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Dental Controversies with Dr Ron Ehrlich

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Dental Controversies with Dr Ron Ehrlich

Imagine if you were told that there wasn't enough space on your hand for all five fingers, so one needed to go, what would you think about that course of therapy?

This is exactly what modern orthodontics proposes for issues such as 'crowding of teeth,' an issue which is ever-increasing in developed nations with "Westernised" diet.

Leading Australian holistic dentist Dr Ron Ehrlich, has in his decades of clinical practice, looked deeper, searching for reasons why dental issues are on the rise, despite widespread availability of dental health services.

In today's podcast, Andrew and Ron explore the controversial issues in dentistry including how to promote healthy jaw size and function, the re-mineralisation of tooth enamel, and the real health issues surrrounding mercury amalgams and root canal therapy.  

Covered in this episode

[00:43] Welcoming Dr Ron Ehrlich
[01:43] Changes and challenges in dental practice
[08:59] Craniofacial development
[12:29] How nutrition affects dental development and  health
[21:20] Tooth enamel and re-mineralisation
[28:07] Root canal controversy
[39:15] The safety of dental materials
[45:55] Ron’s reasons for writing his book
[47:39] Closing remarks


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line today is Dr Ron Ehrlich. He's one of the Australia's leading holistic health practitioners and holistic dentists. In 1983, he cofounded the Sydney Holistic Dental Centre and has developed a patient centred practice and approach to healthcare. He's qualified in nutritional medicine, pain management and of course, holistic dentistry. 

Ron is a member and former board member and vice-president of the Australasian College of Environmental and Nutritional Medicine, ACNEM, from which he gained his fellowship in 1996. He's given keynotes and conducts interactive courses and workshops for health practitioners and the public based on an innovative view of a holistic approach to healthcare, how stress impacts on our health and includes a unique oral health perspective. 

Welcome to FX Medicine, Ron. How are you?

Ron: Good, thanks, Andrew. Well done. Yeah, I'm well.

Andrew: Now, I'm just reading back. 1983 you cofounded the Sydney Holistic Dental Centre. That's a long while ago, sir. You've been in practice for quite some decades. What changes have you seen in that period which awoke the need for individualised care, which obviously wasn't being delivered beforehand?

Ron: Yeah. Well, thanks, Andrew. It has been a long time and that's why we call it a practice because we're still practicing, you know? Like 40 years initial, it's going to be 40 years next year that I've graduated and I've been working together with my brother for the last 38 of those years. And it took us a couple of years to get to the point where we decided a more holistic approach was needed. The changes in dentistry have been huge. I mean, it used to be so simple. And now it's become so complicated. 

And compliance alone, you know, the whole sterilisation compliance issues face us with some really, really challenging...that's challenging in terms of practice management. But also digital, the introduction of digital technology. I mean, X-rays, we used to have to develop with solutions and now we just...instant access to X-rays and they're three-dimensional. So, you know, the changes there have been incredible technologically and also from a practice compliance perspective. I think the other thing that's really changed is how well educated our patients are.

Andrew: Yeah.

Ron: And that is a blessing and it is also a challenge. I think it's a great thing to empower people to be more informed but sometimes, you know, that can be challenging to try to deal with because you do need a little more knowledge than sometimes Google can give you.

And so, you know, there's so many challenges, there's so many changes that have occurred technologically, compliance, patient expectation. You know, the whole world in which we live has become more stressful. I think most people will acknowledge that. 

Andrew: Yeah, yeah.

Ron: It’s prompted me to write a book, of course. But I'd say there's been a lot of those sort of changes.

Andrew: You and your brother, were you always mavericks even when you were learning dentistry or did something wake up later? You know, and if you were mavericks during dentistry, how were you viewed by your peers?

Ron: Yeah, look, you know, I've never ever considered myself a maverick. You know, I honestly don't. I got into the whole area of holistic because I was very interested in the treatment of chronic pain, headaches, neck aches and jaw pain. 
In the '80s, that was referred to as TMJ, temporomandibular joint dysfunction. 

And so I, very early on in my career, realised that by changing the occlusion of an individual, even only slightly sometimes, I could have a profound impact. Hopefully positive, usually positive, but sometimes not, on a person's chronic pain, what they would refer to as tension headaches, neck aches and jaw pain. And that intrigued me. And I thought, “Wow, if malocclusion, if people being not in a perfect balance causes this, then a lot of people are going to need my help." 

And then in about 1983, I was attending a lot of courses. I mean, you could do a course on TMJ dysfunction every week, every week of the year. You know, there were always courses on all over the world and I went overseas. And one course that I attended said, "Our health is affected by stress." And they defined stress as a combination of emotional, environmental, postural, nutritional and dental. And that was a really big turning point for my career.

Andrew: Right.

Ron: So from that point, I started to explore health from that perspective. So I actually never thought of myself as a maverick. I just was intrigued by connections and our ability to make those connections. And that kind of freed me up to think more openly about it. 

And that led me into yes, some more controversial aspects of dentistry: the use of mercury amalgam fillings, whether we should or shouldn't be doing root canals, is water fluoridation a good thing or not. And that...you know, when you start to deal with some issues like that, it makes you seem like a maverick but I never thought of myself like that.

Andrew: I'm actually glad that you say that because it wakes me up to the feeling that just because you question something, doesn't make you a maverick. You can still come to the conclusion, "Yes, that is worthwhile." It's just that you question it. And to me, I think that's so important, just not to accept the status quo, but to say, "Is that really what is the best for our patients? Or is there a better way?" 

Ron: Yes.

Andrew: So is that how your mind functions on a day to day basis?

Ron: Yeah, it does. And I keep a really open mind and I recognise that… Look, I think for things to change, you know, for people to be changing in their view of life, whether that's personal or professional, I think there are two basic things that you need to address. 

One is what's called a “locus of control.” Do you see yourself as just a victim or dictated to by all the authorities? "This is how you will practice or this is how you will live life or this is what will happen to you in life." Or do you feel you exert some control? So do you have an internal or an external locus of control? If you have an internal locus of control, then you've got a more open mind. 

And that leads you into the second aspect which is a tolerance of ambiguity. We love certainty. You know, we love to always be right. We love to have the one answer. We love to know what the right way is. But the reality is that's not how the world works. There are many shades of grey, and so this tolerance of ambiguity is a really important part of keeping an open mind and constantly being open to change.

Andrew: I love those terms. I've never heard of them before. 

Ron: Thank you. Wow.

Andrew: Did you...where did you come across them? Did you...

Ron: Oh, I just made that up. No, no, no. I didn't at all. I did not at all. I did not at all. My wife is in education and interestingly, has worked at the Australian Graduate...had worked at the Australian Graduate School of Management doing instructional design and coaching the coaches, coaching teachers.

Andrew: Yeah.

Ron: And change management is a huge thing in business, and it was in the '80s and it was in the '90s. It still is now. But change management was a really big thing. And so while she was working on those courses, those two elements of change management were quite an accepted form within business at the time, and I thought they had relevance to healthcare and the health professional. So, you know, you can just extrapolate that. It wasn't my own. So I have to owe up.

Andrew: Let's talk firstly about craniofacial development and the issue of, you know, narrow jaws and crowding teeth which I feel, and I'm a layperson in this, I just get the feeling that it's an exploding issue.

Ron: Andrew, it is a really big, big issue. And, you know, in fact, there's just been a very interesting book apart from my own written called "Jaws: The Story of a Hidden Epidemic" and it kind of talks about this hidden epidemic that's going on. And it's not new by any means.

You know, when I've asked people in public forums, probably say 1,000 at least in the last few months, I've asked them to put their hand up. How many people in the audience, and maybe your listeners can put their virtual hand up or their real one anyway, but, you know, say this, how many people listening to this have all 32 of their teeth through, because that's how many teeth we have evolved to have, have been through an imperfect alignment?

Andrew: Yeah, yeah.

Ron: And of those 1,000, I would say 20 people have put their hand up. And so that would suggest to me, but let's say 99%...let's be a little more conservative. Let's say 95% of the population in our Western society has insufficient room for all 32 of their teeth.

Now, you know, most dentists actually have come to accept that as normal and just...you know, we need our wisdom teeth out or your lower teeth are crowded or you've had a tooth out here or there. You know, we've come to accept it. And I find that interesting because literally the shape of your mouth, the shape of your upper jaw determines the shape of your nasal sinuses and nasal passages, the space available. 

Face...the shape of your lower jaw and upper jaw and the way they fit together determines the space available for your tongue. So literally, a crowded mouth doesn't, by definition, doesn't have enough room for all 32 of your teeth, has a narrow upper airway. And a narrow upper airway predisposes you to a range of upper air issues maybe recurring as a child, it may be recurring respiratory problems, enlarged tonsils, mouth breathing, recurring respiratory infections.

So that. But then, in later life...and actually, it's not even later life because in children it's a problem as well. It predisposes you to sleep disorder breathing conditions, some of which can be life-threatening. It also affects your posture causing you to have a more head forward posture. So, you know, we've come to accept this as a kind of normal and I often use the analogy “imagine if we didn't have enough room for all five of our fingers on our hands.”

Andrew: Yeah, yeah.

Ron: And we all said, "Hey, listen. The fourth finger's really not doing anything. Is everyone okay with having that lopped off at 18?" You know, like that's no big deal. It shouldn't be a problem. And you'd say to somebody, "Hey, did you have your fourth finger removed when you were 18?" "No, yeah, yeah, no big deal." We wouldn't accept it as normal. Yet, we've accepted this as normal because well, in a way, the profession has even accepted it as normal and it shouldn't.

And so that leads us into why is it so? Why is it so epidemic? And that is a whole discussion that goes back to nutrition from the moment of...in fact, one would even argue before conception.

Andrew: Yep.

Ron: The nutrition of the mother and the father before the moment of conception but certainly the nutrition of the parents at conception, the nutrition of the mother throughout pregnancy, the nutrition of the child from birth through infancy through adolescence and beyond. So nutritionally, there is an issue there. The texture of the food, the amount of chewing that is required in the food that we eat, and then the effect that that has on the oral musculature, the lips, the tongue and the cheeks. It's called oral myology, a whole new science. So there's a whole quite a lot to discuss there about craniofacial development.

Andrew: It's really interesting. You know, and I got to say like...okay. If we were living a natural diet as an animal in the wild, well, wild animals certainly have health issues. Wild animals certainly don't have a longer period of life than say domesticated animals. And they certainly might even have their own dental issues. And they can be really drastic. So it's not to say that these sort of issues don't happen in the wild, in the wild animal eating their natural diet and things like that. But I think there is also a case for we've changed our diet so far away from the natural diet that we really are seeing this epidemic of dental issues now.

Ron: Yeah, yeah. And look, we don't have to go back to Palaeolithic times. I know the paleo diet is very popular at the moment and I think there's good reason for that. But we don't have to go back to Palaeolithic times. We only have to go back say, 70 or 80 years and there was this brilliant work done by a dentist, Weston A. Price. 

And Weston A Price in the 1920s and '30s was trying to discover what had caused tooth decay because tooth decay was at epidemic proportions. And what he did was he travelled around the world and visited people in various continents. He went to the Outer Hebrides in Scotland, he went to the Alps in Switzerland, he went to Eskimos, he went to North American Indian...Native American populations, he went to South American Native Indian...native populations. He went...visited Australia, he visited the Polynesia, he visited Malaysia, he visited New Zealand and Africa. So he really covered the whole...all the bases.

And what he did was really unique, and I would argue perhaps one of the most important bits of research that's ever been done. A big statement, but there it is. And what he did was he looked at what traditional cultures were eating in their traditional environments. So some people, some groups were eating oats and seafood and they pickled their vegetables. Others were on protein and fat. Others were on rye, dense rye that was grown on, you know...that they harvested, and dairy. So there was a real...you know, there was a real variety in all of these foods. 

And then what he also had the opportunity to do was go down the road and visit the same genetic group that was living in an urban environment eating Western food. And what he found was...well, what he found in the traditional diet, the traditional cultures, was not only did they have no tooth decay but they also had enough room for all 32 of their teeth and then some room behind the wisdom teeth which meant they had broad, wide arches and broad upper airways. But what he also found was they didn't have any of the degenerative diseases that were common at the time, cardiovascular disease, diabetes and stroke. That was in the 1930s. Can you imagine what he'd be up against now?

Andrew: Yeah, absolutely.

Ron: So then he went down the road to the towns and the villages where people were consuming Western diet. The same genetic group but different groups all around the world, and what he found was tooth decay was rampant and so was chronic degenerative diseases. Rampant. And within one generation, within one generation the offspring had more narrow jaws and crowded teeth. So this was a critically important bit of research. 

So what he did then was he took all of the food samples from all these different cultures and he took them back to the States and he analysed them and he found that these nutrient dense foods had three things in common. One, they had 10 times the amount of water soluble vitamins. That is, B group and...well, B group vitamins and minerals. So 10 times that of the same diet that was being consumed in a Western situation. 

They had four times the amount of fat soluble vitamins. That means A, D, E and he had something called “activator X” which has turned out to be vitamin K, K2. So what he found was...and the best source of those vitamins, those fat soluble vitamins was animals, either grown on new pasture or obviously seafood that, you know, had been feasting on plankton and whatever else seafood feasts on at the time.

Andrew: Yeah.

Ron: Now, the problem was that was in the 1930s and our nutrition hasn't improved a whole lot more.

Andrew: No.

Ron: And our degenerative disease has gone through the roof. And so the key is really a nutrient dense food that is high in fat soluble vitamins. Now when you look at the food pyramid and everything that we've been literally pushed down our throats over the last 40 years in public health messages about “low fat this” and “stay away from animal fats” and “get onto the seed oils” and all of that sort of advice, counterproductive. 

I think we have lost diversity, not just in our soil...not just in our food but we've lost it in our soils and we've lost it in, you know... I'm finding it really intriguing that we're hearing so much about the microbiome, you know? And I've actually explored this where the microbiome...there's so much in common with the microbiome of our gut or our body, our mouth and the microbiome of the soil. Because if our microbiome in our gut and in our mouths for that matter is more diverse, then it is more resilient. If the microbiome in our soils is allowed to exist first of all, and then be diverse, then it will deliver the trace minerals that are so essential for a nutrient dense diet to be defined as a nutrient dense diet.

So I agree. I mean our soils are, in Australia for sure, deficient in zinc, selenium, magnesium. You know, that is a real problem. And I think with proper farming practices, that can actually be replaced. I had read that it takes about 500 years for an inch of soil to be regenerated, and I thought that was fact. You know, this is about tolerance of ambiguity, Andrew. And then I did an interview with the regenerative farmer and read a fabulous book called the "Call of the Reed Warbler" and in there with regenerative agricultural practices, you can regenerate an inch or two of soil in 5 to 10 years.

Andrew: Whoa.

Ron: And you can regenerate it into a very diverse microbiome in the soil. So we do have the ability to feed the planet. We do have the ability to grow nutritious foods. But unfortunately food, like healthcare, has become a commodity. It is very, you know...it's... You'd wish it wasn't so. And that’s putting it mildly.

Andrew: I've commonly seen and heard, indeed had recommended to myself and my family these products in dentistry used to help re-mineralise teeth. But there's that issue about re-enamelling, that once the enamel is gone, is it gone? There's nothing that can coat the tooth that's adequate, or what happens in dentistry here?

Ron: Yeah. Well look, the tooth is covered by enamel which is largely an inorganic crystalline structure. And it's very hard. And underneath dentin is...underneath the enamel is the dentin and that's 65% inorganic and 35% organic. And so, it's much softer. So when you lose enamel, what you...you can't...I don't believe you can grow enamel back. You cannot, in my experience, you know, 40 years.

Andrew: That’s reasonable.

Ron: I mean, I could be wrong but, you know, I don't believe you can grow enamel back. But the process of mineralising and demineralising is a very dynamic process, and on a microscopic level is going on all the time. So that's why a diet rich in acidic foods and like carbonated drinks, even if they're zero sugar is very acidic and so the movement of calcium and phosphate out of the tooth is greater than that movement into the tooth. 

And so this is why a healthy microbiome is so important. But there's this interplay of minerals backwards and forwards. But if it's got to the point where on a macroscopic level you can see the loss of enamel, I think the horse has already bolted then. You're not about to...I'm not about to see thin enamel and then put someone on to a re-mineralising program and get them back six months later and go, “Wow! Well, I could see through your tooth. I can't anymore. The enamel's back." I haven't seen that happen.

Andrew: Right.

Ron: But on a microscopic level, in a process level, yes. You know, so are we talking semantics here? Perhaps. But if there's a product that's promising to re-mineralise the tooth, they're talking about it on a microscopic level and addressing that issue. Not, "Hey, my tooth is completely worn down but if I take this, I'm going to grow my tooth back again." That doesn't happen.

You know, there's a book that talks about arresting...of curing your own tooth decay and regrowing tooth and I just think… Look, I can totally get that by changing your diet, you can arrest decay. Yes, I can accept that. But to regrow tooth, I'm sorry. And, you know, it is so easy to take photos in this day and age. I mean, literally it's like a pen in my surgery. I pick up the pen. I point...a camera. I point it at the tooth and bang, I've got a photo. 

So if in my 40 years, I had been able to regrow a tooth, I can assure you those photos would've been plastered over a webpage and I'd have been publishing articles about it, you know, a long time ago. So I think there's maybe a little bit of semantics here but on a macroscopic level, I don't believe it happens.

Andrew: So what then for do you do? What is the appropriate treatment for an issue with enamel quality or enamel coverage, if you like?

Ron: Okay. Well, you know, when going back to the nutritional side of things...and this is something people may not be aware of. But where you have,  for example, tooth quality can be affected by gluten intolerance. Right? 

So when you think about it, we need to be able to absorb our nutrients. And if we have the gluten intolerance and we have a leaky gut, we're not absorbing our nutrients as well as we might and that can...also it causes, of course, many autoimmune conditions but it also can affect tooth quality. So, you know, there are people who have had...who are very scrupulous in their cleaning, and they're eating well and all that but they do end up having decay. 

But if you are wanting to minimise the loss of enamel, well, I mean, I think diet is by far the number one. And oral hygiene would be a very, very close second. I mean, when you start to look at the decreasing decay rates over the last 30 or 40 years globally, oral hygiene would have to be the major component of that. So that's not to be ignored.

And to be...to have things looked at before they become a problem. You know, like we did a workshop recently and we...the five dentists in our practice all sat and we agreed 95% of oral health problems have no pain associated with them at all. And that's a fact that I think a lot of people don't understand and need to because that's a very big part of avoiding the loss of tooth enamel unnecessarily and dentin, and unnecessary dental work.

Andrew: And so is the appropriate treatment really a filling in this instance?

Ron: Look, I mean, if a tooth has...if the form, the shape of the tooth has been compromised or if the decay is getting into the tooth, yes, you need to remove that decay and you need to...then you have a defect which you need to fill. I mean, this is...the best filling material of all is tooth enamel. You know, tooth enamel is still by far and above anything, it’s the best we've got. So everything else is a compromise. If you ask about re-mineralising, we do in our surgery use products that do re-mineralise and harden the surface of the tooth. And some of those products are Tooth Mousse which is basically a casein product.

Andrew: Yep.

Ron: I have no shares in the company. But, you know, it's a calcium and phosphate re-mineralising substance that people apply to their tooth and it has a positive effect. 

I think topical application of fluoride has some place. There's some science to support that. We do not use fluoride as a mass thing, like after you had your teeth cleaned, then rinse that with a fluoride rinse or have it painted on. We don't use it like that in our practice. It should be used carefully. We do apply it as a varnish to an area, so that's more controlled application of a topical fluoride. 

So there are some re-mineralising things. I mean, again, going back to diet. That's the main issue. Do not, you know, do not demineralise your tooth by what you're eating.

Andrew: Yeah. What about these dental controversies that exist? The first one, of course, is root canals. A major, major dental controversy. Can you give us an outline of the issues here?

Ron: Yeah, I can actually. I think this is a really interesting issue. You know, there's a website that I've seen, a very popular website that claims 97% of all terminal cancer patients have had this dental procedure done. Ninety-seven percent? That's incredible. And the procedure is root canal treatment. And when I went onto that site and I read the 10 references at the bottom of it, I looked them all up and not one of them said that. So I was very disappointed. But that's what three and a half or four and a half million people have so far read. So it's a big issue.

One of the things that I would say firstly as a starting point, is that of all the dental procedures that are undertaken, and there are many complex dental procedures undertaken, a root canal is perhaps the most challenging thing a dentist can do well. Because there's a difference. There's a difference between a root canal that's just done, getting people out of pain, that's easy. Anybody can do that. You could train a monkey I'd reckon. No, no, maybe not. You can't train a monkey but you could train anybody to do that. 

But to do a root canal well, and we can talk about what that means, it is an incredibly technologically challenging procedure. I don't do it, myself. My partners...actually, Lewis does it in the practice and he does it, I believe, almost as well as a specialist. And my other partner, Craig Wilson does it, but there are specialists, root canal specialists who do this and do nothing else. 

And the challenge is firstly, to locate the main canals in the tooth. Because this is dentistry 101, dental anatomy 101, Andrew. A tooth is covered by enamel. Underneath enamel is the softer dentin and then inside the tooth is the nerve and the blood vessels that nourish and build and support the tooth. So when that becomes infected, you've got dead tissue inside the tooth and no amount...antibiotics might reduce the pain but it's not going to solve the problem. So, you know, when you have gangrenous tissue inside a tooth, you've got two alternatives. Well, three, three alternatives. One is to ignore it which apparently a lot of people do.

Andrew: Wait for it to progress.

Ron: Yes, wait for it to progress, to their own detriment.

Andrew: Yes.

Ron: The second is to have the tooth out which, you know, raises a whole stack of other issues. Because you've got to replace the tooth and that involves a lot of dentistry and a lot of cost. So let's park that to one side for a moment.

Andrew: Yeah.

Ron: And the third alternative is to do a root canal treatment. Now, a well done root canal treatment does this. It locates the main canals, of which there might be in the front tooth, one and in the back tooth, four or five. Okay? So locating the main canals is the first. And for that, dentists are now using microscopes that have up to 25 times magnification. So, you know, up until microscopes were used, it was thought that there were only 3 canals in an upper molar tooth and ever since microscopes have come along, we realised that in 90% of cases, there are 4 canals in upper molar tooth. Whereas before it was thought there was only 10% or 20%.

So locate the main canals. Slowly increase their diameter so that you can actually get some medicaments down into the canal to sterilise, or to try to sterilise the tooth. And you use a little bit of ultrasonic to vibrate it through the dentin of which there are millions of tubules. And then you place a dressing in there, usually calcium hydroxide which is highly alkaline and you vibrate that through the tooth, and you leave it for a week or two. And then you get the patient back. You wash all of that out. You make sure that you're at the right length, that you haven't left any necrotic, gangrenous tissue inside the main canals and you go through that cleaning procedure again and then eventually, you seal the tooth off with a filling material, again, calcium hydroxide and some flexible plastic.

Now, here's the interesting thing. The way you diagnose that, is you look at an X-ray and you see there is a shadow at the tip of the root. What does that shadow mean? It means that where there was healthy tooth, there is puss and gangrenous tissue. So that's how we diagnose. Well, that's one of the ways we would diagnose the need for it.

Now if you have a well done root canal treatment, and by that I mean technically well done, not just getting people out of pain. Then what you do is 12 months later you take an X-ray and what's happened ideally, is the bone has regenerated. Now these people that say, "Let's remove all root canals," say, "You cannot sterilise a tooth. There's anaerobic bacteria inside a tooth that leeches into the blood and causes tumour necrosis factors and it's a problem that the only way to deal with it is to remove the tooth." 

Now I say to them this, “When you diagnosed the problem, there was infection at the tip of the root. Twelve months later after a root canal was well done, there's healthy, apparently healthy bone around the tooth. Has something positive occurred for bone to regenerate?” And the answer is an obvious one: yes. Yeah. And they go, "Well, you can't diagnose that by X-ray." But hang on. You used the X-ray to diagnose the problem.

Andrew: The pathology. Yeah, that's right.

Ron: So you can't have it both ways. So something positive has occurred. Is it perfect? Now that's the next question. Can we completely sterilise a tooth? And the answer is: no. No. What part of the mouth... I mean, you want to start getting into anaerobic bacteria? Let's look at the bottom of the periodontal pocket and let's say, "Okay. If we follow the same logic, if we have a periodontal pocket, should we be removing every tooth with a periodontal pocket?" And you might go, "Hey, listen. From a business perspective, that's a great idea." But, you know, it's a great business model.

Andrew: Yeah. From a health perspective, no.

Ron: From a health perspective, no. Now, does that mean we don't remove root canals in our surgery? Yes, we do. You know, you don't want to go to extreme lengths to save the tooth. Sometimes it's more important to save the patient. 

But, you know, but I think in our practice we take an approach that there's a hierarchy of treatments and we start from the least intervention to the most intervention. Because as soon as you remove a tooth, you either have to put an implant in and that creates an issue. I mean, are we putting titanium into a jaw bone? The costs involved. You know, the whole story there. Do we put a bridge on it? You know, there's a whole lot of...it's a complicated issue but it's not an issue that lends itself to a quick explanation. 

So in our practice, you know, there are lots of practitioners that say, "Ah, it's rubbish. If a root canal's well done, there's no problem at all.” We don't sit in that space. We acknowledge that even with a well done root canal, there can still be issues associated with that individual. But it's a complex issue, but it's one that we need to approach very conservatively with an open mind.

Andrew: I remember searching recently for issues about root canals and their long-term efficacy and I remember it stated something like 95% or 97% was actually successful over 10 years. And the issues were those people that had to have the job redone because of infection.

Ron: Yeah. Look, it's not as high as that, Andrew and I'm just about to publish an eBook on this very issue that deals with the more recent...it's not quite as high as that because root canals...I mean, you've got to ask “How do you define a successful root canal?” And I would say if there was an area of infection at the tip of the root that that has been completely resolved and there is no recurrence of that. 

But I'll give you an example. I had a patient who came to me for trigeminal neuralgia actually, and we kind of dealt with this very difficult problem, you know, with trigeminal neuralgia. But what I saw in her history was that she also had a chronic kidney infection and she'd been on the care of a urologist for 10 years. She was taking 3 antibiotic tablets a day for 10 years.

Andrew: Wow.

Ron: Every two weeks she was getting her kidney function tested and it had plateaued at around 65% to 70%. Now, this is just in the side story. I didn't go looking for this, right. But in my examination of her, I noticed that her lower incisor tooth had had a root canal treatment done and it had what's called an apicoectomy done which means you go in and do surgery to try and clear up that infection that hasn't resolved. And there was still infection around the tooth. 

And I said to her, "I think you need to have this tooth out." And I said, "And interestingly enough, and I'm certainly not promising this, but I've got an open mind and in Chinese medicine, this tooth lies on the kidney meridian." And I said, "But we're not removing it because of your kidneys. We're removing it because the tooth is infected and it needs to come out."

So we removed the tooth and we curetted out the area of infection, which is also very important to curette out the area. And she then went back to her urologist 2 weeks later and her kidney function had gone to 90%. And we sent her to an integrative doctor and with the help of the integrative doctor, she got off all antibiotics. Can you imagine what that did to her gut?

Andrew: Wow. Yeah.

Ron: But that's a whole story. Now, here's the other interesting part of it. She had a root canal also on her upper tooth which also coincidentally happened to lie on the kidney meridian, which I also found interesting but I didn't remove the tooth. And that was 15 years ago. And she's doing okay.

Andrew: Yeah.

Ron: So, you know, I've got a favourite expression, Andrew. I mean, I wish I was more dogmatic, you know. That would make life a lot more easy.

Andrew: Easier.

Ron: But one of my favourite bumper stickers is "My karma just ran over your dogma."

Andrew: Ron, I have to also ask you about the biocompatibility issue with dental materials. This has been a massive issue, ongoing for many, many years. Why are we not allowed to smoke in public places years before it's then accepted or you can be sued for it from a government level? Why are orthodox dentists already changing mercuric dental material for the more aesthetically pleasing resins years before there's an acceptance that there's an issue with the mercuric amalgams?

Ron: Well, you know, like I said, I came to this through my work with headaches and neck aches, so I really wasn't interested in this aspect of it. And I was working with a whole lot of health professionals in the mid-'80s and they said to me, "Ron, you've got to stop using dental mercury amalgam." And I said, "Look, it's locked in." You know, it's like saying sodium and chloride are a problem, individually. You know, if you had sodium in water, it'd explode and chlorine, you know, we don't want to have chlorine. But we see it and sprinkle it on our food. So there's a difference between a compound and an element. I had all the arguments for it. You see, I knew. And they said, "No, no. Read the literature." And this was in the mid-'80s. So I did. And we were taught and we were told that it was locked in. That was it.

And so I read the literature and I thought, "Well, hang on. There is something here." So the next 3 amalgam fillings that I actually happened to remove, that I knew from the surgery records were 5, 7, 10 years old, I sent off to the Australian Analytical Laboratory for testing. And at the time, the testing cost about 100 bucks each piece and, you know, I think we were only charging $30 or $40 for a filling at a time. And so they came back, and I knew that when they were placed, they were 50% mercury and some of these samples came back 37%, 42%, 43%. And I thought, "Hang on. There is something here." 

And so in 1985 I stopped using dental mercury amalgam and I started to read the literature and I did believe... And I felt that there were two separate issues here. One, should we still be using the material? The answer is definitely no. Two, should we be removing it from everybody? And the answer is probably not. You know, we...and there are some patients who come to see us that want to have their mercury amalgams out and we might do it. But invariably we find that 9 out of 10 of those fillings had some kind of micro leakage or recurrent decay around them because the science tells us the average life of a mercury filling is about 12 years. And a lot of people have had them in for a lot longer than that.

Andrew: A lot longer than that. So the issue is the life expectancy of the actual product, not so much the "toxicity" of the product, per se?

Ron: Precisely. I do believe there is an issue. There is an issue with toxicity. 

Andrew: Oh.

Ron: And the issue I believe is that, you know, mercury escapes from the filling. And it gets... And then people say, "Well, it's an inert mercury that escapes. It's inorganic mercury. Hg0.” But the problem is Hg0, as it does in the environment, goes through methylation when it comes into contact with bacteria of which there are a few in our bodies.

Andrew: Just a few.

Ron: And there are just a few. In fact, I think almost 10 times many more than cells but that's another story. So methylation does occur in the body and it does become bioavailable and it gets stored in the kidney, the liver and the brain. Now, if that was the only environmental toxin we were exposed to, you know, it's not great. It's there in our bodies all the time. It doesn't make sense. It's illogical. But I don't think we should be adding to the burden on an individual. Because in toxicity terms, it doesn't...it's not a linear relationship. One plus one does not equal two.

Andrew: Yeah.

Ron: One plus one might equal 5 or 10. So we want to minimise our patients’ exposure. And when...in 1991, when the world... So this was 1987. I stopped using mercury amalgam and I made it...we made a rule in our practice that we use rubber dam with every single filling we removed. Whether it was a small filling or a large filling, it didn't matter. We used dental dam and a nose piece so the patients wouldn't be exposed to...and that's just following NHMRC guidelines 2002.

Andrew: Right.

Ron: So that's not me being radical. That's just following NHMRC guidelines. So in 1991, for the first time ever, the World Health Organization included dental mercury amalgam in their list of mercury burden on the body. And not surprisingly, it's the biggest contributor. 

So I think...look, dental materials are a huge challenge. I mean, we've got to be putting something in the mouth that's moist, that's full of bacteria, that has to withstand 1,000 pounds per square inch of pressure, that gets subjected to 0 degrees ice and 55 degrees hot coffee or tea and all the temperatures in between. So it's a huge, you know, challenge to find a durable biocompatible material. And I think composite resins... Look, here's the thing, whenever a dentist says, "It's perfectly fine to use dental mercury amalgam." I say to them, "When you have a little bit left over, what do you do with the scrap?" And I know the answer to this.

Andrew: Yeah.

Ron: It's a rhetorical question because by law, it is illegal for the dentist to place that scrap of amalgam into the garbage, the toilet or the sink. It has to be disposed of as toxic waste. According to the authorities, the only safe place to put a dental mercury amalgam is in a human being.

Andrew: Yeah. Yeah.

Ron: I mean, and again, a lot of dentists will say, "This is just the biggest load of crock I have ever heard in my life." And I get that. I know where they're coming from. I used to be like that myself, but not for a long time. This is...I almost 40 years ago used to be like that.

So, you know, this is about tolerance of ambiguity and it’s about keeping open mind. This is how we started the conversation.

Andrew: That’s it. That’s exactly right. I want to quickly ask you a very last question, Ron, just before we go. You've written a book, "A Life Less Stressed"

Ron: Yes.

Andrew: Now, why did you write it? Was it because of professional issues, personal sort of enlightenment with your own life or was it because what you were seeing in your patients was happening again and again and again?

Ron: You know, Andrew, this has been going around in my head, because once you embark on a journey of kind of holistic if you like... I really wrote it for two or three reasons. One, I wanted to...it's a conversation I wish I could've had with every single patient I've ever seen, because it's what's been going in my mind and I've been interested in personally and professionally for almost, well, 35 years.

Andrew: Yeah.

Ron: So there was that. But the word holistic is much maligned. You know, we call ourselves a holistic dental centre and people have all sorts of weird ideas about what holistic means. I mean, you know, it's just the way the body works. It's the way the world works. It's not a new age philosophy. That's the way things are.

So thinking holistically is a good thing and I wanted to explore that a little more. And the other one was stress, because we've been using this five stressor model which says emotional, environmental, postural, nutritional and dental stress affects people's health. And while I don't...it doesn't have all of the answers, it's a great framework for asking all the right questions. And so it was a really cathartic experience for me at this point in my career to just put down what I had learned to this point. And of course, you know, so...already so much more to learn since I've written it.

Andrew: Well, you've learned a hell of a lot in your life and your career, Ron and I got to say I thank you so much for really exposing some of the myths and also enlightening us to some of the real issues that present in modern dentistry, and that you're seeing in your practice and in your patients. And, you know, with "A Life Less Stressed" helping them not just in their dentistry but also in their life/work balance. And so I've got to thank you for joining us on FX Medicine today.

Ron: Thanks for having me, Andrew.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.


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