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This article may be reprinted free of charge provided 1) that there is clear attribution to the Orthomolecular Medicine News Service, and 2) that both the OMNS free subscription link http://orthomolecular.org/subscribe.html and also the OMNS archive link http://orthomolecular.org/resources/omns/index.shtml are included. FOR IMMEDIATE RELEASE
Root Canals Cause Breast Cancer-Frequently
Commentary by Thomas E. Levy, MD, JDOMNS (December 17, 2023) Breast cancer causes enormous morbidity and mortality around the world, and its traditional treatment, along with the relentless progression of the disease, greatly impacts the quality of life for both patients and their families. This cancer basically targets just women, as only a relatively minimal number of cases occur in men (roughly 1%). [1] Yet, despite its predilection for women, breast cancer is still the most common of malignancies (aside from non-melanoma skin cancers) statistically in the overall population. It continues to be the leading cause of cancer deaths across the planet. [2] Redox Biology and ToxinsReduction and oxidation basically refer to the movement of electrons between molecules. When a normal biomolecule with a normal electron content is depleted of one or more electrons, it becomes oxidized. And when that oxidized biomolecule can regain the lost electron(s), it returns to a normal, reduced chemical state. A reduced biomolecule functions normally, while an oxidized biomolecule either partially or completely loses its normal chemical/biological function. More oxidized biomolecules result in the accumulation of largely metabolically inert agents that only occupy space, interfering with normal chemical reactions and no longer directly supporting normal biological function. Examples of biomolecules include sugars, fats, proteins, enzymes, nucleic acids, and structural molecules. Redox (reduction-oxidation) biology is based on the concept that all biological health is directly due to the degree of reduction versus oxidation in the biomolecules throughout the body. Higher reduction/oxidation ratios indicate good cellular health. This has led to the frequent use of the term "oxidative stress" as the premier biomarker and measuring stick of all disease. Widely discussed in the medical and scientific literature, increased oxidative stress, or the excess presence of oxidized biomolecules, is always the primary pathophysiology of any disease under consideration. [3,4] It is characterized by a relatively low antioxidant presence and/or an increased pro-oxidant presence. At the cellular level, all diseases or medical conditions have increased oxidative stress in the cells of the affected organs or tissues. The extracellular areas are often involved as well. As pathology cannot exist in the absence of excess oxidation, there are no exceptions to this premise. All toxins damage by directly or indirectly causing the oxidation of important biomolecules. Oxidation is the chemical process of giving up, or losing, one or more electrons to an electron-robbing toxin (pro-oxidant) that never surrenders that electron back to an oxidized biomolecule once it is acquired. Unless an agent results in the oxidation of biomolecules in the body along with the permanent retention of the electrons it has taken, it is not toxic, and it cannot be toxic. Clinical toxicity and any symptoms of toxicity cannot exist in the absence of excess oxidized biomolecules. As excess oxidation is the basis of all disease, it logically follows that all cancers, either in the breast or elsewhere, result from excessively and chronically elevated oxidative stress at the affected tissue site. This elevated oxidative stress is always secondary to electron-depleted toxins, also known as pro-oxidants, poisons, free radicals, reactive oxygen species, or oxidizing agents. This leads to the following two questions:
Breast Cancer PathophysiologyAll chronic degenerative diseases, including cancer, only arise when an area of affected tissue becomes substantially inflamed and remains that way. Phrased differently, the areas in the body that have exceptionally increased and chronic oxidative stress are the areas where malignant transformation eventually takes place. Lesser degrees of increased oxidative stress, depending on their location, underlie the development and maintenance of all non-malignant diseases as well. But the highest chronic elevations of oxidative stress, both intracellularly and extracellularly, are the reasons for the initiation and evolution of cancerous growth. No cancer has ever developed in an area that was not already inflamed. While a cancer can metastatically seed abnormal cells in a previously normal tissue site, the primary cancer focus will never be initiated in normal, uninflamed tissue. A prolonged and sizeable presence of toxins always precedes the development of cancer in the affected areas of the breast. These toxins are produced by slow-growing pathogens (colonizations), and the pathogens themselves will often be found at the cancer site as well. But toxins (highly pro-oxidant molecules) must always be present in order to provoke and sustain a state of chronic inflammation and excess oxidation. The amount of time that such a toxin/pathogen accumulation needs to be present before a cancer develops is highly variable. Some women with exceptionally strong immune systems, high antioxidant intake, and a relatively lesser degree of toxin/pathogen presence may never demonstrate malignant transformation. Of note, benign breast lumps and other forms of breast pathology result from lesser degrees of toxin exposure. No pathology of any kind can develop when a tissue has intracellular and extracellular levels of oxidation that are physiological in degree (from normal metabolism). Only increased levels of oxidation can result in pathology. And only extremely increased levels of oxidation result in the appearance of cancer. In addition to a blood circulation, the body has a lymphatic circulation as well. This circulation moves lymph, the plasma-like extracellular fluid bathing the cells throughout the body, into the venous blood circulation. Under normal circumstances, this lymph flow is one-way only in the direction needed to reach the blood. [5] The primary role of the lymphatic circulation is to provide an outlet for cellular waste products, excess water, and toxins, as well as to support an immune defense against pathogens. [6] It also periodically condenses into focal bodies known as the lymph nodes. These lymph nodes, of which there are about 500 to 600 in the body, work to concentrate B- and T-lymphocytes needed to combat the infectious agents that are encountered, such that the lymph itself is rendered sterile by the time it leaves the lymph nodes and reaches the blood. [7,8] When draining a large enough source of infection, such lymph nodes will readily enlarge and become sore where they can be felt (palpated), such as in the neck, armpits, or groin areas. Once the processed lymph finally reaches the blood circulation, multiple ways of metabolizing and excreting the remaining non-infective extracellular debris are then available. The breasts have an extensive lymphatic circulation, and much of its lymph comes from drainage of the head and neck. A portion of the breast lymph subsequently flows into a large collecting vessel (thoracic duct), which then empties into the venous circulation. The rest of it first flows into the extensive lymphatic network in the armpits before eventually reaching the thoracic duct and the blood. The lymphatic vessels have a limited ability to contract and promote a one-way flow of lymph. [9] However, this lymphatic movement can be slowed, stopped, or even reversed in direction by the presence of sufficient inflammation and structural damage in the tissue being drained. When there is sufficient impairment of normal lymphatic flow, tissue swelling (lymphedema) can result. In the breast, this impairment of lymphatic drainage can result from either the chronic inflammation in the cancerous tissue, or much more commonly, following the surgical removal of cancer-laden axillary lymph nodes draining the breast. [10,11] The fewer draining lymphatic pathways available, the more likely lymph flow will slow enough to accumulate. Together, both situations result in about 20% of women with breast cancer eventually developing arm swelling due to the back-up of lymph. [12,13] As with tissues elsewhere in the body, the lymphatic system also drains the superficial gum tissue, the deep gum tissue (periodontium), the teeth, and the tonsils. This drainage largely follows gravity and is filtered in the lymphatic vasculature in the floor of the mouth and then the neck. From there much of the drainage proceeds further down into the rich network of lymphatic vessels in the chest and the breasts, with most of the breast lymph then draining directly into the armpits. [14-16] Deep periodontal infection (periodontitis) has been "linked" to many different cancers, including the breast. Of significant note, Maintenance of periodontal health has been found to be effective in the primary prevention of breast cancer. This indicates that periodontal infection has a cause-and-effect relationship to breast cancer, not just a link, association, or correlation. [17] Left unresolved, periodontitis seeds pathogens and their associated toxins throughout the body. To assert that disease occurring after such typical oral pathogens start growing in different tissues is some ill-defined "association" and not a straightforward cause-and-effect relationship defies simple logic. Aside from breast disease and breast cancer, chronically infected gums have been significantly linked to nearly all diseases and conditions. Some studies also document improvement of the "linked" disease with effective periodontitis treatment, as well as a worsening of the disease as periodontitis progresses. This further indicates that periodontitis has a cause-and-effect with most chronic diseases. These diseases and conditions include the following:
The data above on chronic disease and periodontal infection is vital to understanding the impact of root canals and other infected teeth on the general health. Because the pathogens found in infected teeth only come from deep gum infections (except when large cavities allow the pulp to become infected from above), the infections found around the root tips of affected teeth have the same infectious profile as is found in periodontitis. However, the infected teeth, which include all root canal-treated teeth, are even more disease-causing than the infected gums, since they also have the additional following characteristics:
The release of highly pathogenic bacteria into the blood during a root canal procedure has been clearly documented. Of note, their release occurs in the absence of any chewing pressure that would further promote pathogen release. [123,124] Traditional dentists and endodontists (root canal specialists) somehow deny and/or blind themselves to the massive documentation that all root canals are infected. Instead, they collectively maintain that a successful root canal procedure leaves the tooth infection-free just because a root tip abscess was reduced in size and the pain associated with the acute abscess was relieved. Nevertheless, all the research on the impact of periodontitis and abscessed teeth on all chronic disease applies to all root canals as well, regardless of how well they were performed technically. Although less extensively studied than the relation of just periodontitis with chronic diseases, a great deal of research has also established a link between chronically abscessed teeth (CAP-chronic apical periodontitis) and many different diseases. CAP simply means an extension of and a more advanced form of deep gum inflammation and infection (periodontitis), with root tip abscesses seen on imaging. Significant research studies have documented this abscessed tooth-chronic disease link, which includes all root canals that have resulted in the reduction of root tip abscesses on imaging studies. These studies directly mirror the many studies on early periodontitis and chronic diseases cited above and include the following:
While other factors may be involved, it appears likely that men have virtually no breast cancer because the amount of breast tissue is so much smaller than in women, and there is much less toxic and infected lymph from oral cavity infections getting continually filtered in that tissue. And even though there is a large difference in the average amount of breast tissue between men and women, the lymphatic drainage patterns are largely the same. [170] Also, larger and denser breasts, along with overly constrictive bras and clothing, can all impede the rate at which lymph can be conducted through the breasts. Anything that slows lymphatic flow, especially if it has a significant toxin/pathogen content, will be a factor in determining whether significant inflammation is allowed to take hold in an area of the breast draining the lymph from the oral cavity. Consistent with this concept, studies have shown that very large-breasted women who undergo breast reduction surgery lower their chances of breast cancer. [171] Furthermore, it has been shown that women with larger breasts fare worse with breast cancer than women with smaller breasts. [172] Root Canal-Treated TeethThe root canal procedure is one of the most common dental procedures. A meta-analysis revealed that more than half of the subjects in the populations studied had at least one root canal. [173] A very large review and meta-analysis also found that at least half of the population has at least one abscessed tooth. [174] When combined with the prevalence of abscessed teeth that have not received a root canal treatment, the prevalence of infected teeth runs between 55% and 70% of the subjects in the studies. [175-180] Depending on the information source, between 25 and 45 million root canal procedures are performed in the United States every year. Even the low side of the estimate means that a significant majority of adults are always chewing on one or more infected teeth. Another study found that over 60% of people in Europe had abscessed teeth, with the prevalence steadily increasing with age. [181] Furthermore, fully 25% of teeth that have had procedures other than root canal treatments end up chronically abscessed as well. [182] Root canal-treated teeth are generally performed when a patient presents with a painful, acutely-abscessed tooth. The "successful" root canal procedure results in a tooth that no longer hurts, resulting in a happy patient and satisfied dentist, at least for the moment. However, the infection remains as long as the tooth remains unextracted, or when the socket infection remains is not completely cleaned out after extraction. There is an enormous variety and a large total number of different pathogens and other microbes found in and around the root tips of root canal-treated teeth. Fungi, viruses, protozoa and over 460 different types of bacteria have been identified in these infections. [183] No two root canals have the same assortment of indwelling pathogens, and this is why no two root canals inflict the same degree of infectious/toxic damage to the body. Nevertheless, even the "least toxic" root canals can wreak havoc throughout the body. The physiological core of the tooth, known as the pulp, contains the nerves, blood vessels, and connective tissue matrix that keep the tooth alive and viable. Once this pulp has become infected, there is no way to eradicate the infection and restore the pulp to its normal, health-supporting state. Instead, the removal of the pulp by the root canal procedure permanently prevents immune system access to the pathogens in the tooth, especially in the miles of dentinal tubules extending away from the pulp throughout the tooth structure. Without immune support, no infection can be resolved. Furthermore, even without the root canal procedure, the infected pulp quickly destroys the pulp structure itself, just leaving a collection of pus and dead (necrotic) cells that can never be returned to normal. Even though pain can still be felt in the root tips embedded in the jawbone, the upper part of the tooth and the pulp is simply a non-vital shell. In order to stop the immediate infection-causing pain and remove much of the bulk (but never all) of the infection, the root canal procedure drills and routs out as much of the pulp as can be reached, after which it is filled in with an agent to maintain the overall tooth structure. The ends of the pulp space extend to the tooth root tips embedded in the jawbone, and the pulp infection and its necrotic debris effectively "collects" there. This results in well-defined abscesses surrounding the root tips. Chronically infected teeth will usually be found to have clearly visible evidence of this pathology at the root tips. On X-ray or on computed tomography studies variably-sized abscesses will nearly always be seen, appearing as dark areas, or radiolucencies, surrounding the root tips. Rarely, the infected tooth might not contain enough infected debris to be visible in an imaging study, but the lack of an identifiable abscess does not mean the infection is still not there. When a root canal procedure has been performed with optimal expertise, much of the associated root tip abscess will be removed (debulked), and follow-up imaging will no longer easily detect it. However, this does not mean the infection is gone, only that it has been effectively drained. Pathogens and their toxins are still readily expressed into the blood and lymph, especially during chewing. Dr. Boyd Haley conclusively proved that all root canals produce and collect toxins. He devised a test using a process called nucleotide photo affinity labeling to measure the impact of the pathogen-generated toxins in extracted root canal-treated teeth on five key human enzymes. After studying over 5,000 consecutive extracted root canal-treated teeth sent to him from around the country, the results were stunning. ALL tested teeth had significant toxin content. Differences in the degree of toxicity among the teeth were seen, but none were toxin-free. Such variability in toxicity is to be expected, as no two root canals have the same pathogen population. [184] Furthermore, normal teeth extracted for orthodontic purposes never demonstrated any toxicity, even to a minor degree, ruling out "mouth contamination" as a potential reason for the results. Of note, Dr. Haley found similar toxin profiles in the specimens sent to him from cavitation surgery. Cavitations occur when chronic infection remains in the healed-over sockets of extracted teeth. [185] Cavitations have a comparable connection to chronic diseases, including breast cancer, although it is much less extensively studied than the relation between abscessed teeth and chronic disease. [186-189] In addition to the clear visual appearance of chronic infection at the time of extraction, frequently accompanied by putrid odors, ALL root canal teeth extraction sites have pathogens that can be cultured, and microscopic examinations of biopsy specimens always reveal inflamed and necrotic bone and tissue cells resulting from the chronic infection. Infected Teeth-The Hidden PandemicChronically abscessed teeth, as seen in imaging studies, are very common. Furthermore, they are nearly always completely free of pain or any other associated symptoms, and the patient has no reason to suspect that there are any problems in the mouth. In contrast the acutely abscessed tooth, for which many root canals are performed, are typically extremely painful. This is why chronic diseases in adults are the rule and not the exception. Too many physicians and their patients simply "expect" that hypertension, diabetes, cancer, or heart disease are the norm for many older adults. Also of note, the deciduous (non-permanent or baby) teeth in children demonstrate a high incidence of abscess formation. [190] When a child becomes chronically ill, a complete oral examination is just as important as in the adult with a chronic disease. So, for all ages, the important take-away point is that: When the mouth is infection-free, all chronic diseases are very rare. And when there is a chronic disease, oral- or gut-derived pathogen colonization of the affected tissue with local toxin production is almost always the cause. While some individuals, in a completely unpredictable manner, can have one or more root canals without ever resulting in negative clinical consequences, this is very rare. However, significant laboratory abnormalities are often present even when a chronic disease is not yet manifest. Also, clinical medicine always looks for a prompt and clear-cut relationship between an intervention and a negative clinical impact. With root canals and other chronically infected teeth, the leakage of pathogens and toxins can be slow, and breast cancer or a heart attack due to those infected teeth can take years to occur. Complications can occur rapidly after a root canal procedure, but this is not a very common consequence. If that were the case, root canal treatments would have been abandoned long ago. But when someone gets breast cancer years after a root canal, the status of the mouth is simply never considered as the possible reason by the clinician or the patient. A particularly aggressive pathogen of periodontal origin, Fusobacterium nucleatum, has been found in human breast cancer tissue. In an animal model, this pathogen has been shown to promote tumor growth and metastatic spread. [191,192] Higher titers of oral pathogens inside breast cancer cells have also been shown to promote metastatic spread, with experimental reduction of these titers decreasing the chances of metastasis. [193] Animal studies have also shown a commonality of pathogen presence in the mouth, gut, and in breast tumors. [194] Some researchers have actually termed breast cancer as an infectious disease. [195] Many other studies have consistently found pathogenic microbes, including viruses and fungi, in diseased breast tissue, including cancer, and much lower titers of non-pathogenic microbes in normal breast tissue. [196-204] As the mouth is always teeming with microbes (more than 700 different bacterial species) and its lymphatic circulation mostly drains into the breasts, the breast tissue is not completely microbe-free. [205,206] However, it should be pathogen-free, and the non-pathogenic microbes should always be very low in number and difficult to culture. [207] Researchers found a 10-fold (1,000%) increase in bacterial load in breast tumors relative to normal breast tissue. [208,209] In addition to the enormous amount of literature cited above that unequivocally ties mouth infections to chronic diseases, several other studies warrant special attention, as they reveal that pathogens of oral and gut origin have been shown to chronically colonize different diseased tissues, with continuous inflammation resulting from the on-site production of pathogen-related toxins. Breast cancer is but one of many infection-related chronic diseases. Chronic pathogen colonization (CPC) in diseased tissues is addressed more extensively elsewhere. [210] Especially noteworthy studies supporting the widespread presence of CPC and its disease-causing impact include the following:
All chronic diseases need to have a daily source of new oxidative stress greater than the daily intake of antioxidants in diet and supplementation. Otherwise, "chronic" diseases would resolve as the new antioxidant intake repairs the old oxidative damage. This source of the new daily oxidative stress nearly always arises from chronic pathogen colonization in the diseased organ or tissue. New toxin exposure in the affected tissue comes from on-site pathogen-generated toxins and the oxidized (toxic) products of pathogen metabolism. Pathogens also release enormous amounts of pro-oxidant free iron when they finally die and break apart. Chronically Infected TonsilsIn the 1950s Dr. Josef Issels made some remarkable discoveries that remain largely unknown to the medical and dental community. [259] His clinic in Germany treated mostly advanced cancer patients who were seeking to avoid chemotherapy in their pursuit of health. In surveying his own clinic data he found that 98% of the cancer patients had between what he termed "two and ten dead teeth." His treatment not only involved the proper removal of such infected and necrotic teeth, but also routine tonsillectomy. This was not initiated until he retrospectively observed that a significant number of his patients, who initially did well after the extractions, later experienced myocardial infarctions. After making tonsillectomies a part of his treatment protocol in these advanced cancer patients, the prevalence of heart attacks dropped from 40% to 5%. Dr. Issels asserted that "chronically inflamed tonsils are primary head foci which sometimes have an even more damaging effect on the organism as a whole than dental foci," noting that the tonsils are "excretion organs by which the lymphocytes, microbes, toxin-laden lymph, and other matter are discharged." Most significantly, Issels found that in every tonsillectomy performed, biopsy specimens revealed that "severe or very severe destructive tonsillar processes" were present along with chronic infection. This was in spite of the fact that the tonsils did not appear enlarged, inflamed, or infected on examination, which is the major reason they never get noticed or treated. Even though the chronic drainage of infected jawbone lymph results in the tonsils becoming chronically infected, it does not result in them becoming swollen, as is routinely seen with lymph nodes that are in the drainage pathway. This needs to be differentiated completely from acute or recurrent tonsillitis, with clear inflammation and often massive swelling, as often occurs in children. The lymphatic flow into the tonsils is directly connected to the lymphatic drainage of the jawbone that anchors the infected teeth and gums discussed above. Issels noted that Indian ink injected into a sealed dental cavity results in the appearance of inky spots on the tonsillar surface in only 20 to 30 minutes, further establishing this connection. The tonsils are designed to support the immune system in dealing with short-term and minimal pathogen challenges presented to the oral cavity. However, when the tonsil is continuously draining a chronic jawbone infection in the form of a root canal or other abscessed tooth, it is overwhelmed to the point that it goes from protecting against infection to becoming a major focal point of chronic infection itself. In any patient who had infected teeth properly extracted, it must be assumed that the tonsils have already become major focal infections as well. This is especially the case when C-reactive protein (CRP) levels are elevated and remain so after the infected teeth have been properly removed. The complete elimination of oral cavity infections remains in question as long as the CRP remains elevated. [260] Currently, there are several ways to resolve such chronic tonsillar infections, and they should all be used together if possible. Aside from tonsillectomy, the tonsils can be treated with:
This also works well for the large and inflamed tonsils of childhood tonsillitis. Furthermore, a normalization of a previously-elevated CRP level is good confirmation that they are no longer supporting body-wide inflammation. Many tonsillectomies could be completely avoided with these treatments. Breast Cancer TreatmentBased on all the information and research data presented above, it is essential to have as complete a diagnosis of the oral cavity as possible. This requires having a cone beam computed tomography (CBCT or 3D X-ray) properly performed and expertly interpreted. [261] This is the best way to keep from missing a minimally abscessed tooth that it easily missed on regular dental X-rays. Leaving even one infected tooth unextracted can prevent much of the benefit of removing multiple other infected teeth and root canals. A comprehensive protocol for optimizing the benefits of the removal of infected teeth is addressed in detail elsewhere. This includes a recommended and detailed surgical protocol for the dentist performing the extractions. [260] Optimal healing is also strongly supported by a dentist experienced in the proper application of ozone to prevent infection and accelerate quality healing. Uninformed ConsentWhile it is the purported standard of care to make sure the patient is completely aware of the nature of a proposed procedure and its potential complications, an informed consent does not currently exist for the root canal procedure. Root canal dentists are simply unwilling or unable to give the patient even a tiny fraction of the information cited in this article that documents that all root canal-treated teeth are chronically infected and remain that way until they are properly extracted. The current root canal procedure should be limited to patients who are fully informed of the health risks but simply do not want an extraction for any reason at all. In that patient subset, having an expertly-performed root canal that debulks the amount of infection in the targeted tooth can offer benefits. Most patients will opt for protecting their health rather than keeping the tooth. Also, no patient should be denied the option of infected tooth extraction at the outset, as recurrent abscess formation in root canals often occurs, and the patient then ends up receiving "redo" root canal procedures to debulk the new abscess, all the while spending more money, having their body subjected to a longer period of pathogen and toxin exposure, and experiencing more discomfort in the dental chair. The devastating impact on the health of the body by keeping infected teeth in the mouth cannot be overstated. Breast cancer is one of many chronic diseases caused and supported by oral cavity infections. Heart attacks are almost entirely due to oral pathogens metastasizing into and colonizing the coronary artery walls. [262] RecapBreast cancer starts when infected lymph from infected teeth, gums, and tonsils drains into the breast to a degree that the lymph nodes and the immune system can no longer compensate against the chronic pathogen/toxin exposure. Pathogens are present in breast cancer cells and their surrounding extracellular environment. This is a cause-and-effect between the pathogen presence and the development of the cancer. It must never be dismissed as an unclear association, relationship, correlation, connection, link, or any other term that attempts to avoid concluding the fact that infected teeth cause cancer and chronic disease, both in the breasts and elsewhere in the body. Breast cancer needs a comprehensive treatment protocol to achieve the best results, which often results in the disappearance of the cancer without surgery, radiation, or chemotherapy. As Dr. Issels asserted many years ago: "Cancer is a general disease of the whole body from the outset. 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