Devitalized tooth: The disturbing subject

The devitalization of a tooth (endodontics) is a controversial subject in the dental world (if you did not know it!). We know the risks caused by improper handling during endodontics too or not deep enough which are increasingly rare thanks to apex detection devices. We know less about the risks associated with devitalized teeth. Indeed this subject is taboo.:

Many dentists consider root canal treatment (devitalization) as a safe procedure, while other research has shown that this treatment allows dangerous bacteria to grow in the mouth and the rest of the body and eventually cause cancer and cardiovascular disease. The subject within our structure is debated as you will see in this article.

This article has a purely informative role. It aims to sensitize people at risk and to list the most frequent diseases. The diseases mentioned above are by no means a generality and are a summary taken from various medical articles.
The symptoms listed should not be a source of remote diagnosis and in no way replace a visit to your doctor or dentist.

What is devitalization of a tooth

Devitalization (endodontics) is a stomatological procedure performed under local anesthesia consisting in removing the pulp from the main canal of the tooth (made up of nerves and main vessels). It is performed in 2 stages.

The dentist, after having removed the tissues of the tooth and reached the pulp, will remove the latter and clean its canal. For this, a needle whose texture is rough will allow extracting the contents of the canal. This act requires great precision because the entire nerve must be extracted without crossing the apex (the end of the tooth in contact with the bone). Today, electric measuring instruments make it possible to 'reach the apex of the tooth with the reliability of 1/10 of a millimeter. The pulp canal is cleaned and disinfected by injecting an oxygen product. The canal will be temporarily filled for a few days so that the antibacterial products take effect. The dressing is placed.
After a few days, the dental dressing is removed and the cleaned canal again. The canal is filled and the tooth is reconstituted with a composite of the same color as the tooth. Nowadays, photopolymer materials are used (white metal-free filling).

See the dangers of fillings and the decontamination techniques to be implemented for their removal.

Anatomy and structure of the tooth

Contrary to what it seems, a tooth is not an inert tissue. It is alive and constantly irrigated via the dental canal from which nerves and blood vessels pass. This together forms the pulp which crosses the dentin at its center Dentin is covered by a harder tissue, enamel. The visible part of the tooth is called the crown. The tooth is implanted in the bone tissue by the root. The periodontium surrounds the root of the tooth. It forms the cement that will bind the tooth to the bone tissue. This connection is provided by alveolar ligaments.

The pulp and its main canal have many bifurcations and ramifications that irrigate the whole tooth, much like a tree has its trunk and branches. This whole is sterile when the tooth is alive and healthy. When the tooth is devitalized, it dies and releases very harmful toxins. This is the whole question of studies on the toxicity of a dead body in the mouth.

The devitalized teeth scandal

The scandal of mercury fillings is well known, but there is a much more serious one according to some scientists. The poisoning is caused by devitalized teeth. Indeed, during a devitalization, the main channel of the tooth is cleaned, however, the tooth is made up of hundreds of subchannels and bifurcations which are not. These latter release bacteria which spread by absorption to the bone tissues and then into the blood.

The subject being very sensitive and little known in France by the dentists themselves, the objective of this article is not to take a position for one or the other of the theses but to inform and share the opinions of different specialists as is the case in many countries.

In France, this act is recommended and reimbursed by social security which itself recognizes the abuses of certain practitioners who resort to this act in a preventive manner. We also find this drift in certain clinics practicing dental tourism and who, in order to avoid that the patient has to come back in case of tenderness, prefer to treat the canal directly. At the same time, devitalization is not recommended by the order of stomatologists in some countries. As we can see, this subject divides part of the profession up to the health policies of certain states.

In France, the question appeared in 2004 in the report submitted by Corinne Lepage, then ex-Minister of Health who recommended the extraction of devitalized teeth for therapeutic purposes. Quickly challenged by the order of dentists mounted at the crenel, the latter will go to court to have this text brought down. The former minister will qualify this trial as a 'Witch hunt organized by a tribe protecting its privileges'. Although several studies validate the thesis of "anti-devitalization ", they will lose their case and a dental surgeon will have his right to practice withdrawn.

So what to think? Several studies have demonstrated the non-toxicity of fillers used in endodontics. But a problem of methodology appears in these studies. The possible poisoning would not come from the products of complement but bacteria developing in the subchannels and bifurcations following the degradation of dead tissue. Studies demonstrate that toxins are released from devitalized teeth.

Toxicity of devitalized teeth

Although we know today that bacteria and toxins are released from devitalized teeth, it is not easy to prove that these are the sole responsible for diseases. more studies suggesting it. Among the best known of these studies we find:

The German oncologist, Dr. Joseph Issels , insists on having all devitalized teeth automatically extracted, convinced that they are the cause of many diseases such as cancer.
Dr. Price , a dentist who became famous for his experiments which consisted of extracting devitalized teeth from people with heart disease or arthritis then transplant them under the skin of rabbits, which develop the same diseases within weeks.
Dr. Boyd Haley , professor and researcher at the University of Kentucky, denounces a large-scale poisoning settling dentists and the pharmaceutical industry. He carried out further research on the work of Dr. M. Price by analyzing the bacteria present in devitalized teeth. His conclusions were shocking: "About 25% contained bacteria that produce toxins rather benign. 50% of the teeth studied contained bacteria in their structure that could interfere with the proper functioning of the immune system. The bottom 25% of the teeth contained bacteria that produced toxins more potent than botulinum (important note, botulinum is widely recognized as the most toxic substance to humans). " This bears repeating. 25% of devitalized teeth contain a toxin stronger than the strongest toxin known to man. It was previously behind the scandal over mercury fillings
Dr. Mercola or Prof. Haley recommend removing devitalized teeth, even if they look healthy.
The Anveli centers and Prof. Ihde have found through our studies clinically that the bone in the segments treated with root canal was of poorer quality than the untreated segments and that the success rate in implantology was lower in these areas.

Despite everything, many questions remain unanswered. Are the injected materials perfectly neutral? Can having a dead body (devitalized tooth) in the body affect the oral situation and health more generally ?

Devitalization, a profitable act

The French have two to three times more devitalized teeth than other Europeans. The reimbursement of social security and mutuals has largely contributed to the explosion of this practice even when it is not carried out in a therapeutic goal.

As we have seen above, the devitalization of the tooth was designed to avoid the extraction of the tooth when it presents a deep decay. Unfortunately, we see in our patients that most of them between them have devitalized teeth that have been devitalized in a preventive manner. Most often performed during the fitting of a crown or veneer, it prevents the tooth from becoming sensitive to hot and cold.

Bone atrophy can reach 5 to 6 millimeters the first year (hence the advantage of immediate implantation post-extraction) then 1 to 2 mm per year.

In our courses and congresses, we meet a large number of dentists, stomatologists who are simply not informed of the toxicity of this act. It is a quick, painless, profitable act since the patient is reimbursed by social security is often not against.

Diseases related to devitalized teeth

Many bacteria are present in devitalized teeth. These bacteria can be the source of disease or harmful effects on health. Here is a non-exhaustive list:

Fusobacterium, Porphyromonas and Treponema bacteria are linked to atherosclerosis .
Porphyromonas bacteria is linked to disease Alzheimer's by its ability to create inflammation in the body.
Porphyromonas, Treponema and Tannerella are linked to poor blood sugar control and diabetes .

Conclusion

Why devitalize?
You will think after reading this article that we are fiercely against devitalization. Well no, that is the paradox. There is no There are sometimes no other means of saving the affected tooth. However, it must be performed in a perfectly controlled manner and after having tried to keep the tooth alive as much as possible. Devitalization should not be carried out in the case of implantation. a crown if the tooth is not attacked by a decay that has reached the nerve.When it is a single tooth the risk is less, but the more the number of devitalized teeth in the mouth, the greater the risk of poisoning is high.

How to avoid devitalizing a tooth?
The first thing to do is preventive. Maintaining good dental hygiene to avoid any decay from s' If the nerve is affected by caries then the question will arise whether to devitalize the tooth and keep it with the risks mentioned above or extract the latter and make a bridge, a dental implant or remain edentulous. What makes this choice even more difficult is that it is often made without even the patient's prior consent. You go to your dentist to get a dental crown or treat a toothache and come out with a devitalized tooth.

What if your dentist tells you to devitalize your tooth?
If your dentist informs you of the need to devitalize a tooth, it is already a good thing since he informs you before performing the act. Your decision will also depend on how much confidence you have in your dentist. First of all ask him if he thinks it is possible to keep the tooth alive. If the nerve is not directly affected it can fill the cavity and you will notice after 5 to 6 weeks if the tooth is still sensitive. You must ask him to do everything to save this tooth. This may take several consultations.

Sources used for writing this article

American Association of Endodontists, "Root Canal Safety."
ME Vienna et al., "Effect of root canal procedures on endotoxins and endodontic pathogens, "Oral Microbiology and Immunology vol. 22, issue 6 (December 2007).
PNR Nair, "On the causes of persistent apical periodontitis, "International Endodontic Journal vol. 39, issue 4 (April 2006).
A. Cope et al., "Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults, " Cochrane Reviews, June 2014.
Analia Veitz- Keenan and Angela M De Bartolo, "Insufficient evidence of the effect of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess, "Evidence-Based Dentistry vol. 15 (2014).
EL Souza et al., "Macrophage cell activation with acute apical abscess contents determined by interleukin-1 Beta and tumor necrosis factor alpha production, "Journal of Endodontics vol. 40, issue 1 1 (Nov. 2014).
José F. Siqueira, Jr. and Isabela N. Rôças, "Microbiology and Treatment of Acute Apical Abscesses, "Clinical Microbiology Reviews, April 2013.
V . Vengerfeldt et al., "Highly diverse microbiota in dental root canals in cases of apical periodontitis (data of illumina sequencing), " Journal of Endodontics vol. 40, issue 11 (Nov. 2014).
Byalakere Rudraiah Chandra Shekar et al., "Herbal extracts in oral health care - A review of the current scenario and its future needs, " Pharmacognosy Review vol . 9, issue 18 (Jul-Dec 2015).
C. Fernandez et al., "Identification of Synergistetes in endodontic infections, " Microbial Pathogenesis vol. 73, Nov. 2014.