March 12, 2019
by Gary Glassman, Chief Dental Officer, dentalcorp; Ian Watson, DDS, MScD, FRCD(C)
It has often been said that to bring attention to a controversial matter simply affirms its existence, memorializes it and gives it credibility. The corollary is to ignore it and allow wrong and negligent statements to pass as science. Instead of burying our heads in the sand, we would much rather bury bad science once and for all. We do this with the best interest of patients in mind.
In life, when things go wrong, it is human nature to search for reasons and causes. While searching for answers is a worthy endeavour, jumping to conclusions and ascribing blame without evidence is irresponsible. When this happens in medical circumstances, it is altogether misleading and unfair to patients to give them false information and send them on a wild goose chase.
If you haven’t heard, let me be the first to introduce you to a documentary on Netflix called “Root Cause.” The documentary follows an individual’s experience with root canal treatment, and the alleged systemic issues he claims arise directly from the root canal treatment.
Unfortunately, there is a small group of naysayers that look to root canal treated teeth as being the root of all evil. Or to put it more appropriately the Evil of all Root!
This misinformation is promulgated based on the flawed focal infection research by Dr. Weston Price in the 1930s, which states bacteria trapped in dentin tubules remaining after root canal treatment cause almost any type of ‘degenerative’ disease, including kidney disease, heart disease, rheumatic fever, and multiple sclerosis. With this decade old flawed research as his justification, it has been recommended that patients afflicted with such conditions consider extracting all their endodontically treated teeth!
Several examples of misinformation are cited in this movie. For instance, it was erroneously stated that “97% of patients with breast cancer had a root canal on the same side as the cancer.” I researched this declaration, and I found NOTHING! Not one iota of scientific evidence to support this claim. This is the equivalent of saying “100% of patients with cancer drink water.” Correlation does not equal causation.
As recently as 2013, a study published in a journal of the American Medical Association (JAMA Otolaryngology – Head & Neck Surgery) found that a patient’s risk of cancer doesn’t change after having a root canal treatment; in fact, patients with multiple endodontic treatments had a 45 percent reduced risk of cancer.
Another claim was “The #1 cause of heart attack is root canal treated teeth.” A study conducted over 44 years, called the Baltimore Longitudinal Study of Aging, published in the International Endodontic Journal in 2016, evaluated whether apical periodontitis, root canal treatment, and endodontic burden were associated with long term risk of cardiovascular disease. The study actually suggests a possible risk reduction with root canal treatment versus non-treated teeth with apical lesions, which supports the evidence that untreated abscessed teeth may contribute to an increased risk of cardiovascular disease and not root canal treated teeth as the contributing factor!
The American Association of Endodontists and Canadian Academy of Endodontics are continuing to educate its members and the general public by noting that no modern evidence exists to support claims that endodontically treated teeth serve as infection foci. In fact, untreated, infected teeth create that very cesspool from which consequences arise.
Predictable, successful endodontic treatment, using sophisticated techniques is the best strategy to reach a satisfactory conclusion. The removal of contaminants and organic substrate from within the root canal system in its totality is the indisputable biologic imperative of endodontic treatment.
Providing patients with access to comprehensive, proven facts about the safety and efficacy of endodontics and root canal treatment is the best strategy for countering misinformation. In fact, the practice of endodontics is rooted in scientific evidence that has evolved over decades. Anecdotal stories, in any realm of medicine and dentistry are hardly enough to change tried, tested and true treatment paradigms. Anecdotes can lead to hypotheses, but without empirical scientific evidence to back them up, they remain “one man’s story”.
The American Association of Endodontists website, www.aae.org has up to date content and resources which include “Root Canal Safety Talking Points”, “Myths About Root Canals”, and a “Root Canal Safety” video, all which can be shown to patients to dispel any myths and negative propaganda about root canal treatment.
As per a recent AAE communique: “Legal counsel has been consulted by the AAE and the ADA to discuss options to compel Netflix and other online hosts to remove this misleading and harmful content. After consultation, the AAE is filing formal complaints with the patient protection agencies, including state and medical boards. Additionally, the AAE is working with the ADA on formal outreach not only to Netflix, but all online platforms hosting the film, and urging removal for the safety of the public.”
Endodontic treatment has experienced, and will continue to experience some of the highest success rates found in dentistry, preventing unnecessary loss of teeth and contributing to a healthy, functional and aesthetically pleasing dentition.
Special thanks to Dr. Maneesh Sharma, President of the Canadian Academy of Endodontics and the CAE’s efforts for their position paper on this topic, Spring Hatfield, RDH for her helpful insight and the American Association of Endodontists for their powerful stand against harmful misinformation. OH
About the Authors
Gary Glassman, DDS, FRCD(C) The author of numerous publications, Dr. Glassman lectures globally on endodontics, is on staff at the University of Toronto, Faculty of Dentistry in the graduate departmentof endodontics, and is Adjunct Professor of Dentistry and Director of Endodontic Programming for the University of Technology, Kingston, Jamaica. Gary is a fellow of the Royal College of Dentists of Canada, Fellow of the American College of Dentists, the endodontic editor for Oral Health dental journal, Faculty Chair for DC Institute and Chief Dental Officer for dentalcorp Canada. He maintains a private practice, Endodontic Specialists in Toronto, Ontario, Canada. His personal/professional website is www.drgaryglassman.com and his office website is www.rootcanals.ca He can be reached at email@example.com.
Dr. Ian Watson is a certified dental specialist in root canal therapy. He has been educated at the University of Western Ontario, the University of Toronto, Faculty of Dentistry and the Boston University School of Graduate Dentistry. He has practiced an endodontist in Mississauga, Ontario since 1981. He has been on staff at the University of Toronto, Department of Graduate Endodontics. He is Past President of the Canadian Academy of Endodontics. He is a Fellow of the International College of Dentists, the Academy of Dentistry International, the Pierre Fauchard Academy, and the Royal College of Dentists of Canada.