There are many different dental procedures, but the root canal procedure is one of the most common ones. A large number of adults have gone through it at some point. Does this mean root canals are something we should take for granted? One dentist focused on this question and came to his own conclusions.
Dr. Robert Kulacz shared his views in the best-selling book The Toxic Tooth: How a Root Canal Could Be Making You Sick. The book addresses this dilemma and offers a different perspective on the issue. It is important to say at the start that his opinion is a minority one, and that major dental organizations consider root canal treatment safe.
Dr. Robert Kulacz worked as an associate for 6 years before starting his own dental practice in New York in 1992. Just like almost all other dentists, he performed typical dental procedures, including root canals.
He did dozens of root canals before he heard an interesting story from a patient. The patient said he had heard a doctor claim that root canals might be associated with different diseases.
At first, Dr. Kulacz was surprised and rejected these claims as ridiculous. However, the patient gave him website addresses from different organizations, including the IAOMT – the International Academy of Oral Medicine and Toxicology.
Dr. Kulacz opened these websites and read about the topic because he wanted to show the patient that he was wrong and that the American Dental Association knew what it was doing.
But he found something he did not expect. He read articles and papers by doctors and dentists such as Weston Price and even went to an IAOMT conference. He listened to Dr. Boyd Haley’s theory about root canals, changed his mind, and stopped performing them.
Informed Consent about the Root Canal Procedure: Why Is It Important?
Dr. Robert Kulacz decided to stop doing root canals back in 1995. Interestingly, he is not in favor of banning this procedure, but he points out that informed consent is important.
According to the ADA (American Dental Association), a root canal is a safe procedure and there is no valid evidence linking it to systemic diseases. Dr. Kulacz and a number of other doctors and dentists disagree with this position.
He believes that patients should be told about his concerns: that, in his view, some bacteria may remain in a root canal tooth, that bacteria may reach other parts of the body, and that bacteria living in the tooth and in the bone close to it may release toxins. With this information, he says, patients can make a sound decision.
Most dentists are confident that cleaning, irrigating, and instrumenting the root canal removes the bacteria well enough for the tooth to stay healthy. Dr. Kulacz argues that the area can never be made fully sterile.
The Concerns Dr. Kulacz Raises about Root Canals
According to Dr. Kulacz and dentists who share his view, a biopsy of a root canal tooth will often show leftover necrotic debris in the canal. In their opinion, this means the tooth is not completely clean, and they believe the situation can be similar in the surrounding bone.
The ADA, on the other hand, explains that any bacteria left after the root canal procedure are sealed inside the tooth. Dr. Kulacz questions this. The filling material used to seal the canal, known as gutta-percha, may not reach the small lateral canals that branch off from the main canal. Because of that, he believes some leakage is possible.
He also argues that even a well-sealed root canal may not keep in the very small toxin molecules produced by trapped bacteria.
Most of the tooth structure is made of dentinal tubules. These are tiny hollow structures that run outward from the main canal. It is often said that if the tubules of a single tooth were laid end to end, they would form a line about three miles long.
According to Dr. Kulacz, these tubules are a place where bacteria can stay out of reach of cleaning. He describes the tooth as porous, a bit like a sponge.
Dr. Kulacz says that if teeth had a solid structure, similar to metal, with no side branches, dentists could clean the main canal easily and seal it perfectly. That is not the case. Still, he notes that this doesn’t mean every root canal tooth leads to an infection or to illness. In his view, it depends on the specific type of bacteria present, the toxins they release, and the state of the person’s immune system.
Millions of root canals are completed every year, by some estimates up to 30 million. Dr. Kulacz believes that, with numbers this large, at least some of these teeth may be causing problems. The great majority of treated teeth, however, last for many years without complications.
The Debate about Oral Bacteria and Other Health Conditions
Dr. Kulacz believes that root canal teeth can carry chronic low-grade infections, and that these may make other health issues worse, heart disease for example. The ADA maintains that there is no valid evidence that root canal teeth cause disease elsewhere in the body, but some doctors and dentists do not accept this position.
Heart disease is generally understood to start with damage to the inner lining of the blood vessels. Cholesterol and immune cells called macrophages then build up in the artery wall and form plaque.
Inflammation can cause this plaque to rupture inside the blood vessel, which may lead to a blood clot and eventually to a heart attack. Some studies have compared bacterial DNA found in the arterial plaque and blood clots of heart attack patients with the DNA of bacteria in the mouth.
These studies reported that some of the bacteria found in the mouth, including those linked to gum disease, were also detected in plaques and blood clots in the coronary arteries.
This suggests that oral bacteria can travel from the mouth to other parts of the body. According to Dr. Kulacz, the same bacteria have also been found in the fluid around the heart.
Dr. Kulacz sees these findings as support for a connection between oral infection and cardiovascular issues. Researchers continue to study the link between oral health and heart health, and an association of this kind does not prove that one causes the other. What most experts agree on is that good oral hygiene matters for general health.
Why Dr. Kulacz Believes the Problem Can Grow over Time
Because the inside of a root canal tooth no longer has a blood supply, Dr. Kulacz argues that any bacteria remaining there are out of reach of the immune system. In his view, an infection in such a tooth can become worse after some time.
He also points to studies suggesting that some bacteria found in root canals can resist the white blood cells that would normally attack them. According to him, bacteria may stay protected from the immune system by:
- Immobilizing white blood cells and antibodies
- Mimicking the body’s own harmless bacteria, which are not targeted by white blood cells (bacterial mimicry)
- Creating sticky biofilms
Making the Right Decision
What you should know is that cavities and infected teeth are closely associated with diet. Eating too much sugar is one of the main problems.
A poor diet can also affect the immune system, and when it is weak, bacteria may cause more damage. But is it a good idea to remove all root canal teeth? Dr. Kulacz disagrees.
He says people should not reject modern dentistry just because they question one part of it. Claiming that the removal of root canal teeth will protect you from diseases is not true. The key is to achieve balance.
So, if you are planning to have a root canal procedure, talk openly with your dentist, ask about the benefits, the possible risks, and the alternatives, consider your personal situation, and then make a decision together. Do not delay care for an infected or painful tooth, because an untreated dental infection can become serious.
Ozone Therapy
One alternative that some dentists offer before a root canal is ozone therapy. It is usually done with a syringe at the base of the tooth, and it normally takes a few visits to the dental office. Supporters say that ozone acts against infectious material, although the evidence for it is still limited.
Some dentists report that they were able to avoid a root canal with this therapy. However, if the pulp tissue has already been badly damaged by the infection, ozone is not expected to work. If you are interested in this option, ask your dentist whether it is suitable for you.
If you and your dentist decide on a tooth extraction instead of a root canal, there are a few different ways to restore the missing tooth. The most affordable and most popular option is a partial denture, or removable appliance. The only downside is that you have to take it out at night and clean it regularly. This is an almost non-invasive option for missing teeth.
Another popular but more costly option is a bridge. The teeth next to the gap are carefully prepared for crowns, and the replacement tooth is attached to them. This is a permanent restoration. It has one disadvantage – the dentist has to remove healthy enamel from the adjacent teeth, which can increase the risk of dental problems in the future.
Dental Implants as an Option
The last option in cases like this is a dental implant. Here, a screw is placed directly into the jaw bone. After three to six months, once the dentist is sure that it provides a safe base, a tooth is made on top of the implant. The implant acts as a root and the crown acts as a tooth. This is a well-established option, but it comes with certain downsides too.
To start with, a titanium implant means placing a piece of metal in the jaw bone. Dr. Kulacz says this can lead to a “battery” or galvanic response if you have other metals in your mouth, and that some patients may experience sensitivity or an allergic reaction. Such reactions are considered uncommon.
If you are thinking about a titanium implant and you are sensitive to metals, tell your dentist. You can ask about allergy testing for the metals found in the implant, and people with a known metal sensitivity may want to discuss other options.
Zirconium Implants
Some dentists, including Dr. Kulacz, prefer zirconia (zirconium) implants because they do not release the metallic ions associated with titanium implants.
However, if an implant is placed in bone where a root canal tooth used to be, and the area was not cleaned completely and thoroughly, there is a chance that the bone is still infected. In other words, the implant would be placed in infected bone, which is not a good starting point.
According to Dr. Kulacz, when dentists remove a root canal tooth, they should also remove the periodontal ligament (the small sling that keeps the tooth attached to the jawbone), a small part of the bone around the area, and the socket bone or lamina dura (the support of the existing tooth). This is done with a special round, slow-speed bur, together with irrigation and sterile closure. In his view, this is the best way to protect the health of the bone.
When this is done properly, he says, the infected tissue is cleared away and the jaw bone gets a good blood supply, which supports recovery. The result should be healthy bone that is free of infection.
That is a good place to put an implant. To check for traces of possible residual infection, a dentist can send tissue for biopsy and bacterial cultures. The results usually come back fairly quickly, and there is no need to rush the decision.
A Problem Related to Dental Implants
Another common issue related to dental implants is gum disease. Inflammation or infection in the gums around an implant can be as troublesome as inflammation or infection around a tooth or in the jaw bone. Natural, healthy teeth come with a barrier that helps protect the surrounding bone from bacteria.
According to studies, this barrier is made of fibers from the gum. These fibers attach to the root and the bone, which helps protect the bone area from bacteria. Dental implants cannot form the same kind of barrier. What they get instead is a tight cuff of gum tissue that forms around the post holding the crown in place.
To keep this tissue in good shape, patients need to maintain excellent oral hygiene. This helps protect them from inflammation, which can loosen the tissue around the implant. If you have gum disease and you are not cleaning the implant post properly, the problem may progress faster than it would around natural teeth. So, if you have a dental implant, good oral hygiene and regular dental check-ups are essential.
Dr. Kulacz’s View on Non-Vital Teeth
A root canal tooth no longer has living pulp inside it. Dr. Kulacz describes it as non-living tissue that, in his opinion, should not stay in the mouth. He compares it to appendicitis: surgeons do not seal an inflamed appendix inside the body and leave it there – they remove it. He questions why dentistry takes a different approach with root canal teeth. Most dentists do not accept this comparison and point out that saving the natural tooth is usually the preferred option.
Dr. Kulacz says that some patients who visited him reported feeling better after their infected root canal teeth were extracted and the area had time to recover. These are individual reports and not proof that the extraction was the reason. He also refers to the early 20th-century work of Dr. Weston Price, who reported reproducing human diseases in lab rabbits by placing extracted human root canal teeth under their skin.
The American Dental Association does not accept Dr. Price’s work. It explains that his experiments were poorly controlled, used unrealistic amounts of bacteria, and that later research was not able to reproduce his results. Dr. Kulacz disagrees and maintains that Dr. Price used an adequate amount of bacteria and a single root canal tooth.
He believes that the same results would be seen if the experiments were repeated today, and he says he did not receive an answer when he emailed to ask for the record of the later study. The disagreement between the two sides remains open, which is one more reason to discuss any concerns directly with your own dentist.
Source Weston A. Price
Image Source Bristol Medical Centre
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always talk to your doctor about any health concern.