canals do contain a mixture of strict anaerobes. Low grade but chronic periapical inflammation is the result that may last for years.”

Other organisms such as yeasts, funguses and ‘cell-wall-deficient forms’ (Lida Mattman) also inhabit this tissue[18]. The dead teeth thus become a focus of infection which can cause numerous disease states throughout the body. Anaerobic bacteria produce incredibly potent neurologic and hemolytic toxins. A true “Toxin Factory”.

7. If it does not hurt it must be OK!

FALSE! Weston Price’s comments are most succinct;
“Local comfort……… may constitute both what is probably one of the greatest paradoxes and one of the costliest diagnostic mistakes through injury to health, that exists in dental and medical practice ………… the absence of this local reaction and the consequent destruction by the infection products, permits them to pass through the body to irritate and break down that patient’s most susceptible tissue”.

Lack of pain around the tooth is usually taken to mean a successful root therapy. Unfortunately it does not rule out the possibility of systemic effects.

8. Systemic effects need not be thought of in relation to dental disease.

FALSE! All researchers from Weston Price[19] , Billings, Rosenow, Stortebecker, Ratner and many others, have demonstrated the spread of systemic disease from infected teeth and gums. It is only the dental profession, who are not trained in medicine, that refuse to accept this basic concept. The research of Steinman[20] in the 70’s conclusively demonstrates the relationship of metabolic dysfunction and dental disease.

Patrick Stortebecker and others have demonstrated the transport of all materials, microorganisms and their toxins directly from the tooth back to the brain via the blood and by transport along the nerve fibres.[2,3,4,5] Many other research articles have shown that whatever you put in a tooth can be transported to the rest of the body. [21,22 23,24]

As Schondorf states “A root canal treatment which does not plant a focus, does not exist”

References:
1-Focal Infection – The endodontic point of view Ehrmann Oral Surgery Vol 44 No 4 October 1977
2-Stortebecker P “Dental Infectious Foci and diseases of the nervous system – spread of microorganisms and their products from dental infectious foci along direct cranial venous pathways eliciting a toxic – infectious encephalopathy” Acta. Psych Neural Scand 36 Suppl. 157 (1961) 62
3-Stortebecker P “The cranial venous system filled from pulp of a tooth – Proceedings” 3rd Int. Congress of Nero Surg. Copenhagen Aug 1965
4-Stortebecker P “Dental significance of pathways for dissemination from infectious foci.” J Can Dent Assoc 33:6 1967 pp301-311
5-Stortebecker P “Chronic dental infections in the etiology of Glioblastomas. 8th int congress” Neuropathy. Washington D.C. Sept 1978 J Neuropth. Exp. Neurology 37(s) 1978
6-Shklar , Person, Ratner. Oral pathology and Trigeminal Neuralgia III J Dent Res. 1976;55(B):299
7-Ratner E., Langer., Evins M., alveolar Cavitational Osteopathosis manifestations of an infectious process and its implications in the causation of chronic pain. J Periodoontal 1986;57:593-603
8-M.K Sharief N Eng J Med 1991 325:467-72
9-More Cures for Cancer Translation form the German by Dr Josef Issels Helfer Publishing E. -Schwabe, Bad Homburg FRG.
10-Malcolm Davis . Periapical and intracanal healing following incomplete root canal fillings in dogs. Oral Surgery May 1971 Vol 31 No 5.
11-Australian Dental Association handout December 1996
12-Philip Delivanis Oral Surgery 1981 Vol 52 No 4
13-Phillip Delivanis Oral Surgery 1981 Vol 52 No 4
14-The persecution and trial of Gaston Naessens. By Christopher Bird Pub. HJ Kramer Inc Tiburon CA ISBN 109876543 (1991)
15-The Cancer Cure that worked. The Rife Report. Life of Dr Royal Rife. By Barry Lynes , Marcus books 1994
16-K.E Safvi J. Endo. vol 17 No 1 Jan 1991
17-Wu, Moorer, Wesselink. Capacity of anaerobic bacteria enclosed in a simulated root canal to induce inflammation. Int. Endodontic Journal (1989) 22, 269-277
18-Personal research with Dr J Burke of Australian Biologics, Sydney
19-Weston Price. Dental Infections Oral and Systemic. Vol 1 & 2
20-R.Steinman J Southern California State Dental Assoc. Vol 28, No11 November 1960
21-Capra N. Andersopn KV. Pride JB. Jones TE simultaneous “Demonstration of Neuronal Somata that innovate the tooth pulp and adjacent periodontal tissues using two retrogradely transported anatomic markers.” Exp. Neurol 86(1984) 165-170
22-Marfurt C. Turner D Uptake and transneuronal transport of Horseradish Peroxidase – Wheat Germ aglutinin by Tooth Pulp Primary Afferent Neurons’ Brain Res. 452(1988) 381-387
23-Marfurt C. Turner D ‘The central Projections of tooth pulp afferent neurons in the rat as determined by the Transganglionic transport of Horseradish Peroxidase” J. of Comp.Neuro 223 (1984) 535-547.
24-Arvidson J. Gobel S. “An HRP study of the Central Projections of Primary Trigeminal Neurons which innovate tooth pulps in the cat. ” Brain Res. 210 (1981) 1-16.

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THE FOCAL INFECTION THEORY

Although there exists a great deal of controversy regarding the success of endodontic therapy, the scientific facts at the present time are that only about 10% of root canal treated teeth experience some type of failure. The controversy over endodontic treatment is not new. Beginning in about 1912, there was wide acceptance of the theory of “focal infection” which resulted in the wholesale extraction of both vital and pulp less teeth. It wasn’t until well after World War II, with the availability of improved x-rays, anesthetics, new methods and products, and the publication of the first major text book devoted to “Root Canal Therapy” that the “focal infection” theory lost favor and “saving” rather than extracting the tooth became the “standard of care.” Now however, the 1990’s has seen a resurrection of the focal infection theory.

Lets look briefly at the “Focal Infection” theory. The main purpose of the dental pulp is to supply nutrients  to the dentin as long as the tooth is alive. This is done through microscopic tubules in the dentin. To give you some indication of what is meant by microscopic, each tooth contains approximately 1.5 million tubules. As the living cells necroses (rot) within the central pulp chamber of an infected tooth, this same phenomenon is happening within the tubules. In theory, root canal therapy attempts to completely obliterate and fill the main pulp chamber and canals. However, it is impossible to fill the millions of microscopic tubules. Once inside the tooth, bacteria can remain within the tubules, growing and multiplying. Because microbes can change their form and function in response to  changed microenvironment within the tubules, they can go on living in spite of the altered oxygen and food supply. As they do so, they begin to produce various toxic chemicals, which have been shown to be harmful, sometimes being especially toxic to specific organs or organ systems. This phenomenon was confirmed in a recent 1987 study by Tronstad and Associates demonstrating that anaerobic bacteria 9bacteria not requiring oxygen to survive) were able to survive and maintain an infectious disease in periapical lesions of non-vital teeth. In a 1991 follow up study of endodontically treated teeth, these authors recovered microorganisms from periapical lesion of all examined teeth.

The immediate question this raises is: If there are bacteria present from every endodontically treated tooth, why doesn’t every root canal treated tooth become abscessed and fail? An oversimplification of the answer is that your own body’s immune system is able to contain and neutralize the bacteria.
Dr. Weston Price, during the early 1990’s, devoted most of his brilliant career to investigation of the focal infection theory. his research, involving thousands of patients and rabbits, formed the basis for the over 220 articles and 3 major books which he authored. In essence, the focus infection theory research by Dr. Price holds that it is not the bacterial that causes systemic problems, but rather the toxic chemicals produced from the necrosis and decay within the tubules, whether the tooth had been endodontically treated or not. As a consequence of the fact that there was no way to completely seal the apex (tip of the root) and the tubules, the need to extract both vital and pulp less teeth, when an infection was evident, became the effective treatment.

There are now a group of dentist around the country who are openly advocating the extraction of every root canalled tooth on the basis of the research done by Dr. Price. This is certainly a radical approach to solving a problem that appears to be limited to only about 10% of the total number of root canal treatments done. Furthermore, it certainly does not take into consideration the use of calcium oxide as a root canal medication in the treatment of infected root canals. much of the current confusion in the minds of the public about the efficacy of root canal therapy has been precipitated by the book “root Canal Cover Up” written by George Meinig, D.D.S., past president of the American Association of Endodontists. Dr. Meinig extensively cites the work of Dr. Price and concludes that there is a serious problem with root canal therapy and teeth that have had root canal treatment. This, of course, is a major break with his own previous training and the policies of both the American Association of Endodontists, and the American Dental Association. Patients going to an “establishment” endodontist or dentist who does not subscribe to the focal infection theory are given a much different picture on the efficacy of root canal treatment rely heavily in the use of some very toxic chemicals and cements. And although there is a 90% success rate for most endodontic procedures, it is still a scientific fact that using the existing endodonitic materials and techniques, there is no way to totally deal the apex of the tooth and the dentinal tubules.

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  1. Jazakillahu khayran informasinya ummu…

  2. terima kasih infonya


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