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Did George Meinig have it right when he wrote ‘The Root Canal Cover-Up back in 1993?  Yes and no.  The reason I say this is explained below, so keep reading. In his book, Meinig highlights the research done by Westin Price a century ago demonstrating how root canal infections cause other health conditions and illnesses in the body.  Price was most famous for his rabbit experiments, where he implanted root canal teeth from his patients into rabbits and tracked how that animal fared afterward.  What he observed was that the rabbits got sick and in many cases died as a result.  After observing this scores of times, he coined the phrase ‘focal infection’, which basically means that the bacteria in one part of the body can affect or cause illness in another part of the body.

The best example of the focal infection theory is dental infections being linked to heart disease.  Over 600,000 people die from heart disease in the U.S. every year.  It is the leading cause of death for both men and women, accounting for 1 in 4 deaths. There is ample research showing a connection between gum disease and heart disease.  More recently research has come out connecting infected root canals and heart disease.  Westin Price also found the organ most affected by infected teeth was the heart.  That is why it’s so important to find and treat infected teeth and failing root canals.

Did George Meinig advocate extracting all root canal teeth?

I had the pleasure of meeting George Meinig back in the 90’s.  That’s him pictured to the left.  He was a very kind and caring man.  Actually, he didn’t advocate extractions in all cases.

Many alternative doctors today believe that Westin Price and George Meinig advocated extracting all infected teeth and teeth that have had prior root canals. This is simply not true.  In George Meinig’s book he states, “I imagine most readers will conclude Price was in favor of extracting all root canal filled teeth and would never consider treating one.  You will be pleased to know that is not what he recommended.  Price wrote, ‘Don’t jump to the conclusion that all root-filled teeth should be extracted.’  Time and again he stated the governing factor which must dominate the decision for a dentist or patient as to whether or not a root canal treatment should or should not be retained, depends on that person’s defense system and any family genetic problems he may have inherited.  In fact, Price found that 25 percent of patients with family histories free of degenerative diseases, who had excellent immune systems, could expect to have and retain root canal fillings and live without complications.”

So according to both Meinig and Price, root canal treatments can be and are usually successful in genetically strong patients who have excellent immune systems.

The bottom line conclusion of Price’s and Meinig’s work

Price found most of the root canals done during his day inadequate and harboring bacteria.  This is because they were not instrumented or filled properly, so the bacteria remained or came back quickly to infect not only the tooth but, the bone around the tooth.  He came up with the term ‘focal infection’ because the tooth became a focus of infection leaking bacteria into your jaws, bloodstream and the rest of your body.

Meinig updated Price’s work by bringing electron microscope images into the discussion showing how even in modern day endodontics bacteria was being left behind in the dentinal tubules of the teeth.

Both doctors tried to find solutions to the problem.  Meinig used to lecture and attended endodontic meetings to keep the conversation alive.  In his book he reflected on Price’s work, ‘It is certainly unfortunate that all of these important discoveries were forced underground and lost to the world as it is quite likely that an effective sterilization of the bacteria which invade dentin tubules would be now have been determined.

Price usually recommended avoiding root canal treatment and extracting the tooth if the individual’s immune system is battling one or more degenerative illnesses or chronic diseases.  If you have an immune condition like an autoimmune disease, Lyme disease, a heart condition, arthritis, and possibly even cancer you need to be more careful in doing root canals.  Basically, any condition that weakens your immune system makes root canals riskier and less likely to succeed.  If your body is already dealing with an immune challenge, infected teeth just add more stress to an already taxed immune system, and visa versa.  Any infection in the body is bad.  Just because a tooth doesn’t hurt or there is no swelling doesn’t mean it’s OK.

Meinig was well aware that bacteria was left behind after root canal therapy, leaking toxicity called endotoxins into the body, as he was an endodontist himself.  However, he also stated that people do not have to become sick or die from focal infections, but to stop or prevent their occurrence, the bacteria and their toxins which arise from the dentin tubules or other sources must be eliminated.

New hope for patients keeping their teeth

Remember when I said above yes and no to answer the question, ‘Did Meinig have it right?’  The reason I said yes is that Westin Price as well as George Meinig were right during their times.  Keep in mind Price did his research 100 years ago and it correctly reflected the reality of root canals during his day.  Similarly, when George Meinig wrote his book, ‘The Root Canal Cover-Up’ in 1993, dentists and endodontists had no answer for the bacteria left behind in the dentinal tubules after endodontic therapy.

Why did Price find so many problems with root canals and demonstrate that they actually were causing illness in his patients and verified in lab animals?  Because his research took place in an age where the results possible were nowhere near where they are today.  In fact, when I look at the radiographs of root canals done at that time and printed in Price’s research, it’s a wonder they worked as often as they did.  The technique and results were not good, and they have improved significantly over the years.

That was then and this is now.  A lot has changed in the world of root canal therapy, especially in the last five years.  New technologies have come onto the scene that will change the results possible and improve the health of not only teeth but the patient as well.  Also, new protocols have been developed using these technologies that allow results not possible just 5 years ago.  These technologies include:

  • Cone Beam 3D imaging of teeth (a mini cat scan) that allows dentists to see previously missed root canal problems and infections
  • Dental microscopes that allow practitioners to see small canals and anatomy that previously resulted in recurrence and failure
  • NiTi rotary files that allow dentists to clean curved difficult anatomy and yet keep canal preparation size small so as not to weaken the tooth
  • The GentleWave® System which is similar to PIPS but harder to use and doesn’t work for all teeth
  • A new bioceramic sealer, called BC sealer, that is:
    1. Highly biocompatible meaning the body doesn’t react negatively to it
    2. Highly antibacterial, having a pH of 12+
    3. Does not shrink like other sealers that can allow new bacteria to colonize
    4. Osteogenic and hydroxyapatite producing, meaning it encourages new bone growth and tooth health
    5. Bonds to dentin, meaning it helps seal tubules, canals and accessory canals

While all of these advances in technology and protocols are revolutionary in their own right, I feel that there is one technology that surpasses them all.

A New Wave of Endodontists Ride Into Town

Dr. Val Kanter, a board certified endodontist in Beverly Hills, has developed a protocol combining the erbium laser made by Fotona and ozone, to remove the harmful bacteria that is usually left behind with traditional root canals.  That’s her pictured to the right.

Dr. Kanter’s work builds on the work of Mark Colanna, who is a dentist practicing in Whitefish, Montana.  Dr. Colanna in conjunction with Dr. Enrico DiVito, a practicing endodontist in Scottsdale AZ, are the original dentists who figured out how to use an erbium laser to produce photon induced photoacoustic streaming (PIPS) during root canal therapy.   Dr. DiVito has authored seven articles on PIPS and co-authored the book, ‘Lasers in Endodontics.’

More recently, there has been an advancement to the PIPS frequency called SWEEPS, which is basically PIPS on steroids.  Much of the work done to develop SWEEPS was done by Enrico Divito, a specialist, and professor in Rome, Italy.  He was also a co-author of the book, ‘Lasers in Endodontics’ along with Dr. DiVito.

What is revolutionary about the work of these specialists is that it addresses the latent bacteria left behind by traditional endodontics.  All the developments above are recent, having taken place over the last 5 years or so, but research is starting to come out showing just how effective PIPS and SWEEPS are in eliminating even deep-seated bacteria in microtubules of root canal teeth.  See my articles over the next few months highlighting some of these research papers.

Finally, a way to kill bacteria hiding in dentinal tubules

George Meinig in his book wrote, ‘I hope techniques will be forthcoming which will solve dentin tubule sterilization problems, and the use of lasers is a possibility.’  I have been waiting my entire career for a way to remove the bacteria from the small canals and the microtubules of the teeth.  That day has finally arrived.

The PIPS and SWEEPS protocols, when combined with antibacterial rinses commonly used during root canal therapy, produces a whole new level of result not possible until now.

In addition, the protocol developed by Dr. Kanter using ozone is ingenious.  Ozone effectively and efficiently deals with the problem of residual bacteria in the accessory canals and the dentinal tubules that both Price and Meinig were talking about.

In my mind, this is one of the biggest breakthroughs I have experienced in my 33 years as a dentist.  As you can tell I’m pretty excited about it.

Dr O’s recommendations

Recommendation #1:  In my experience, up to 40% of the root canals done in the past have some level of bacterial infection that is visible on imaging.  So, if you have root canals and suspect that one or more of them may be infected, take a 3-D image to be sure.  If you are not local to me, this can be set up at a lab in your area.

Recommendation #2:  I firmly believe that at least 2/3rds of the root canal teeth can be saved and the infection resolved with the erbium laser in SWEEPS mode.  If you are interested in this technology and live near me, you can call my office and talk to Victoria or Sherry at (760) 632-1304.  If you are not near to San Diego and don’t want to travel, try to find someone near you who is well versed in this technology.

Recommendation #3:  If you are immune compromised, meaning that you have an autoimmune condition, Lyme disease, cancer, etc., it would be beneficial to have some testing done.  This would show whether you have systemic inflammation and other markers to indicate that you may be a slow healer and may not respond well to endodontic therapy.  I can order a blood test if you are my patient.  If not, try to find a practitioner who can help you with these issues.  Some people just can’t tolerate root canals and don’t do well with them.  After testing is done, a realistic assessment of the risks involved can be made and discussed before any treatment commences.

Recommendation #4:  If you and your health practitioner decide that a root canal is not a good idea in your particular case, or if the tooth is just too far gone to risk trying to save, then extraction of the tooth remains your only option.  In these cases, I usually recommend replacing the tooth with an implant.  Other options include a bridge, a removable partial, or doing nothing (although this can result in bite collapse and teeth moving, which you don’t want).  Each option has its advantages and disadvantages and should be discussed with your dentist.

In my practice, I use zirconia implants because they are white (more cosmetic) and they are non-conductive, meaning they don’t conduct electrical charge or heat like titanium implants.  Down the road zirconia implants also don’t corrode like some titanium implants have been found to do, releasing titanium particles into macrophages and immune cells causing inflammation and peri-implantitis.

If you are in San Diego or around Los Angeles we can help you with zirconia implants in two office locations, as I work with a specialist, an expert on zirconia implant.  His office is in Orange County and he also sees patients at our office in Encinitas.  We invite you to call our office if you would like to discuss this with Dr O or his specialist.