Meetinghouse Dental Care
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Biologic Extractions

BIOLOGIC EXTRACTIONS of INFECTED TEETH

Written by Anthony Trovato, MSACN, LMT

If a tooth is to be removed for any reason, we recommend certain steps to optimize post operative healing and bone/tissue regeneration.

Periodontal Ligament

All teeth have a periodontal ligament (PDL) composed of collagenous bundles, loose connective tissue, blood, lymph vessels, and nerves.  The PDL helps hold the tooth in place and functions like a shock absorber.  When you bite down and chew, the PDL protects the tooth from shattering by compressing a fraction of a millimeter like a spring.

In an extraction, the PDL should be removed with the tooth as a preventive measure.

It is standard of care for an oral surgeon to assume that the periodontal ligament adheres to the tooth in an extraction.  If left in an extraction site, its continued presence prevents biologic recognition of the absence of the tooth; bone cells will not proliferate and migrate through a membrane intended by nature to define growth limits of the jawbone.  

If the tooth to be extracted is a re-infected root canaled tooth, the PDL itself will inevitably retain infection and may present with a calcium-dense wall around the abscess that must be debrided, perforated, or roughened at the extraction visit to facilitate blood flow for post-extraction healing.

A note regarding extraction of root canal-treated teeth:

Radiographic radiolucencies are abscesses, often addressed in allopathic dentistry by referral to an endodontic specialist for performance of root canal therapy.   Holistic dentistry, aware of the connection between jawbone infection and immunocompromise and degenerative diseases, recommends extraction unless patient is just not yet ready emotionally or is mid-orthodontic treatment, etc., in which cases a root canal can be performed as a temporary procedure.

(See the documentary, Root Cause, available for purchase on Amazon.  The book, Hidden Infection, by medical doctor, Thomas Levy, is also available through Amazon.)

Abscesses can also be a manifestation of chronic apical periodontitis (CAP), an advanced, virulent form of generalized periodontitis.  Periodontitis elevates inflammatory biomarkers and increases oxidative stress.  CAP abscesses around the apex (tip) of a tooth can be painful OR totally asymptomatic.  In its painless or silent form, CAP is common in the general population and may only be discoverable by 3-D x-ray around a previously root-canaled treated tooth or, equally, around a tooth that has always been considered healthy and that has never undergone root canal therapy or even any dentistry of any kind. 

Again, holistic dentistry prefers extraction; even the most impeccable micro-endodontic treatment (root canal therapy procedure) will not be able to realize a perfectly bacteria-proof sealing of the chamber from which the infected tooth nerve has been removed. Accessory side canals and the endo-perio connection through dentinal tubules will always remain.  Root canal-treated teeth are, simply put, dead teeth.  The dead tooth, originally an organ with its own nerve and blood supply, will inevitably be populated by various, partly unknown species of anaerobic, pathogenic bacteria that will degrade remaining organic tissue in dentinal tubules and secrete harmful metabolic toxins over time.  Every chewing process releases the bacteria and toxins into the lymphatic system of surrounding tissue.  On a physical level, these infections are not local but, rather, systemic, and they can travel through the lymphatic system and the bloodstream to affect organs and glands through the entire body.  On an energetic level, root-canalled teeth act like scars or blockages and can alter energy in associated meridians.

Generally, teeth are associated with the following meridians, with sight variations according to the meridian chart consulted:

#1 is on the small intestine meridian and can be involved with issues in the duodenum and the heart. 

#2 is on the stomach meridian and can involve issues with the pancreas, stomach, breast and bladder. 

#3 is on the stomach meridian and can involve issues with the liver, kidneys, pancreas, stomach and breast. 

#4 is on the large intestine meridian involving right lung, liver, large and small intestine, duodenum and gallbladder. 

#5 is on the large intestine meridian involving right lung, liver, pancreas, stomach and large intestine.

#6 is on the liver/gallbladder meridian and can involve the liver, gallbladder and heart.

#7 is on the kidney/bladder meridian and can involve the kidney, bladder and the urogenital system.

#8 is on the kidney/bladder meridian and can involve the kidney, bladder and the urogenital system.

#9 is on the kidney/bladder meridian and can involve the kidney, bladder and the urogenital system.

#10 is on the kidney/bladder meridian and can involve the kidney, bladder and the urogenital system.

#11 is on the liver/gallbladder meridian and can involve the liver, gallbladder and heart.

#12 is on the large intestine meridian involving left lung, liver, pancreas, stomach and large intestine.

#13 is on the large intestine meridian involving left lung, liver, large and small intestine, duodenum and gallbladder. 

#14 is on the stomach meridian and can involve issues with the liver, kidneys, spleen, stomach and breast. 

#15 is on the stomach meridian and can involve issues with the spleen, stomach, breast and bladder.

#16 is on the small intestine meridian and can be involved with issues in the jejunum, ileum and heart.

#17 is on the small intestine meridian and can involve issues with liver, heart, jejunum and ileum.                             

#18 is on the large intestine meridian and can involve issues with the left lung and large intestine.

#19 is on the large intestine meridian involving the left lung and large intestine.                                                                           

#20 is on the stomach meridian and can involve issues with the stomach, breast and spleen.

#21 is on the stomach meridian and can involve issues with the pancreas, liver, spleen, breast and stomach.

#22 is on the liver/gallbladder meridian and can involve issues with the pancreas, liver, bile ducts and lungs.

#23 is on the kidney/bladder meridian involving the left kidney, bladder and the urogenital system. 

#24 is on the kidney/bladder meridian involving the left kidney, bladder and the urogenital system.

#25 is on the kidney/bladder meridian involving the right kidney, bladder and the urogenital system.

#26 is on the kidney/bladder meridian involving the right kidney, bladder and the urogenital system.

#27 is on the liver/gallbladder meridian and can involve issues with the pancreas, liver, gallbladder and lungs.

#28 is on the stomach meridian and can involve issues with the pancreas, liver, stomach, breast and pylori.

#29 is on the stomach meridian and can involve issues with the pancreas, breast, pylori’s and stomach.

#30 is on the large Intestine meridian involving the ileocecal and large intestine.

#31 is on the large intestine meridian and can involve issues with the right lung, large intestine and ileocecal.

#32 is on the small intestine meridian and can involve issues with the heart, ileocecal and ileum.

Cavitations

Conditions that foment the formation of a cavitation might include insufficient removal of the periodontal ligament (PDL) during a tooth extraction procedure or lack of adequate debridement of any protective calcium perimeter present in the socket.  PDL removal and debridement are procedures intended to remove necrotic tissue from the socket, cleaning the socket until what remains is living, bleeding, healing cancellous bone. Removal of the PDL would typically be inadvertent in a routine non-biologic extraction procedure, resulting when the ligament uncharacteristically preferred adherence to the tooth rather than to the surrounding bone.

Holistic dentistry notes that the continued presence in the extraction site of the PDL effectively prevents adjacent bone from biologically recognizing that the tooth has been extracted; cells will not proliferate spontaneously and migrate through a membrane intended by nature to define jawbone growth.  As long as the PDL remains intact, or largely intact, the underlying bone cells consider the tooth present, and no biological signal for bone growth is triggered.  At the upper portion of the extraction site, however, where there is no PDL, osteoblastic bone activity does initiate, and a thin cortex of bone will heal across the hole, potentially establishing an anaerobic environment in which residual infection can proliferate, facilitating the POSSIBLE creation over time of a pocket of infected bone (cavitation).

The cone beam scan reveals density measurements of bone in the sites of extracted or missing teeth.  A density reading of less than zero indicates absence of bone and a probable cavitation site: an acidic, infected hole in the bone which may assume a shape similar to that of a river with tributaries.  Necrotic bone in a cavitation interrupts oxygen and blood supply to the affected bone, resulting in a potential breeding ground for  various, partly unknown species of anaerobic, pathogenic bacteria that degrade remaining organic tissue and secrete harmful metabolic toxins both locally and systemically. Infection can stay subclinical (producing no symptoms of redness, swelling, or temperature increase) indefinitely.  Cavitation pockets are impossible to detect on traditional 2-D radiographs (panoramic, full mouth series, peri-apical).  3-D conebeam technology like our VaTech Green Machine is required to view and/or to measure bone density.  Healthy bone measures between 200 and 1000. Suspicious bone measures between 50 and 200.  Anything less than a measurement of 50 is indicative of a cavitation.

Research by Dr. Boyd Haley, University of Kentucky, shows that ALL tested root canalled teeth and cavitation tissue samples contained toxins that shut off enzymes used by the body to produce ATP (the molecule that supplies energy to cells).  Other research indicates that toxins synergistically combine with chemicals (environmental toxins) and/or heavy metals (mercury, lead, cadmium) to form even more potent toxins.

Some people experience severe pain in cavitation areas.  The term used to describe this condition is NICO (neuralgia-inducing cavitational osteonecrosis).  NICO lesions can produce severe facial pain, neuralgia, headaches, or even a phantom toothache (tooth pain where there is no tooth).

It is important to note that not all standard-of-care extractions result in cavitations and that only a relatively small number of cavitations become NICO legions. Condensing osteitis is NOT always present. 

While we do not perform cavitation surgery in our facility, we can refer you to a specialist who does.

Biologic Extraction Technique

When you opt for an extraction, communicate that your dentist requests complete removal of the periodontal ligament and up to one millimeter of spongy bone from entire bony socket, including apex, via a number 8 or #10 long-shanked surgical round bur.  Make this request prior to scheduling the extraction so you know if your oral surgeon is willing. 

A bur is recommended because studies show that manual scraping of the PDL might push bacteria and toxins back into good cancellous bone, potentially resulting in lack of primary healing and in a greater chance of persistent or recurrent infection.  Use of a surgical bur after tooth removal insures complete extrication of the PDL as well as more thorough removal of the compromised necrotic bone/tissue surrounding an infected PDL.  Removing infected bone and/or surrounding calcium-dense wall (via osteoectomy or alveoplasty or debridement) takes the socket down to good, bleeding, healing bone, promoting natural nutrient flow into the area as well as waste products out.

Expect to bleed with a biologic extraction.  An extraction that does not bleed is NOT a good extraction.  Infected bone does not bleed.  Furthermore, bleeding helps remove residual infection and begins the healing process with the formation of the clot.  If you are still experiencing a trickle of blood after an hour, place a wet, black tea bag (not herbal; you need the tannins) over extraction site in place of the gauze, clamp gently, and hold in place for a half hour to help the clot to form.

Oxygen-Ozone

We recommend a post-extraction healing injection with medical-grade oxygen-ozone, preferably the same day or soon after. 
 
After Care Instructions

-Place gauze over the extraction site and bite firmly.  Replace gauze as needed for 30 minutes or until bleeding ceases.
-The anesthetic will wear off in a few hours.  Be careful not to bite your lips, tongue, or cheek while you are numb. 
-For at least 24 hours, AVOID the following: smoking, drinking through straw, blowing nose, excessive spitting, vigorous rinsing, hot foods/liquids (so as to avoid creating a dry socket by dislodging the forming blood clot and so as to avoid prolonged bleeding).
-Other than natural remedies indicated by your health provider, use only NON aspirin pain medication (Tylenol, Motrin, Advil) to alleviate discomfort as may be needed.
-After 24 hours, begin to rinse gently with warm salt water.  Combine ¼ teaspoon salt and 1 cup water, and rinse every four hours.

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