Appropriate Pre- and Post-Extraction Protocols When Surgical Intervention is Necessary
The decision to pull a tooth is a very important and permanent one. It requires the active participation of the patient, the holistic physician/practitioner, and the biological dentist. If tooth extraction (or surgery of a former extraction site) is deemed necessary, individuals greatly enhance their chances of a positive outcome by adhering closely to pre- and post-cavitation surgery protocols.
A dental “focus” is defined as an area anywhere in the mouth— whether a tooth or an extraction site—that is chronically irritated and/ or infected. These “dental focal infections” can include impacted wisdom teeth, incompletely extracted wisdom (and other) teeth, failed root canals, failed dental implants, and devitalized teeth (from deep fillings, crowns or physical trauma). What makes chronic dental focal infections so particularly difficult to diagnose is their relative silence in the mouth. That is, in contrast to acute illnesses such as ear infections that can feel quite fiery and hot, typically dental foci “smolder” for years, manifesting only mild and intermittent symptoms of pain and swelling.
DENTAL FOCI AND DISTURBED FIELDS
However, what is not silent are the “disturbed fields” which these dental focal infections typically cause in the body. For example, although a left lower (number 17) impacted wisdom tooth may manifest no significant pain or inflammation locally, the patient may be quite aware of distal symptoms related to this site. Chronic left shoulder pain and/or intermittent heart pain and palpitations are classic signs and symptoms of the disturbed fields secondary to this chronic dental focal infection (Figure 1).
Note that these symptoms are also ipsilateral; that is, on the same side as the dental focus. If, for example, a patient complains of chronic right-sided symptoms such as writer’s cramp (wrist tendonitis), right hip or shoulder pain, and right sciatica, a knowledgeable doctor or practitioner would first want to rule out an ipsilateral—that is, right-sided—dental focal infection (Figure 2). This tendency of dental foci to cause ipsilateral disturbed fields is therefore an excellent diagnostic clue that can be used in helping to determine the primary cause of a patient’s particular chronic one-sided symptoms.
CONSERVATIVE BIOLOGICAL DENTISTRY
Good dentists do everything possible to try to save a tooth. They don’t recommend extraction—or even a root canal—until all other avenues of treatment have been exhausted. These can include ozone injections to try to heal infection in the tooth, laser treatments, isopathic remedies (Notatum 4X, Aspergillus 4x, etc.), and nutritional support (ubiquinol/CoQ10, crystal sulfur/MSM, Schuessler’s cell salts, original Quinton Marine Sea Plasma, etc.).
Additionally, both biological dentists and holistic physicians and practitioners endeavor to first adequately diagnose what’s wrong with the tooth (or socket) in order to determine the underlying problem. For example, if a patient is eating excessive sugar this could be the true cause of pain and inflammation manifesting in a first molar. This tooth has a reflexive relationship with the pancreas and stomach. By changing one’s diet (and nothing is more motivating than the thought of a root canal or the loss of a tooth) to a nutrient-dense one and avoiding refined sugar, along with supportive nutritional supplementation, the first molar can often be saved.
It should also be noted that it is essential in most cases to clear the teeth of any toxic dental materials such as mercury amalgam, and aluminum and nickel in conventional porcelain and gold crowns, before extracting teeth. Clearing the mouth of these heavy metals often removes a galvanic dental focus. This term refers to the intermittent pain or irritation (or no local symptoms) induced in a tooth from two different metals placed on or near a tooth.
DENTAL GALVANIC FOCI
Dental galvanism, or electrogalvanism, can even occur from just one amalgam filling since these fillings themselves are a mixture of mercury, silver, copper, tin and zinc. However, galvanic dental foci typically arise from a highly positively charged gold crown placed on or near a highly negatively charged mercury amalgam filling. When mercury makes contact with gold in the mouth, a galvanic cell or “dental battery” is formed, with a current running between the mercury (functioning as an anode) and the gold (functioning as a cathode). The resulting anodic corrosion of mercury in these dental batteries has been measured at ten to twenty times higher than corrosion in a single amalgam filling alone.
As previously described, these strong electrical currents that create a dental galvanic focus can be relatively asymptomatic locally, but refer pain to distal parts of the body (ipsilateral disturbed fields), or they can cause intermittent mild irritation or pain in the tooth itself and surrounding gums. Unfortunately many dentists misdiagnose galvanic pain and refer patients to endodontists for a root canal. This is very disturbing to see in a patient’s history since these galvanic foci could have been cleared conservatively by simply replacing the gold and mercury with metal-free alternative dental materials, and thus saving the tooth.
Therefore, if your dentist recommends a root canal for a sore or painful tooth, it is essential to get a second opinion. In fact, the ready recommendation of a root canal should be a red flag for any patient to seriously consider changing from a conventional dentist to a biological (holistic) one. Your health—and even your life—depend on it.
HIGH QUALITY X-RAYS ESSENTIAL
A periapical view, which is a specific x-ray of the root of the tooth in question, is essential to diagnosis. If there is a clear radiolucency at the root of the tooth; that is, a black circular area, this is an indication of a cavitation or hole in the jawbone. This area of chronic ischemia (lack of blood supply) and infection is referred to by various terms (osteonecrosis, osteomyelitis, NICO, etc.), but broadly speaking it is a dental focal infection. When there is an obvious radiolucency apparent on x-ray there is very little one can do to save the tooth, although some dentists have been able to reduce and even clear very small cavitation areas through ozone injections. However, in most cases, when the x-ray is positive, the decision whether to do a root canal or extract the tooth then needs to be made.
If the periapical view of the tooth is negative; that is, no black radiolucency or other signs are apparent, then the biological dentist and physician endeavor to do everything possible to save the tooth with holistic therapies and supplements. However, it is important to remember that x-rays are not always definitive in determining dental foci. In fact, radiological evidence of a bone cavitation area is not even visible until as much as thirty to fifty percent of the jawbone is destroyed.1 So if symptoms continue despite holistic care, further imaging studies may be appropriate such as a 3-D Cone Beam Scanner, which uses digital technology to record images, revealing much more than simple “flat” x-rays.
ROOT CANAL OR EXTRACTION?
The irreversible decision of whether to have a root canal or extraction should only be made when both the dentist and doctor have exhausted all conservative measures to try to reduce the infection and save the tooth. When these efforts have failed over time, the first decision a patient must face is whether to have a root canal procedure or to extract the tooth. Dr. Weston A. Price, the quintessential holistic physician, always weighed the state of the tooth against the health of the patient: “. . . all pulpless teeth, root filled or not, harbor so much danger of becoming infected that they should be extracted, though the time as to when they should be extracted will depend on several contributing factors. If the patient belongs to a family in which there is a low defense for streptococcal infection, it had better be soon. . . If the patient is in another group with a very high defense and not much danger of overloads, and if it is a tooth that is greatly needed by that patient, I would advise you to do what I do: retain some of those root filled teeth, because I believe they are of more value to the patient in the mouth than out.”2
Price’s counsel, delivered during a 1926 dental conference, still holds the weight of truth today. That is, most biological dentists and practitioners find that if a patient is in excellent health, he or she can handle the stress of a root canal tooth. However, it is important for this tooth, as well as any associated ipsilateral disturbed fields in the body, to be monitored over time. If at any point positive signs and symptoms arise, and the patient’s health is compromised, then the decision as to whether the root canal tooth should be extracted must be reevaluated.
In contrast, if a patient has suffered from chronically ill health for many years, then the decision of whether to extract a devitalized or root canal tooth is clearer. In these cases surgery is typically very appropriate. Or, for example, if a patient receives a grave diagnosis such as breast cancer, it is important that all root canal teeth anywhere in the mouth—but especially ipsilateral to the breast—be cleared in the face of this serious disease in order to try to save the patient (Figure 3).
However, even when it’s clear that a tooth can’t be saved, simple extractions can be as irresponsible and ineffective as when an untrained conventional dentist removes mercury amalgam fillings. What is required is a knowledgeable and skillful dentist and sufficient pre- and post-surgery treatment in a well-prepared patient. This type of surgery is termed “cavitation surgery.”
HISTORY OF CAVITATION SURGERY
Cavitation has a dual meaning. As previously described, a cavitation is a cavity or hole of infection in a bone. In surgical nomenclature however, cavitation surgery is the term for the dental surgical procedure that removes diseased bone from within this cavity so that new healthy bone can grow back.
G.V. Black, DDS, MD (1836-1915), known as the “Father of Cavitation Surgery,” treated many of these areas of chronic osteitis (bone inflammation) at the turn of the twentieth century. In his two-volume opus entitled Work on Operative Dentistry, Dr. Black characterized these cavitations in the jawbone as a progressive “death of bone” which was able to “soften the bone, often hollowing out the cancellous portions of large areas of bony tissue.”3 As described previously however, Black was amazed that even the larger jawbone cavitation areas full of necrotic (dead) debris could cause no visible redness, swelling or increase in patients’ temperature. However, when these bone cavitation lesions were “opened freely and every particle of softened bone removed until good sound bone forms…,” Black found that “. . . generally, the case makes a good recovery.”4 Thus, Dr. Black identified the serious pathological processes that are generated in infected teeth and bone, noted that these chronic dental focal infections were often relatively silent, and pioneered the cavitation surgery methods that are still being emulated today by trained biological dentists in the removal of these dental focal infections.
CHOOSING A BIOLOGICAL DENTIST
Biological dentists who specialize in cavitation surgery attend continuing education courses to learn how to most expertly extract devitalized teeth, as well as how to effectively clean out extraction sites that harbor infection from previously incorrectly extracted teeth. The primary cause of these jawbone cavitations in extraction sites is the failure of the conventional dentist or oral surgeon to remove all of the periodontal ligaments when pulling a tooth. These remaining periodontal ligament pieces later act as a barrier to the creation of new blood vessels and, therefore, to the regrowth of new bone. Dr. Hal Huggins likens the severity of this dental omission to the failure of removing the placenta (afterbirth) after delivering a baby: “Bone cells will naturally grow to connect with other bone cells after tooth removal—providing they can communicate with each other. If the periodontal ligament is left in the socket, however, bone cells look out and see the ligament, so they do not attempt to ‘heal’ by growing to find other bone cells.”5
In these incomplete extractions, approximately two to three millimeters of bone will superficially grow over the socket area, but beneath the bone a hole, or cavitation, will remain (Figure 4). As described previously, the term for the degeneration of bone in these cavitation areas, osteonecrosis, is defined as the death of tissue due to poor blood supply. Synonyms of osteonecrosis are inflammatory liquefaction, and, more familiarly, gangrene. Although this latter term may seem exaggerated since it conjures up ghastly images of partial amputations on the battlefield, for those of us who have witnessed a biological dentist spooning out oily black mushy bone from an osteonecrotic cavitation site, the term seems perfectly appropriate (Figure 5). Many dentists have this diseased tooth and bone tissues analyzed through pathology labs (contact Dr. Jerry Bouquot at (713) 500-4420, or email@example.com). In one clinical study of thirty-eight patients referred by me to Dr. Russ Borneman for cavitation surgery, one hundred percent showed positive histological (tissue-related) signs of ischemic osteonecrosis (bone death) and osteomyelitis (bone marrow infection), thus confirming the clear pathological tissue within these dental focal infections.6
It is essential to choose a well-trained and skillful dentist or oral surgeon to treat these ischemic cavitation sites. The best referral comes from your holistic doctor or practitioner if he or she is knowledgeable about dental focal infections. Referral from a family member, friend, or work colleague who has had success with a particular biological dentist can also be valuable. Additionally, going to the websites of the three major biological dental organizations in the U.S. can help further narrow down the decision-making process of choosing the right professional for this very specialized surgery. These organizations are: the International Academy of Biological Dentistry and Medicine (www.iabdm.org); the International Academy of Oral Medicine and Toxiciology (www.iaomt.org); and the Holistic Dental Association (www.holisticdental.org).
PRE- AND POST-SURGICAL PROTOCOL
Every biological dentist or oral surgeon has suggested procedures to follow before and after surgery. The following protocol is based on my experience over the past two decades preparing patients for surgery and treating them afterwards, and I hope can add to and support the biological dentist’s directions. With this protocol, along with carefully diagnosing for whom, as well as when, cavitation surgery is appropriate, and most important, the skill of a well-trained dentist or oral surgeon, I have had a ninety-nine percent success record since 1996.
In the majority of cases it is best to clear the mouth of heavy metals before cavitation surgery. In fact, this may even obviate surgery in some individuals who have galvanic-induced dental foci as described previously. Additionally, patients with non-toxic dental restorations heal much better from surgery than those with toxic metals in their mouth. In contrast however, mercury removal is often contraindicated in cancer patients (until the tumors are cleared and lab tests negative), whereas cavitation surgery to remove the root canals and other devitalized teeth can be clearly indicated, tolerated well, and even life-saving in this population of patients.
It is also important that liver detoxification pathways and kidney clearance functions are as optimal as possible. A simple Comprehensive Wellness Profile (CWP) from Direct Labs (www.directlabs.com) is a very affordable (over $500 worth of tests for only $97) and easy blood test to run to determine the functioning of these, as well as other organs and systems, in the body. Of course, a complete history and exam should also be performed by the holistic doctor or practitioner and the biological dentist to further assist in making the decision if the patient is healthy enough to undergo dental surgery.
If an individual is very ill, it is often necessary to have this patient on his or her deepest homeopathic constitutional remedy for at least a month or two in advance, in order to facilitate immune, metabolic, and nervous system functioning before surgery. The new Sankaran sensation method of constitutional homeopathy is the single most curative modality known by this author to achieve health, and thus prepare an individual for a successful surgical outcome.
Another important assessment to make before surgery is to determine whether the patient has a major tonsil focus. Chronic tonsil focal infections and chronic dental focal infections feed into each other and further infect each other. Patients with a chronic tonsil focus who want to have their wisdom tooth cavitation sites treated, for example, often don’t heal well. This observation was made in the 1920s by Dr. Henry Cotton (1876-1933), a brilliant, if controversial, psychiatrist who specialized in researching the effect of focal infections in the onset of mental illness. In his book, The Defective, Delinquent, and Insane, Cotton asserted that in most cases the wisdom teeth were not infected because they were impacted but were impacted because they were infected, and that this “infection is transmitted from the tonsils.”7 Before these suspected primary tonsil focus patients have dental surgery therefore, it is important to reduce the tonsil focus through avoiding commercial pasteurized dairy (the typical allergy food that causes chronic upper respiratory infections and the tonsillitis in childhood that eventually coalesces to a more hidden chronic tonsil focal infection later in life), rubbing Notatum 4X drops over the tonsils on the upper anterior neck area, and to be on their constitutional homeopathic remedy according to the new Sankaran system.
Finally, vegans, and even many lacto-ovovegetarians typically do not consume enough protein to heal tissue, and thus, the surgical site, adequately. Lacto-ovo-vegetarians often become sensitive to the over-ingestion of eggs and dairy foods over the years, which greatly reduces their absorption of these normally utilizable protein foods. Lab tests and energetic testing can determine if a patient is deficient in protein, and if so, the encouragement of eating more eggs and dairy (if there is no allergy) as well as meat broths if the patient is willing, is often needed for at least one to two months in order to have a successful surgical outcome.
THE FIVE HEALING DAYS
It is imperative for patients to take at least three days off after surgery, but the most optimal protocol is to take the day of, plus the following four days off, a time period I have labeled as the “Five Cavitation Surgery Healing Days.” Patients should plan to rest and avoid any strenuous physical activity during this time. In fact, any exercise (except slow and short walks) or vibration from extensive car and plane travel can delay, and even block, healing of the surgery site.
This rest and healing time is significant because if a “dry socket” forms from the invasion of bacteria in the area between the blood clot and the bone and the blood clot is lost, the surgery almost always must be redone at some later point. Dry socket is signaled by significant pain in the surgical site or the ipsilateral ear, and typically a foul odor. The standard treatment of antibiotics often does little because there is no blood flow in the area, and eugenol from the oil of cloves may actually further impair healing of the site. I typically recommend more Notatum 4X drops and laser treatments, as well as a castor oil pack on the suspected disturbed field (stomach, small intestine, liver, etc.) in the body. The best course of action though is for patients to take five full days off and follow this protocol carefully in order to allow complete healing of the site, and therefore only have to undergo this cavitation surgery procedure once.
Figure 5 – Necrotic bone on left, healthy bone on right.
The use of a therapeutic laser (830 nanometers and 100 milliwatts) is so effective during these five days in healing the inflamed nerves and soft (gums) and hard (bone) tissues, that it has become a sine qua non in my post-surgical protocol (available from firstname.lastname@example.org). Patients rent this laser so they can use it in the comfort of their own home, treating the surgical site for one minute at a time, anywhere from six to ten times a day. This laser is so healing to tissue that it often obviates the need for any pain medication, or at the least, considerably reduces the amount of pain pills needed.
Isopathic drops such as Notatum 4x and Aspergillus 4x (www.bioresource.com) are especially helpful post-surgically to augment healing in the site. Further, they can be dropped onto the surgical site at a protocol of two to three drops, three times a day during these five days, and then one or two times a day for one week afterward. When the laser is next applied over the site, these isopathic drops are then photophoretically driven into the surgical site for even deeper healing.
Acute homeopathic remedies are also an important component in this protocol. Arnica montana 30C is most commonly prescribed to reduce pain and heal the bruising post-surgery at a dose of two pellets, three times a day, for five days, and then once a week thereafter. If the surgery was very deep and there is a chance that the maxillary (upper jaw) or mandibular (lower jaw) trigeminal nerve was injured, Hypericum perforatum 30C should also be taken at a different time of the day, but at a similar dosage schedule as the Arnica. If the surgery was particularly extensive and intense, patients may want to take the stronger 200C potency of both of these remedies. However, for those individuals who are already on their constitutional homeopathic remedy, usually redosing this remedy one to two times after surgery is all that is required.
One to two vials of the mineral-rich Quinton Marine Sea Plasma (www.originalquinton.com) taken daily after surgery further ensures healing of the gums, jawbone, and neighboring teeth during these five days. Patients should hold the contents of each vial in the mouth for approximately a minute or more before swallowing.
Finally, nutrient-dense bone broths are essential during these five recovery days. A clear broth from grass-fed organic beef, chicken, turkey, lamb, or from wild fish is especially important the first two days when the surgical incision has not fully closed and you don’t want any food particles to get lodged in there. Later you can purée vegetables (carrots, squash, turnips, onions, kale, etc.) to make a thicker soup to stave off hunger and supply more needed vitamins and antioxidants for further healing of tissues.
POST-SURGERY OFFICE VISIT
Besides the post-surgery dental visit to check on healing of the site and to remove any stitches, it is important for the patient to also see a doctor or practitioner knowledgeable in focal infections. At that visit the surgical site is checked, any neighboring autonomic ganglia (groups of nerve areas that can hold bacteria and other toxins transported from nearby ipsilateral dental foci) are treated, and any related disturbed fields caused by the focal tooth (or extraction site) are addressed if necessary. This clean up of all the areas in the body disturbed or infiltrated by infection from the chronic focal infection ensures more complete healing of the site, with no reflex “back flow,” or re-introduction of toxins or microbes, back into the dental focal area.
It is important that the decision whether to sacrifice a tooth or repeat surgery of an incompletely extracted site be made by the team of a doctor or practitioner knowledgeable about focal infections, a skillful and experienced biological dentist, and an informed patient. Appropriate pre- and post-surgery protocols can ensure a successful outcome and complete healing of the surgical site. For more information on diagnosing and treating dental focal infections please refer to my book, Radical Medicine (www.radicalmedicine.com).
1. J. Bouquot, In Review of NICO (Neuralgia-Inducing Cavitational Osteonecrosis), G. V. Black’s Forgotten Disease, 3rd ed. (Morgantown, WV: The Maxillofacial Center, 1995, p.3.
2. A. Nichols, The Virulence and Classification of Streptococci Isolated from Apical Infections,” The Journal of the American Dental Association, 13 (1926), p. 1227.
3. A. Black, G. V. Black’s Work on Operative Dentistry, vol. 1 (Chicago: Medico-Dental Publishing Company, 1936), p. 4.
5. H. Huggins, It’s All in Your Head (Garden City Park, NY: Avery Publishing Group, Inc., 1993), p. 46.
6. R. Borneman and L. Williams. “Histological Signs of Dental Ischemic Necrosis and Oteomyelitis Correlated with Clinical and Kinesiological Testing Indicators” (unpublished research findings from the Head and Neck Diagnostics of America Laboratory, Seattle, 1995-96).
7. H. Cotton, The Defective, Delinquent, and Insane (New York: Arno Press, 1980 [orig. pub. 1921]), p. 46.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Winter 2011.