• Toxic Tooth Preface.

• It’s Time to Break Down the Wall Between Dentistry and Medicine. By Bruce Donoff MD, DDS (Stat news 2017)

• Dental Caries and Head and Neck Cancer ​​ (JAMA, 2013)

• AAE Newsletters

• Jerry Bouquot, DDS, MSD Biographical Profile

• Patient Letters to the NYS Dental Board

• Weston Price Bio

• Articles by Easlick and Grossman that are referenced by the AAE ​​ that they say debunks Focal Infection Theory. Current peer reviewed research shows that these articles are filled with false assumptions and outdated information.

• Article about Dr. Oz article in response to his critics.

• Article: Yes, Licensing Boards Are Cartels. The Case For Why Congress Should Get Involved. ​​ By Eric Boehm. Sept. 2017).

• Article: The Truth About Dentistry. It’s Much Less Scientific-And More Prone to Gratuitous Procedures-Than You may Think. By Ferris Jabr. The Atlantic. May, 2019).

• Article: Root Canal Safety. By Dr. Marcus Johnson. This article is endorsed by the AAE.

• More on Stephen Barrett, Jackson Leeds and others.

Appendix A: ​​ Toxic Tooth Preface

Appendix B:

The belief that oral health is an integral part of total health is gaining momentum. Bruce Donoff, D.M.D.M.D., professor of oral and maxillofacial surgery and dean of the Harvard School of Dental Medicine writes:

​​ 

“Ever since the first dental school was founded in the United States in 1840, dentistry and medicine have been taught as — and viewed as — two separate professions. That artificial division is bad for the public’s health. It’s time to bring the mouth back into the body. As taught in most schools today, dental education produces good clinicians who have a solid understanding of oral health, but often a more limited perspective on overall health. Few dental students are equipped to take a holistic view that may include taking a patient’s vital signs, evaluating their risk of heart disease or stroke, spotting early warning signs of disease…

My school, the Harvard School of Dental Medicine, was founded 150 years ago on July 17, 1867. It was the first American dental school affiliated with a university and its medical school, and the first to grant the doctor of dental medicine ​​ (D.M.D.) degree. The school’s mission is “to develop and foster a community of global leaders dedicated to improving human health by integrating dentistry and medicine at the forefront of education, research, and patient care.” At commencement, dental graduates are welcomed into a “demanding branch of medicine.”…

Poor oral health is more than a “tooth problem.” We use our mouth to eat, to breathe, and to speak. Oral pain results in lost time from school and work and lowered self-esteem. Inflammation in the gums and mouth may help set the stage for diabetes, cardiovascular disease, and other chronic conditions. Dental infection can lead to the potentially serious blood infection known as sepsis. In the case of 12-year-old Deamonte Driver, an infected tooth led to a fatal brain infection.

Writing in the Millbank Quarterly, John McDonough, professor of public health practice at the Harvard T.H. Chan School of Public Health asked, “Might oral health be the next big thing?” I believe that it needs to be — and should be.”

The school has also established the Oral Physician Program, a general practice dental residency program at the Cambridge Health Alliance, which integrates oral health, primary care, and family medicine training. We also plan to establish a new combined DMD/MD program with a hospital-based residency to train a new type of physician focused equally on oral health and primary care.

Other institutions are also expanding the concept of dental care and chipping away at the barriers between dental care and primary care. Kaiser Permanente Northwest, for example, has opened a truly integrated medical-dental practice in Eugene, Ore. The Marshfield Clinic in Wisconsin is advancing the concept with integrated medical-dental electronic health records.

Here’s what an integrated dental health/primary care visit might look like to a patient: When you go for a routine teeth cleaning, you would be cared for by a team of physicians, dentists, nurses, and physician and dental assistants. One or more of them would take your blood pressure, check your weight, update your medications, see if you are due for any preventive screenings or treatments, and clean your teeth. If you have an artificial heart valve or have previously had a heart infection, or you are taking a blood thinner, your clinicians will manage these conditions without multiple calls to referring doctors.

Finding the political will to integrate dentistry and primary care is a challenge. Various organizations including the DentaQuest Foundation, the Santa Fe Group, and Oral Health America have taken up the task. The majority of this work is designed to raise awareness of oral health, educate non-dental health care providers, and create political interest in promoting oral health. However, while interprofessional education has met with some success, interprofessional practice remains elusive.

The culture of the dental profession must change to promote closer connections between dentistry and primary care. …

Appendix C: ​​ 

October 2013

Dental Caries and Head and Neck Cancers

Mine Tezal, DDS, PhD1; Frank A. Scannapieco, DMD, PhD1; Jean Wactawski-Wende, PhD2; et alJukka H. Meurman, MD, PhD3; James R. Marshall, PhD4; Isolde Gina Rojas, DDS, PhD5; Daniel L. Stoler, PhD6; Robert J. Genco, DDS, PhD1

Author Affiliations Article Information

JAMA Otolaryngol Head Neck Surg. 2013;139(10):1054-1060. doi:10.1001/jamaoto.2013.4569

Abstract

Methods

Study Design and Population

We conducted a case-control study of newly presenting patients of the Department of Dentistry and Maxillofacial Prosthetics at Roswell Park Cancer Institute (RPCI). All patients seen between June 15, 1999, and September 14, 2007, except those who had a history of cancer, dysplasia, or immunodeficiency or were younger than 21 years were included. The RPCI patients come mainly from the surrounding Erie, Niagara, and Chautauqua counties and have a wide range of socioeconomic status. This study was reviewed and approved by institutional review boards of the RPCI and the State University of New York at Buffalo.

Cases

All patients with newly diagnosed primary HNSCC during the study period who met the inclusion criteria were included as cases. The following sites, identified from the RPCI Tumor Registry according to the International Classification of Diseases for Oncology, Third Edition,15 were included: oral cavity, including oral tongue (C02.0-C02.9), gum (C03.0-C03.9), floor of the mouth (C04.0-C04.9), hard palate (C05.0), buccal mucosa (C06.0), vestibule (C06.1), retromolar area (C06.2), and other parts of the mouth (C06.8-C06.9); oropharynx, including base of tongue (C01.0), soft palate (C05.1), tonsil (C09.0-C09.9), and oropharynx (C10.0-C10.9); and larynx (C32.0-C32.9).

Controls

All new patients seen at the department during the same time period as the cases but who did not have a diagnosis of cancer or dysplasia and met the inclusion criteria were included as controls. These included general dentistry patients, as well as those with a diagnosis of benign mucosal lesions such as fibroma, lipoma, wart, traumatic lesion, mucocele, cyst, abscess, pyogenic granuloma, frictional keratosis, and chemical burn. Employees of RPCI were excluded because they represent a different referent population from the one that the cases came from. The diagnoses of controls were obtained from the RPCI Hospital Information System.

Assessment of Oral Variables

The numbers of teeth with caries, fillings, crowns, and endodontic treatments, as well as the severity of periodontitis and missing teeth, were assessed from panoramic radiographs taken at admission before treatment. Severity of periodontitis was assessed according to extent of ABL in millimeters as described previously.14 One examiner blind to cancer status performed all dental measurements. To establish intraexaminer reliability, duplicate measurements were made on 5 randomly selected patients (110 teeth/207 sites). The κ statistics for the numbers of teeth with caries, fillings, crowns, and endodontic treatments and missing teeth were 0.91, 0.96, 1.00, 1.00, and 1.00, respectively. The mean (SD) differences of duplicate ABL measurements were 0.22 (0.41) mm.

Explanatory Variables

Information on the following variables, obtained at the time of diagnosis, was available in patient records: age at diagnosis, sex, race (white, black, Asian, or other), ethnicity (Hispanic or non-Hispanic), marital status (married, single, divorced, widowed, or separated), medical insurance (traditional, Medicare, Medicaid, or uninsured), smoking status (never, former, or current; packs per day), alcohol use (no or yes; drinks per day), tumor stage (I-IV), and tumor differentiation (poor, moderate, well).

Statistical Analysis

Demographic, lifestyle, and clinical characteristics of the study population were summarized by frequency distributions for categorical variables and means with standard deviation for continuous variables. We computed decayed, missing, and filled teeth (DMFT), a widely used measure of caries history.16 To estimate the unadjusted association of HNSCC with dental caries and other exposure variables, crude odds ratios (ORs) and their 95% confidence intervals were calculated from cross-tabulations. Tertiles in the control group were used to categorize exposure variables. The independent association of each exposure variable with HNSCC was estimated from multiple logistic regression analysis. Because of colinearity, each dental variable was evaluated in a separate model. For variable selection, we assessed change in OR when the covariate was added individually to the model. Potential effect modification in the association of dental caries with HNSCC by each covariate was evaluated in stratified analyses and by including multiplicative interaction terms in regression models. A 2-sided P ≤ .05 was considered statistically significant. SPSS Statistics, version 20.0 (IBM), was used for all data analyses.

Results

Discussion

Back to top

Article Information

Appendix D:

These are two newsletters published by the AAE. Current research directly contradicts some of the statements and assumptions presented in these ​​ newsletters.

Compare what the AAE states in these newsletters to the actual peer reviewed scientific article presented and see what is true, what is misleading, and what is completely false in these AAE newsletters.

Selected References for Spring/Summer 2000

ENDODONTICS: Colleagues for Excellence
Oral disease and systemic health: What is the connection?

American Association of Endodontists. Root canal therapy safe and effective, Endodontics: Colleagues for Excellence. F/W 1994.

American Heart Association recommendations. Prevention of bacterial endocarditis, JAMA 1997;227:1794-1801.

Baumgartner, J C et al. The incidence of bacteremias related to endodontic procedures I. Nonsurgical endodontics J Endodon, 1976;2:135-140.

American Association of Endodontists, The incidence of bacteremia in endodontic manipulation – preliminary report Oral Surg Oral Med Oral Pathol, 1960;

Peters, LB et al, The fate and the role of bacteria left in root dentinal tubules, Int Endod J, 1995;28:95-99.

American Academy of Periodontology Periodontal disease as a potential risk factor for systemic diseases J Periodontology 1998;69:841-850.

Beck J et al, Periodontal disease and cardiovascular disease, J Periodontology 1996;67:1123-1137.

Offenbacher, S et al, Periodontal infection as a possible risk factor for preterm low birth weight, J Periodontology 1996;67:1103-1113.

Slots, J Casual or causal relationship between periodontal infection and non-oral disease? J Dent Res 1998;77:10.

Herzber MC and Meyer MW Effects of oral flora on platelets: Possible consequences in cardiovascular disease, J Periodontology 1996;67:1138-1142.

Grossman LI, Root Canal Therapy. 4th Edition. Lea & Febiger, Philadelphia. pp. 18-24, 1940.

Appendix E:

Biographical profile of Jerry Bouquot, DDS, MSD.

Dr. Jerry Bouquot earned his DDS and MSD degrees from the University of Minnesota, with postdoctoral fellowships to the Mayo Clinic and the Royal Dental College in Copenhagen, Denmark as the recipient of a Career Development Award from the American Cancer Society.

He holds the record as the youngest oral pathology chair in U.S. history and for more than 26 years was chair of two diagnostic science departments, one in West Virginia University and the other at The University of Texas Health Science Center at Houston.

He has received more than 50 honors and awards, including WVU’s highest awards for teaching and service to humanity, and its alumni association’s Lifetime Achievement Award. He received the St. George National Award, the highest award given by the American Cancer Society for lifetime efforts in cancer control, and has been awarded the Bridgeman Distinguished Dentist Award from the West Virginia Dental Association, the Distinguished Leadership Award from the West Virginia Public Health Association, a Presidential Certificate of Appreciation from the American Academy of Oral Medicine, Honorary Life Membership from the International Association of Oral Pathologists, the Distinguished Alumnus Award from the University of Minnesota and both the Fleming and Davenport Award for Original Research and the Award for Pioneer Work in Teaching & Research from The University of Texas.

He is now a retired adjunct professor of The University of Texas and West Virginia University, and remains the director of research for his private research center, the Maxillofacial Center for Education and Research.

He has been director of two of the largest U.S. oral pathology biopsy services, one of which received tissue from 45 states and five foreign countries. He has been the dental director of the West Virginia Bureau for Public Health, a Senior Visiting Scientist of the Mayo Clinic, a Special Advisor to the National Institutes of Health, an Honorary Member of Dental Informatics of the University of Göteborg, Sweden, a Gorlin Visiting Professor of the University of Minnesota, and the Oral Cancer Control Coordinator for the state of West Virginia.

He has been a consultant to Pittsburgh Children's Hospital and the New York Eye & Ear Infirmary. He has been awarded Fellowship in the International College of Dentists, the American College of Dentists, the Academy of Dentistry International, the American Academy of Oral & Maxillofacial Pathology and the Royal Society of Medicine (U.K.); he has been on the Scientific Advisory Boards of four U.S. and European corporations. During his career, he peer-reviewed more than 1,500 scientific papers for more than 40 journals.

Dr. Bouquot has more than 340 published papers, abstracts, books and book chapters. His work has been translated into numerous languages, has been cited more than 6,000 times in the literature, and has been used by state and national governments to determine oral health policy.

He is co-author of the most popular textbook of oral pathology, has named more than three dozen oral diseases, has been a reviewer for more than 40 medical and dental journals, and has been on the editorial boards of four international dental journals. He has presented more than 1,600 research and continuing education seminars in more than 30 countries and all 50 U.S. states, and has taught what are possibly the longest-running community-based CE courses in U.S. dentistry. His informational websites are the two most popular oral pathology sites on the internet, together getting almost 6.5 million hits annually.

Dr. Bouquot is a past president of the American Board of Oral & Maxillofacial Pathology, the Eastern Society of Teachers of Oral Pathology, the Western Society of Teachers of Oral Pathology, the Organization of Teachers of Oral Diagnosis, four regional dental societies, and the West Virginia Division of the American Cancer Society. He has been a member of the Executive Council of the American Academy of Oral & Maxillofacial Pathology, the national Board of Directors of the ACS and the Board of Trustees for the eight-state South Atlantic Division of the ACS. As a member of the ACS National Research Committee, he was among those responsible for reviewing and approving more than $90 million in cancer research grants annually.

Board Certification

American Board of Oral & Maxillofacial Pathology

APPENDIX F:

APPENDIX G: ​​ Weston Price Bio

APPENDIX H: ​​ Easlick and Grossman references used by the AAE. I believe that it is important to see the actual articles used to refute focal infection and see how they hold up to current peer reviewed research.

Some of the assumptions used by Easlick and Grossman to debunk focal infection have since been proven false and therefore do not debunk focal infection.

Interestingly, the AAE cites these two studies and authors as their number one and number two references on the safety of root canal teeth.

​​ 

APPENDIX I:

Dr. Oz Is No Wizard, but No Quack, Either

By Bill Gifford

• April 25, 2015

Remembering Roger Boisjoly: He Tried To Stop Shuttle Challenger Launch

By Howard Berkes ​​ 2012

But Boisjoly did talk about it in a hotel room in Alabama, revealing for the first time the details of that effort to keep Challenger on the launch pad. He asked that he not be named but he agreed to be quoted anonymously. As he spoke with Zwerdling, a second engineer revealed the same details to me under the same conditions at his home in Brigham City, Utah.

Boisjoly's family agreed to release him from our pledge of confidentiality so that his efforts to get the truth out can be widely known.

"We all knew what the implication was without actually coming out and saying it," a tearful Boisjoly told Zwerdling in 1986. "We all knew if the seals failed the shuttle would blow up."

Armed with the data that described that possibility, Boisjoly and his colleagues argued persistently and vigorously for hours. At first, Thiokol managers agreed with them and formally recommended a launch delay. But NASA officials on a conference call challenged that recommendation.

"I am appalled," said NASA's George Hardy, according to Boisjoly and our other source in the room. "I am appalled by your recommendation."

Another shuttle program manager, Lawrence Mulloy, didn't hide his disdain. "My God, Thiokol," he said. "When do you want me to launch — next April?"

These words and this debate were not known publicly until our interviews with Boisjoly and his colleague. They told us that the NASA pressure caused Thiokol managers to "put their management hats on," as one source told us. They overruled Boisjoly and the other engineers and told NASA to go ahead and launch.

"We thought that if the seals failed the shuttle would never get off the launch pad," Boisjoly told Zwerdling. So, when Challenger lifted off without incident, he and the others watching television screens at Thiokol's Utah plant were relieved.

"And when we were one minute into the launch a friend turned to me and said, 'Oh God. We made it. We made it!'" Boisjoly continued. "Then, a few seconds later, the shuttle blew up. And we all knew exactly what happened."

Until NPR's story, the special commission investigating the Challenger tragedy hadn't even interviewed all the engineers involved in the pre-launch debate.

The explosion of Challenger and the deaths of its crew, including Teacher-in Space Christa McAuliffe, traumatized the nation and left Boisjoly disabled by severe headaches, steeped in depression and unable to sleep. When I visited him at his Utah home in April of 1987, he was thin, tearful and tense. He huddled in the corner of a couch, his arms tightly folded on his chest. But he was ready to speak publicly.

Challenger's Whistle-Blower: Hero And Outcast

The engineer who opposed the doomed launching of the shuttle finds himself ostracized as he embarks on several new careers. PHOENIX--When the shuttle Challenger blew up, the explosion lit a fuse in Roger Boisjoly's conscience. A structural engineer for Morton Thiokol Inc., the firm that later bore blame for the disaster, Boisjoly had argued against the launch the night before and, like the rest of the nation, watched in horror when the shuttle blew up. "I left the room and went directly to my

Jan 20, 1990

ELIZABETH PENNISI

5

PHOENIX--When the shuttle Challenger blew up, the explosion lit a fuse in Roger Boisjoly's conscience. A structural engineer for Morton Thiokol Inc., the firm that later bore blame for the disaster, Boisjoly had argued against the launch the night before and, like the rest of the nation, watched in horror when the shuttle blew up. "I left the room and went directly to my office where I remained in shock the rest of the day," he recalls about that terrible morning four years ago this week.

Not surprisingly, his former employer does not share Boisjoly's eagerness to discuss his actions and their meaning. A spokesman for Morton Thiokol declined to comment on any matter relating to Boisjoly, saying that the subject is closed. But colleagues applaud Boisjoly's efforts to raise the issue of professional ethics and to stress its importance.

Yes, Licensing Boards Are Cartels

The case for why Congress should get involved.

Eric Boehm|Sep. 13, 2017 9:05 am

The Truth About Dentistry

Itʼs much less scientific—and more prone to gratuitous procedures—than you may think.

FERRIS JABR

MAY 2019 ISSUE | HEALTH

Arsh Raziuddin

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I N THE EARLY 2000S Terry Mitchell’s dentist retired. For a while, Mitchell, an electrician in his 50s, stopped seeking dental care altogether. But when one of his wisdom teeth began to ache, he started looking for someone new. An

acquaintance recommended John Roger Lund, whose practice was a convenient 10-minute walk from Mitchell’s home, in San Jose, California. Lund’s practice was situated in a one-story building with clay roof tiles that housed several dental offices. The interior was a little dated, but not dingy. The waiting room was small

and the decor minimal: some plants and photos, no fish. Lund was a good- looking middle-aged guy with arched eyebrows, round glasses, and graying hair that framed a youthful face. He was charming, chatty, and upbeat. At the time, Mitchell and Lund both owned Chevrolet Chevelles, and they bonded over their mutual love of classic cars.

Lund extracted the wisdom tooth with no complications, and Mitchell began seeing him regularly. He never had any pain or new complaints, but Lund encouraged many additional treatments nonetheless. A typical person might get one or two root canals in a lifetime. In the space of seven years, Lund gave Mitchell nine root canals and just as many crowns. Mitchell’s insurance covered only a small portion of each procedure, so he paid a total of about $50,000 out of pocket. The number and cost of the treatments did not trouble him. He had no idea that it was unusual to undergo so many root canals—he thought they were just as common as fillings. The payments were spread out over a relatively long period of time. And he trusted Lund completely. He figured that if he needed the treatments, then he might as well get them before things grew worse.

Meanwhile, another of Lund’s patients was going through a similar experience. Joyce Cordi, a businesswoman in her 50s, had learned of Lund through 1-800- DENTIST. She remembers the service giving him an excellent rating. When she visited Lund for the first time, in 1999, she had never had so much as a cavity. To the best of her knowledge her teeth were perfectly healthy, although she’d had a small dental bridge installed to fix a rare congenital anomaly (she was born with one tooth trapped inside another and had had them extracted). Within a year, Lund was questioning the resilience of her bridge and telling her she needed root canals and crowns.

TheAtlantic – The Trouble With Dentistry - The Atlantic - Ferris Jabr

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Cordi was somewhat perplexed. Why the sudden need for so many procedures after decades of good dental health? When she expressed uncertainty, she says, Lund always had an answer ready. The cavity on this tooth was in the wrong position to treat with a typical filling, he told her on one occasion. Her gums were receding, which had resulted in tooth decay, he explained during another visit. Clearly she had been grinding her teeth. And, after all, she was getting older. As a doctor’s daughter, Cordi had been raised with an especially respectful view of medical professionals. Lund was insistent, so she agreed to the procedures. Over the course of a decade, Lund gave Cordi 10 root canals and 10 crowns. He also chiseled out her bridge, replacing it with two new ones that left a conspicuous gap in her front teeth. Altogether, the work cost her about $70,000.

A masked figure looms over your recumbent body, wielding power tools and sharp metal instruments, doing things to your mouth you cannot see.

In early 2012, Lund retired. Brendon Zeidler, a young dentist looking to expand his business, bought Lund’s practice and assumed responsibility for his patients. Within a few months, Zeidler began to suspect that something was amiss. Financial records indicated that Lund had been spectacularly successful, but Zeidler was making only 10 to 25 percent of Lund’s reported earnings each month. As Zeidler met more of Lund’s former patients, he noticed a disquieting trend: Many of them had undergone extensive dental work—a much larger proportion than he would have expected. When Zeidler told them, after routine exams or cleanings, that they didn’t need any additional procedures at that time, they tended to react with surprise and concern: Was he sure? Nothing at all? Had he checked thoroughly?

In the summer, Zeidler decided to take a closer look at Lund’s career. He gathered years’ worth of dental records and bills for Lund’s patients and began to

scrutinize them, one by one. The process took him months to complete. What he uncovered was appalling.

W E HAVE A FRAUGHT RELATIONSHIP with dentists as authority figures. In casual conversation we often dismiss them as “not real doctors,” regarding them more as mechanics for the mouth. But that disdain

is tempered by fear. For more than a century, dentistry has been half-jokingly compared to torture. Surveys suggest that up to 61 percent of people are apprehensive about seeing the dentist, perhaps 15 percent are so anxious that they avoid the dentist almost entirely, and a smaller percentage have a genuine phobia requiring psychiatric intervention.

When you’re in the dentist’s chair, the power imbalance between practitioner and patient becomes palpable. A masked figure looms over your recumbent body, wielding power tools and sharp metal instruments, doing things to your mouth you cannot see, asking you questions you cannot properly answer, and judging you all the while. The experience simultaneously invokes physical danger, emotional vulnerability, and mental limpness. A cavity or receding gum line can suddenly feel like a personal failure. When a dentist declares that there is a problem, that something must be done before it’s too late, who has the courage or expertise to disagree? When he points at spectral smudges on an X- ray, how are we to know what’s true? In other medical contexts, such as a visit to a general practitioner or a cardiologist, we are fairly accustomed to seeking a second opinion before agreeing to surgery or an expensive regimen of pills with harsh side effects. But in the dentist’s office—perhaps because we both dread dental procedures and belittle their medical significance—the impulse is to comply without much consideration, to get the whole thing over with as quickly as possible.

The uneasy relationship between dentist and patient is further complicated by an unfortunate reality: Common dental procedures are not always as safe, effective,

or durable as we are meant to believe. As a profession, dentistry has not yet applied the same level of self-scrutiny as medicine, or embraced as sweeping an emphasis on scientific evidence. “We are isolated from the larger health-care system. So when evidence-based policies are being made, dentistry is often left out of the equation,” says Jane Gillette, a dentist in Bozeman, Montana, who works closely with the American Dental Association’s Center for Evidence- Based Dentistry, which was established in 2007. “We’re kind of behind the times, but increasingly we are trying to move the needle forward.”

Consider the maxim that everyone should visit the dentist twice a year for cleanings. We hear it so often, and from such a young age, that we’ve internalized it as truth. But this supposed commandment of oral health has no scientific grounding. Scholars have traced its origins to a few potential sources, including a toothpaste advertisement from the 1930s and an illustrated pamphlet from 1849 that follows the travails of a man with a severe toothache. Today, an increasing number of dentists acknowledge that adults with good oral hygiene need to see a dentist only once every 12 to 16 months.

Many standard dental treatments—to say nothing of all the recent innovations and cosmetic extravagances—are likewise not well substantiated by research. Many have never been tested in meticulous clinical trials. And the data that are available are not always reassuring.

The Cochrane organization, a highly respected arbiter of evidence-based medicine, has conducted systematic reviews of oral-health studies since 1999. In these reviews, researchers analyze the scientific literature on a particular dental intervention, focusing on the most rigorous and well-designed studies. In some cases, the findings clearly justify a given procedure. For example, dental sealants—liquid plastics painted onto the pits and grooves of teeth like nail polish —reduce tooth decay in children and have no known risks. (Despite this, they are not widely used, possibly because they are too simple and inexpensive to earn

dentists much money.) But most of the Cochrane reviews reach one of two disheartening conclusions: Either the available evidence fails to confirm the purported benefits of a given dental intervention, or there is simply not enough research to say anything substantive one way or another.

Fluoridation of drinking water seems to help reduce tooth decay in children, but there is insufficient evidence that it does the same for adults. Some data suggest that regular flossing, in addition to brushing, mitigates gum disease, but there is only “weak, very unreliable” evidence that it combats plaque. As for common but invasive dental procedures, an increasing number of dentists question the tradition of prophylactic wisdom-teeth removal; often, the safer choice is to monitor unproblematic teeth for any worrying developments. Little medical evidence justifies the substitution of tooth-colored resins for typical metal amalgams to fill cavities. And what limited data we have don’t clearly indicate whether it’s better to repair a root-canaled tooth with a crown or a filling. When Cochrane researchers tried to determine whether faulty metal fillings should be repaired or replaced, they could not find a single study that met their standards.

“The body of evidence for dentistry is disappointing,” says Derek Richards, the director of the Centre for Evidence-Based Dentistry at the University of Dundee, in Scotland. “Dentists tend to want to treat or intervene. They are more akin to surgeons than they are to physicians. We suffer a little from that. Everybody keeps fiddling with stuff, trying out the newest thing, but they don’t test them properly in a good-quality trial.”

The general dearth of rigorous research on dental interventions gives dentists even more leverage over their patients. Should a patient somehow muster the gumption to question an initial diagnosis and consult the scientific literature, she would probably not find much to help her. When we submit to a dentist’s examination, we are putting a great deal of trust in that dentist’s experience and intuition—and, of course, integrity.

W HEN ZEIDLER PURCHASED LUND’S PRACTICE, in February 2012, he inherited a massive collection of patients’ dental histories and bills, a mix of electronic documents, handwritten charts, and

X-rays. By August, Zeidler had decided that if anything could explain the alarmingly abundant dental work in the mouths of Lund’s patients, he would find it in those records. He spent every weekend for the next nine months examining the charts of hundreds of patients treated in the preceding five years. In a giant Excel spreadsheet, he logged every single procedure Lund had performed, so he could carry out some basic statistical analyses.

The numbers spoke for themselves. Year after year, Lund had performed certain procedures at extraordinarily high rates. Whereas a typical dentist might perform root canals on previously crowned teeth in only 3 to 7 percent of cases, Lund was performing them in 90 percent of cases. As Zeidler later alleged in court documents, Lund had performed invasive, costly, and seemingly unnecessary procedures on dozens and dozens of patients, some of whom he had been seeing for decades. Terry Mitchell and Joyce Cordi were far from alone. In fact, they had not even endured the worst of it.

Whereas medicine has reckoned with some of its own tendencies toward excessive and misguided treatment, dentistry has lagged behind.

Dental crowns were one of Lund’s most frequent treatments. A crown is a metal or ceramic cap that completely encases an injured or decayed tooth, which is first shaved to a peg so its new shell will fit. Crowns typically last 10 to 15 years. Lund not only gave his patients superfluous crowns; he also tended to replace them every five years—the minimum interval of time before insurance companies will cover the procedure again.

More than 50 of Lund’s patients also had ludicrously high numbers of root canals: 15, 20, 24. (A typical adult mouth has 32 teeth.) According to one lawsuit that has since been settled, a woman in her late 50s came to Lund with only 10 natural teeth; from 2003 to 2010, he gave her nine root canals and 12 crowns. The American Association of Endodontists claims that a root canal is a “quick, comfortable procedure” that is “very similar to a routine filling.” In truth, a root canal is a much more radical operation than a filling. It takes longer, can cause significant discomfort, and may require multiple trips to a dentist or specialist. It’s also much more costly.

[ Read: Americans are going to Juarez for cheap dental care ]

Root canals are typically used to treat infections of the pulp—the soft living core of a tooth. A dentist drills a hole through a tooth in order to access the root canals: long, narrow channels containing nerves, blood vessels, and connective tissue. The dentist then repeatedly twists skinny metal files in and out of the canals to scrape away all the living tissue, irrigates the canals with disinfectant, and packs them with a rubberlike material. The whole process usually takes one to two hours. Afterward, sometimes at a second visit, the dentist will strengthen the tooth with a filling or crown. In the rare case that infection returns, the patient must go through the whole ordeal again or consider more advanced surgery.

Zeidler noticed that nearly every time Lund gave someone a root canal, he also charged for an incision and drainage, known as an I&D. During an I&D, a dentist lances an abscess in the mouth and drains the exudate, all while the patient is awake. In some cases the dentist slips a small rubber tube into the wound, which continues to drain fluids and remains in place for a few days. I&Ds are not routine adjuncts to root canals. They should be used only to treat severe infections, which occur in a minority of cases. Yet they were extremely common in Lund’s practice. In 2009, for example, Lund billed his patients for 109 I&Ds.

Zeidler asked many of those patients about the treatments, but none of them recalled what would almost certainly have been a memorable experience.

In addition to performing scores of seemingly unnecessary procedures that could result in chronic pain, medical complications, and further operations, Lund had apparently billed patients for treatments he had never administered. Zeidler was alarmed and distressed. “We go into this profession to care for patients,” he told me. “That is why we become doctors. To find, I felt, someone was doing the exact opposite of that—it was very hard, very hard to accept that someone was willing to do that.”

Zeidler knew what he had to do next. As a dental professional, he had certain ethical obligations. He needed to confront Lund directly and give him the chance to account for all the anomalies. Even more daunting, in the absence of a credible explanation, he would have to divulge his discoveries to the patients Lund had bequeathed to him. He would have to tell them that the man to whom they had entrusted their care—some of them for two decades—had apparently deceived them for his own profit.

Arsh Raziuddin

T HE IDEA OF THE DENTIST AS POTENTIAL CHARLATAN has a long and rich history. In medieval Europe, barbers didn’t just trim hair and shave beards; they were also surgeons, performing a range of minor operations including

bloodletting, the administration of enemas, and tooth extraction. Barber surgeons, and the more specialized “tooth drawers,” would wrench, smash, and knock teeth out of people’s mouths with an intimidating metal instrument called a dental key: Imagine a chimera of a hook, a hammer, and forceps. Sometimes the results were disastrous. In the 1700s, Thomas Berdmore, King George III’s “Operator for the Teeth,” described one woman who lost “a piece of jawbone as big as a walnut and three neighbouring molars” at the hands of a local barber.

Barber surgeons came to America as early as 1636. By the 18th century, dentistry was firmly established in the colonies as a trade akin to blacksmithing (Paul Revere was an early American craftsman of artisanal dentures). Itinerant dentists moved from town to town by carriage with carts of dreaded tools in tow, temporarily setting up shop in a tavern or town square. They yanked teeth or bored into them with hand drills, filling cavities with mercury, tin, gold, or molten lead. For anesthetic, they used arsenic, nutgalls, mustard seed, leeches. Mixed in with the honest tradesmen—who genuinely believed in the therapeutic power of bloodsucking worms—were swindlers who urged their customers to have numerous teeth removed in a single sitting or charged them extra to stuff their pitted molars with homemade gunk of dubious benefit.

In the mid-19th century, a pair of American dentists began to elevate their trade to the level of a profession. From 1839 to 1840, Horace Hayden and Chapin Harris established dentistry’s first college, scientific journal, and national association. Some historical accounts claim that Hayden and Harris approached the University of Maryland’s School of Medicine about adding dental instruction to the curriculum, only to be rebuffed by the resident physicians, who declared

that dentistry was of little consequence. But no definitive proof of this encounter has ever surfaced.

Whatever happened, from that point on, “the professions of dentistry and medicine would develop along separate paths,” writes Mary Otto, a health journalist, in her recent book, Teeth. Becoming a practicing physician requires four years of medical school followed by a three-to-seven-year residency program, depending on the specialty. Dentists earn a degree in four years and, in most states, can immediately take the national board exams, get a license, and begin treating patients. (Some choose to continue training in a specialty, such as orthodontics or oral and maxillofacial surgery.) When physicians complete their residency, they typically work for a hospital, university, or large health-care organization with substantial oversight, strict ethical codes, and standardized treatment regimens. By contrast, about 80 percent of the nation’s 200,000 active dentists have individual practices, and although they are bound by a code of ethics, they typically don’t have the same level of oversight.

[ Read: Why dentistry is separate from medicine ]

Throughout history, many physicians have lamented the segregation of dentistry and medicine. Acting as though oral health is somehow divorced from one’s overall well-being is absurd; the two are inextricably linked. Oral bacteria and the toxins they produce can migrate through the bloodstream and airways, potentially damaging the heart and lungs. Poor oral health is associated with narrowing arteries, cardiovascular disease, stroke, and respiratory disease, possibly due to a complex interplay of oral microbes and the immune system. And some research suggests that gum disease can be an early sign of diabetes, indicating a relationship between sugar, oral bacteria, and chronic inflammation.

Dentistry’s academic and professional isolation has been especially detrimental to its own scientific inquiry. Most major medical associations around the world have long endorsed evidence-based medicine. The idea is to shift focus away

from intuition, anecdote, and received wisdom, and toward the conclusions of rigorous clinical research. Although the phrase evidence-based medicine was coined in 1991, the concept began taking shape in the 1960s, if not earlier (some scholars trace its origins all the way back to the 17th century). In contrast, the dental community did not begin having similar conversations until the mid- 1990s. There are dozens of journals and organizations devoted to evidence- based medicine, but only a handful devoted to evidence-based dentistry.

In the past decade, a small cohort of dentists has worked diligently to promote evidence-based dentistry, hosting workshops, publishing clinical-practice guidelines based on systematic reviews of research, and creating websites that curate useful resources. But its adoption “has been a relatively slow process,” as a 2016 commentary in the Contemporary Clinical Dentistry journal put it. Part of the problem is funding: Because dentistry is often sidelined from medicine at large, it simply does not receive as much money from the government and industry to tackle these issues. “At a recent conference, very few practitioners were even aware of the existence of evidence-based clinical guidelines,” says Elliot Abt, a professor of oral medicine at the University of Illinois. “You can publish a guideline in a journal, but passive dissemination of information is clearly not adequate for real change.”

Among other problems, dentistry’s struggle to embrace scientific inquiry has left dentists with considerable latitude to advise unnecessary procedures—whether intentionally or not. The standard euphemism for this proclivity is overtreatment. Favored procedures, many of which are elaborate and steeply priced, include root canals, the application of crowns and veneers, teeth whitening and filing, deep cleaning, gum grafts, fillings for “microcavities”—incipient lesions that do not require immediate treatment—and superfluous restorations and replacements, such as swapping old metal fillings for modern resin ones. Whereas medicine has made progress in reckoning with at least some of its own tendencies toward excessive and misguided treatment, dentistry is lagging

behind. It remains “largely focused upon surgical procedures to treat the symptoms of disease,” Mary Otto writes. “America’s dental care system continues to reward those surgical procedures far more than it does prevention.”

“Excessive diagnosis and treatment are endemic,” says Jeffrey H. Camm, a dentist of more than 35 years who wryly described his peers’ penchant for “creative diagnosis” in a 2013 commentary published by the American Dental Association. “I don’t want to be damning. I think the majority of dentists are pretty good.” But many have “this attitude of ‘Oh, here’s a spot, I’ve got to do something.’ I’ve been contacted by all kinds of practitioners who are upset because patients come in and they already have three crowns, or 12 fillings, or another dentist told them that their 2-year-old child has several cavities and needs to be sedated for the procedure.”

Trish Walraven, who worked as a dental hygienist for 25 years and now manages a dental-software company with her husband in Texas, recalls many troubling cases: “We would see patients seeking a second opinion, and they had treatment plans telling them they need eight fillings in virgin teeth. We would look at X-rays and say, ‘You’ve got to be kidding me.’ It was blatantly overtreatment—drilling into teeth that did not need it whatsoever.”

Joyce Cordi’s new dentist says her X-rays resemble those of someone who had reconstructive facial surgery following a car crash.

Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings;

rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.

A multitude of factors has conspired to create both the opportunity and the motive for widespread overtreatment in dentistry. In addition to dentistry’s seclusion from the greater medical community, its traditional emphasis on procedure rather than prevention, and its lack of rigorous self-evaluation, there are economic explanations. The financial burden of entering the profession is high and rising. In the U.S., the average debt of a dental-school graduate is more than $200,000. And then there’s the expense of finding an office, buying new equipment, and hiring staff to set up a private practice. A dentist’s income is entirely dependent on the number and type of procedures he or she performs; a routine cleaning and examination earns only a baseline fee of about $200.

In parallel with the rising cost of dental school, the amount of tooth decay in many countries’ populations has declined dramatically over the past four decades, mostly thanks to the introduction of mass-produced fluoridated toothpaste in the 1950s and ’60s. In the 1980s, with fewer genuine problems to treat, some practitioners turned to the newly flourishing industry of cosmetic dentistry, promoting elective procedures such as bleaching, teeth filing and straightening, gum lifts, and veneers. It’s easy to see how dentists, hoping to buoy their income, would be tempted to recommend frequent exams and proactive treatments—a small filling here, a new crown there—even when waiting and watching would be better. It’s equally easy to imagine how that

behavior might escalate.

“If I were to sum it up, I really think the majority of dentists are great. But for some reason we seem to drift toward this attitude of ‘I’ve got tools so I’ve got to fix something’ much too often,” says Jeffrey Camm. “Maybe it’s greed, or paying off debt, or maybe it’s someone’s training. It’s easy to lose sight of the fact that even something that seems minor, like a filling, involves removal of a human body part. It just adds to the whole idea that you go to a physician feeling bad and you walk out feeling better, but you go to a dentist feeling good and you walk out feeling bad.”

Arsh Raziuddin

I N THE SUMMER OF 2013, Zeidler asked several other dentists to review Lund’s records. They all agreed with his conclusions. The likelihood that Lund’s patients genuinely needed that many treatments was extremely low. And

there was no medical evidence to justify many of Lund’s decisions or to explain the phantom procedures. Zeidler confronted Lund about his discoveries in several face-to-face meetings. When I asked Zeidler how those meetings went, he offered a single sentence—“I decided shortly thereafter to take legal action”— and declined to comment further. (Repeated attempts were made to contact Lund and his lawyer for this story, but neither responded.)

One by one, Zeidler began to write, call, or sit down with patients who had previously been in Lund’s care, explaining what he had uncovered. They were shocked and angry. Lund had been charismatic and professional. They had assumed that his diagnoses and treatments were meant to keep them healthy. Isn’t that what doctors do? “It makes you feel like you have been violated,” Terry Mitchell says—“somebody performing stuff on your body that doesn’t need to be done.” Joyce Cordi recalls a “moment of absolute fury” when she first learned of Lund’s deceit. On top of all the needless operations, “there were all kinds of drains and things that I paid for and the insurance company paid for that never happened,” she says. “But you can’t read the dentalese.”

“A lot of them felt, How can I be so stupid? Or Why didn’t I go elsewhere?” Zeidler says. “But this is not about intellect. It’s about betrayal of trust.”

In October 2013, Zeidler sued Lund for misrepresenting his practice and breaching their contract. In the lawsuit, Zeidler and his lawyers argued that Lund’s reported practice income of $729,000 to $988,000 a year was “a result of fraudulent billing activity, billing for treatment that was unnecessary and billing for treatment which was never performed.” The suit was settled for a confidential amount. From 2014 to 2017, 10 of Lund’s former patients, including Mitchell and Cordi, sued him for a mix of fraud, deceit, battery,

financial elder abuse, and dental malpractice. They collectively reached a nearly $3 million settlement, paid out by Lund’s insurance company. (Lund did not admit to any wrongdoing.)

Lund was arrested in May 2016 and released on $250,000 bail. The Santa Clara County district attorney’s office is prosecuting a criminal case against him based on 26 counts of insurance fraud. At the time of his arraignment, he said he was innocent of all charges. The Dental Board of California is seeking to revoke or suspend Lund’s license, which is currently inactive.

Many of Lund’s former patients worry about their future health. A root canal is not a permanent fix. It requires maintenance and, in the long run, may need to be replaced with a dental implant. One of Mitchell’s root canals has already failed: The tooth fractured, and an infection developed. He said that in order to treat the infection, the tooth was extracted and he underwent a multistage procedure involving a bone graft and months of healing before an implant and a crown were fixed in place. “I don’t know how much these root canals are going to cost me down the line,” Mitchell says. “Six thousand dollars a pop for an implant —it adds up pretty quick.”

Joyce Cordi’s new dentist says her X-rays resemble those of someone who had reconstructive facial surgery following a car crash. Because Lund installed her new dental bridges improperly, one of her teeth is continually damaged by everyday chewing. “It hurts like hell,” she says. She has to wear a mouth guard every night.

What some of Lund’s former patients regret most are the psychological repercussions of his alleged duplicity: the erosion of the covenant between practitioner and patient, the germ of doubt that infects the mind. “You lose your trust,” Mitchell says. “You become cynical. I have become more that way, and I don’t like it.”

“He damaged the trust I need to have in the people who take care of me,” Cordi says. “He damaged my trust in mankind. That’s an unforgivable crime.”

This article appears in the May 2019 print edition with the headline “The Trouble With Dentistry.”

ABOUT THE AUTHOR

FERRIS JABR is a writer based in Portland, Oregon. His work has appeared in The New Yorker, The New York Times Magazine, and Scientific American.

APPENDIX M:

This article is found on the American Academy of Endodontists webpage.

My comments are in red and are supported by current research presented in my paper.

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Root Canal Safety

The Truth About Endodontic Treatment and Your Health

A Consultation with Dr. Marcus Johnson

This article is endorsed by the

Dear Doctor,
I read on the internet that root canals cause cancer. Is this true?

Dear Jennifer,
Unfortunately, sources that rank high on a Google search do not always rank high on truth. So let’s set the record straight: Root canal treatment does not cause cancer or any other disease. Root canal treatment does not cause cancer or any disease. It is the residual infection in the tooth and the surrounding bone after a poorly performed root canal procedure that can be a risk factor for various systemic diseases. The fact is that root canal treatment—performed 25 million times every year by skilled dental professionals—stops infection and saves teeth. This is a misleading statement because all root canal teeth remain infected after root canal treatment and lingering infection can persist in the surrounding bone long after a root canal is completed. ​​ All root canals are NOT the same. A mediocre root canal procedure eaves abundant dead tissue and infection inside the tooth and prevents complete healing of the infection in the bone around end of the tooth root. A skilled ​​ endodontist using advanced techniques and equipment such as photo acoustic laser can perform a root canal with a much higher degree of competence than standard root canal treatment. Let’s take a closer look at what root canal treatment is, why it’s needed, and where these discredited theories come from.

Tooth Anatomy 101

A smile reveals the pearly-white crowns of your teeth. But each tooth also has one or more roots that extend down into the bone beneath your gums. In addition, there is a hollow space in the center of each tooth called the “pulp chamber” that contains living tissue (pulp). The nerves and blood vessels of the pulp pass through narrow spaces called canals, which branch from the pulp chamber and out through the root tip. Once outside the tooth, they connect with the rest of the body.

Now let’s go back to that pearly-white tooth surface you can see. This is enamel, the hardest substance in your body. It protects teeth from damage and harmful bacteria. But sometimes a tiny hole (cavity) or a crack develops in the enamel that allows bacteria to get in and begin eroding the tooth. If left alone, these bacteria may reach the pulp tissue, causing tooth destruction, inflammation and pain.

If this inflammatory process remains untreated, the pulp tissue can die off—leading to bacterial infection.  An infection inside the tooth may pass through the root canals into the surrounding tissues, bone and supporting structures. This infection can result in a painful jaw abscess, and in rare cases may be life-threatening. In some cases the pain may eventually subside or go away. However, the infection won’t—even with the use of antibiotics. Removing the infection is necessary to safeguard your oral health and even your general health.

There are only a few effective treatment options to address an infected tooth: You can extract (pull) the tooth; you can get a “root canal”—shorthand for what dentists call endodontic (“endo” – inside; “odont” – tooth) treatment; or you can get an apicoectomy, a minor surgical procedure that involves cutting out the infection from the end of the root. Only endodontic treatment or apicoectomy can actually save the tooth.

Saving an Infected Tooth

Endodontic treatment involves removing inflamed, diseased pulp tissue and their byproducts, disinfecting the tooth, and then sealing the inner chamber and the canals so that bacteria will not be able to get back in. Conventional root canal treatment leaves a significant amount of dead tissue in the root canal system and ​​ does not predictably and effectively disinfect the root canal system, and porous dentin tubules. A highly skilled endodontist using photoacoustic laser technique will do a much better ​​ job at achieving total removal of dead tissue and root canal disinfection. This in turn will allow better healing of the infection in the surrounding jaw bone. ​​ This is done in a dental office, usually under local anesthesia. The tooth is then restored with a permanent filling material and often crowned (capped) to strengthen it. A root-canal-treated tooth can last decades with proper care.

Dentists who specialize in this treatment are called endodontists. They go to specialty school for an additional two years or more after dental school to learn state-of-the-art techniques, often utilizing tiny instruments, microscopes and digital imaging. They do this because they want to stop disease, not cause it!

Discredited Theories

The root (if you’ll pardon the pun) of the false assumption that endodontic treatment can cause cancer is based on false theories of an early 20th century dentist named Weston Price. He believed that leaving a “dead” organ in the body (in this case, the tooth) leads to numerous seemingly unrelated maladies. Yet getting rid of dead tissue is exactly what root canal treatment is designed to do It does NOT get rid of dead tissue. Standard root canal treatment leaves a significant amount of dead tissue in the root canal system. —with the significant bonus of keeping the tooth!

In 1951, the highly respected Journal of the American Dental Association, an evidenced-based publication, devoted an entire issue to re-examining Dr. Price’s ideas. This has been proven false. Not surprisingly, his conclusions did not hold up to the standards of modern scientific research and dental care. FALSE. The 1951 analysis by the American Dental Association is flawed and based on outdated beliefs such as bacteria ​​ detected in root canal teeth is the result of contamination. Current peer reviewed studies show the role of chronic inflammation and infection on systemic diseases, just like Price showed over 100 years ago. From that point on, endodontic procedures became the preferred method of treating salvageable infected teeth. And since then, advancements in medicine, techniques and technologies have made root canal treatment more predictable and successful than ever.

As for the risk of cancer specifically, a study published in a journal of the American Medical Association (JAMA Otolaryngology—Head & Neck Surgery) found in 2013 that cancer risk does not increase after having a root canal treatment. In fact, the study showed that dental patients with multiple endodontic treatments had a 45 percent reduced risk of cancer! NO. The article cited was not about root canals at all. The article was about how the acid produced by cavity causing bacteria and create an immune response that may lower the incidence of one type of cancer in the mouth. Not all types of cancer in all parts of the body. Most importantly, root canal teeth were only mentioned because people with a root canals tend to have a lot of cavities therefore a lot of acid producing bacteria. Root canal teeth had absolutely ​​ nothing to do with the ​​ mechanism of action. The analysis by this author is misleading and false.

This is not to say that root canal treatment doesn’t have any risks—all medical procedures do. For example, while the success rate of root canal treatment is very high, there is a risk that it won’t work the first time and the infection could return. Soreness and lingering numbness from local anesthesia are also potential risks.

Yet tooth extraction also has risks that include infection, soreness, lingering numbness and accidental damage to adjacent teeth. In addition, there is the added expense of replacing the extracted tooth if one chooses to so do.

The Choice Is Yours

The choice of whether or not to undergo root canal treatment is yours alone. It’s important to discuss all risks and benefits with your endodontist or general dentist fully so you understand your options. And in order to make an informed decision, it is essential to have the most up-to-date evidence-based information available—not discredited antiquated theories. They are not discredited theories and they are not antiquated. ​​ Interestingly, the American Dental Association cites a 1951 publication as their source in the attempt to debunk focal infection.!! But don’t look at the old research. Look at the current research. And current research is reestablishing the role of focal infection on systemic diseases. Don’t hesitate to ask your endodontist or general dentist if you would like to know more. You can also visit the website of the American Association of Endodontists for scientifically accurate information on root canal procedures. They are not a source of trusted information in my opinion.

Review Date: 7/1/2018
Authored By: Dr. Marcus Johnson

APPENDIX N:

Below is an article published in the peer reviewed journal Operative Techniques ​​ in Otolaryngology-Head and Neck Surgery where I was lead author along with two Ear Nose and Throat physicians. This article is actually one of the references cited by the AAE in the article Maxillary Sinusitis of Endodontic Origin. The surgery for this case was performed in the operating room at Putnam Hospital. I performed the surgery to remove the infected tooth and diseased bone in the upper jaw and ENT physician Gary Fishman, MD performed the sinus surgery. These are the kinds of cases that I performed while on staff at Putnam hospital.

Also below is also a fax sent to Putnam Hospital by attorney Jackson Leeds. I never met Jackson Leeds but I heard a lot about him from others who were also targeted by him. I will not get into the motives behind Jackson Leeds actions because as lawyers do what lawyers do, he may file a frivolous nuisance lawsuit against me. But suffice it to say he seemed to have been following everything that I did. Putnam hospital of course ignored his fax and nothing became of it. Atypical facial pain, or NICO as it was called, was such a very small percentage of my practice anyway and there are many peer reviewed studies supporting the treatment when properly diagnosed.

This was the minefield I was playing in. Lawyers trying to disrupt my practice with faxes like these. Internet trolls trying to get patients to sue me. A lawsuit filed against me (and others) by attorney David Wilzig in California where the plaintiff never wanted me included in the lawsuit, was happy with my treatment, and had no idea that Wilzig had sued me!!

You can read more about this case and others, Wilzig and his relationship with quackwatch and Stephen Barrett here:

https://bolenreport.com/quackbuster-attack-on-nico-flops/

https://bolenreport.com/wp-content/uploads/2016/04/Panahpour-v-Wilzig-Complaint-Stamped-1.pdf

Just a few references regarding quackwatch and Stephen Barrett.

You can google quackwatch and Stephen Barrett and decide for yourself he is a credible source, and most importantly, an objective and fair source.

https://www.sitejabber.com/reviews/quackwatch.com

http://doctorwatch.blogspot.com/2010/04/dr-ray-sahelian-md-discusses-quackwatch.html

https://archive.org/stream/QuackWatchStephenBarrettIsABIGQuackENCOGNITIVE.COM/QuackWatch--Stephen%20Barrett%20Is%20a%20BIG%20Quack%20%7C%20ENCOGNITIVE.COM_djvu.txt

Founder, executives of drug company guilty in conspiracy that fed opioid crisis

 Reuters 4 hours ago

By Nate Raymond

BOSTON (Reuters) - The founder of Insys Therapeutics Inc on Thursday became the highest-ranking drugmaker executive convicted in a case tied to the U.S. opioid crisis, when he and four colleagues were found guilty of bribing doctors to prescribe an addictive painkiller, helping drive the epidemic.

A federal jury in Boston found John Kapoor, 75, the drugmaker's former chairman, and his co-defendants guilty of racketeering conspiracy for a scheme that also misled insurers into paying for the drug.

Kapoor's 2017 arrest came on the same day U.S. President Donald Trump declared the epidemic that has caused tens of thousands of overdose deaths annually a public health emergency.

Kapoor was found guilty of running a wide-ranging scheme to bribe doctors nationwide by retaining them to act as speakers at sham events at restaurants ostensibly meant to educate clinicians about its fentanyl spray, Subsys.

Prosecutors said Kapoor also directed efforts to defraud insurers into paying for the drug. His co-defendants include former Insys executives and managers Michael Gurry, Richard Simon, Sunrise Lee and Joseph Rowan.

John Kapoor, right, oversaw Insys’s marketing strategy of hiring doctors as seminar speakers as cover to pay them more than $1m to prescribe high doses of Subsys. (Photo: Brian Snyder/Reuters)

They face up to 20 years in prison. They denied wrongdoing, and defense lawyers signaled plans to appeal.

"Dr. Kapoor is disappointed in the verdict, as are we," Beth Wilkinson, Kapoor's lead attorney, said in a statement. "Four weeks of jury deliberations confirm that this was far from an open-and-shut case."

The U.S. Food and Drug Administration approved Subsys in 2012 only for use in treating severe cancer pain. Yet prosecutors claimed doctors who took bribes often prescribed Subsys to patients without cancer, helping boost sales for Chandler, Arizona-based Insys.

Fentanyl is an especially potent opioid, 100 times stronger than morphine.

Kapoor's lawyers acknowledged Insys paid doctors but contended he believed they were being legally paid to discuss Subsys' benefits.

Wilkinson in her opening statement in January told jurors Kapoor had no knowledge of "side deals" being cut with doctors. She said a former executive turned government witness, Alec Burlakoff, kept Kapoor in the dark about them.

Burlakoff, Insys' ex-vice president of sales, and Michael Babich, its former chief executive, testified against Kapoor after pleading guilty to participating in the scheme.

Jurors during the trial watched a rap video Insys produced for its sales staff describing its strategies that starred Burlakoff dressed as a dancing bottle of Subsys.

Witnesses also testified that Lee, an ex-stripper turned Insys regional sales director, gave a lap dance to a doctor at a Chicago club while pushing him to prescribe Subsys.

"We were expecting a different result," said Peter Horstmann, Lee's attorney. He promised to challenge the verdict.

(Reporting by Nate Raymond; Editing by Scott Malone and Bill Berkrot)