Despite scare stories from holistic dentists, cavitations probably don’t exist


Shaun Sellars
Shaun Sellars is a general dentist working in Suffolk. He is currently working towards a Masters’ degree in Dental Law and Ethics and writes a regular column on ethical dilemmas for the British Dental Journal. His areas of interest include Evidence-Based Dentistry and non-clinical skills in dental practice.

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Root canals spread toxic bacteria and are linked to cancer”. Or so says a widely repeated claim from the godfather of pseudoscience Joseph Mercola.

Dentists usually carry out root canal treatment (RCT) when decay penetrates through the enamel and dentine of a tooth and into the pulp, which contains the blood and nerve supply to the teeth. This can be incredibly painful, and the only way to remove the pain is either to remove the tooth in its entirety, or to remove the pulp by carrying out RCT. Here the dentist cleans out the canals in the tooth, the area where the pulp sits in the roots, shapes the inside of the canals, and disinfects the inside of the tooth. An inert substance, usually gutta-percha, is then used to fill the canals.

In making claims for the danger of RCTs, Mercola cites the work of the ‘Worlds Greatest Dentist’, Weston A. Price. Practicing at the turn of the 20th Century, Price is generally considered to be the father of the ‘holistic’ dental movement (more on this in the future, I’m sure).

Price spent a quarter of a century researching root-treated teeth, and eventually concluded that general systemic conditions often occurred due to root canal treatment, and that instead of treating the root, dentists should remove the tooth. His work was ultimately discredited and forgotten over time, until the likes of Mercola resurrected it.

Mercola makes many claims about RCT, including that dentists aren’t taught about accessory canals in teeth (we are – they can be a pain), and that it’s impossible to remove all the bacteria from the tooth through root treatment. This latter claim is actually true, but it is mitigated somewhat by the material used to seal the gutta-percha in the tooth. In theory, this sealant mummifies the remaining bacteria, rendering them inert.

Despite this, RCTs are somewhat unpredictable, with a failure rate of up to 10% in general practice (although the failure rate is lower if a specialist carries out the procedure). The relatively high failure rate is partly due to it being bloody difficult: it’s the dental equivalent of trying to thread a needle with your eyes closed while wearing a pair of oven gloves.

Mercola also reports on the work of a Dr Robert Jones, of Quantum Cancer Management. Jones found that in his study of 300 people with breast cancer, 93% of the women studied had RCTs, and that tumours  ‘in the majority of cases, occurred on the same side of the body as the root canal(s) or other oral pathology.’ But there appears to be no sign of this study in the PubMed database of healthcare research, and the Quantum Cancer Management website, linked to by Mercola, now seems to be dead.

Just for a minute, let’s pretend this research is believable. Would preventing breast cancer be as simple as removing a few teeth? Of course not. Because, although there’s no evidence to show this, Mercola and a host of ‘biological’ dentists claim removing a tooth ‘incorrectly’ can allegedly lead to a NICO. These are areas of Neuralgia-Inducing Cavitational Osteonecrosis, more commonly known as cavitations.

A dentist and her assistant work on a patient's teeth

Cavitations occur, it is claimed, due to avascular necrosis – a lack of blood supply to the bone marrow of the jaw, which causes the death of surrounding tissue. Despite first being described in the 1920s, there is little-to-no good quality research into NICOs, and the majority of dentists question whether they exist at all (spoiler alert: they probably don’t).  The theory is that if your dentist doesn’t remove the periodontal ligament when extracting the tooth, the socket won’t fully heal, leaving an area of chronic infection, the cavitation, behind.

What research does exist is often carried out by the likes of Hal Huggins and Thomas Levy, who between them have written several books on the perceived dangers of dental treatment. Huggins ran the US Based Huggins Diagnostics Center until 1995, when it was closed following a series of lawsuits and negligence claims. The Center provided several holistic treatments including ‘safe’ amalgam removal, using the Huggins designed ‘Amalgameter’ to detect apparently toxic levels of mercury being released from silver fillings. Huggins himself had his licence to practice stripped in 1996 after being found to be diagnosing mercury toxicity in all of his patents, including some without any amalgam fillings. Although he died in 2014, his thoughts and teaching live on in the practice of a multitude of ‘holistic’ and ‘biological’ dentists who claim to specialise in treating issues such as cavitations.

One particular feature of cavitations is their general elusiveness and ability to avoid detection. Until recently, the only definite way of detecting cavitations was by the use of a specific device, the Cavitat. This imaging device was developed by a former pilot, Bob Jones, who claims that his infected teeth nearly killed him in the late 1980s. Jones claims that his health was restored following the removal of the infected teeth.

Now, I can’t make a definite link between the Bob Jones, inventor of the Cavitat, and the Robert Jones who produced the research linking breast cancer to RCTs, but it does seem to be at best a huge coincidence. Of course, it may not be Bob, but it might be his son Robert who helped train Cavitat users. Thanks to some legal wrangling, the Cavitat machine is no longer available. Still, various other treatment modalities have taken its place, including similar devices and the use of CT scans to help dentists uncover the sites of the mythical cavitations.

Treatment of cavitations usually involves painful – and unnecessary – debridement of the area, which is often followed up by ozone therapy and other low evidence interventions—all of this coming at a high cost to the patient, rarely covered by insurance schemes. Patients are, in many cases, left with ongoing pain from the surgery sites, and with no improvement of their initial symptoms, which leads them onto further, more drastic treatment.

So here we have a story of debunked century-old research, picked up on by unscrupulous dentists claiming to act holistically or in a ‘natural’ manner (nothing we do is particularly natural), being exploited for clicks by one of the ringleaders of pseudoscience. Add in a magic machine that can detect the dental equivalent of unicorns, and you have a perfect way of extracting money from genuinely unwell people.

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