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Gammal on Focal Infection
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Focal Infection or Not Robert Gammal BDS. FACNEM(Dent) source: BCD Introduction In recent years there has been a reawakening of the dangers of oral infections and their potential disastrous effects on systemic health. Dead and infected teeth are often treated 'conservatively' in modern dentistry by performing a treatment called Root Canal Therapy. As dentists we are indoctrinated that it is better to save a tooth at any cost - although the real costs to individual health and the society at large are usually totally overlooked by the teaching institutions. This may at first seem surprising considering that dentistry is touted as a health providing profession. On the other hand, if the dental profession were to accept the reality of Focal Infection (and the potential sources of this oral infection), we would have to reassess some of the fundamental treatment concepts being taught and practiced in dentistry. Root Canal Therapy must surely be one of the prime candidates for this reassessment. With the resurgence of an interest in this area, there is also a blatant resistance by the dental profession of the reality of Focal Infection Theory. Both the Australian Dental Association and the universities have stated that Focal Infection is a concept dating back 150 years and one, which has been disproven by recent research. This supposed research has never been cited by either the Australian Dental Association or the universities. This attitude flies in the face of published scientific research some of which is even published in the dental journals. In 1996 the Journal of Periodontology devoted a whole issue to this subject relating periodontal disease to a variety of systemic diseases which included coronary heart disease, diabetes and low birth weight babies. Quintessence International is one of the most highly respected dental journals in the world. They state in 1997: "The detrimental effect of focal infection on general health has been known for decades. Chronic dental infections may worsen the condition of medically compromised patients." (335) As is common in these sorts of debates the dental authorities will mention research which is 100 years old - in this case the work of people like Billings, Rosenow and Price - and claim that because it is old research it is no longer relevant. They completely ignore the research which is more current. Interestingly all of the research conducted by Dr Weston Price in the 1920's is fully supported by the recent literature. It is well accepted in the profession that any form of oral surgery will produce a bacteremia and that this may cause infections in susceptible tissues, especially the heart. What is less accepted is that other sources of sepsis exist in the mouth. These include;
The substances that are spread from such a focus of course include the bacterial, viral and fungal organisms that survive in such foci. It will also include the endotoxins produced by anaerobic organisms in the foci. (354-361) Current research indicates that other toxins produced by anaerobic organisms are also released into the body - these include hydrogen sulphide products and methyl mercaptans, both of which are highly poisonous products. (362-385) What this means of course is that a dental focus of infection may not only infect other tissues but also poison the body with a variety of toxins. Professor Boyd Haley from Kentucky University has recently demonstrated the presence of these toxins and has developed techniques to test for them. (You can visit Prof Haley's site at http://www.altcorp.com/oralartc.htm/) Distribution of organisms and their toxins throughout the body is by various routes: (341-353) blood circulation through out the body lymphatic distribution locally and then to blood stream retrograde axonal transport - transport along nerve fibres and back to the brain.
In 1951 the problem of focal infection was discussed at length in the Journal of the American Dental Association. -Mechanism of Focal Infection J Am Dent Assoc Vol 42 June 1951 Definitions "A Focus of infection has been defined as a circumscribed area infected with micro-organisms which may or may not give rise to clinical manifestations. A Focal Infection has been defined as sepsis arising from a focus of infection that initiates a secondary infection in a nearby or distant tissue or organs." The article states clearly that "The concept of focal infection in relation to systemic disease is firmly established" and that "The origin of many toxic or metastatic diseases may be traced to primary local or focal areas of infection". This article also states that there are two major mechanisms of focal infection: a) an actual metastasis of organisms from a focus
Once the infection passes the abscess area about the tooth: a) they may multiply in the blood setting up an acute or chronic septicaemia.
The authors continue to show a relationship to allergic / immune reactions: The bacteria at the focus may undergo autolysis or dissolution. Some of the products of this dissolution, diffusing into the blood or lymph , may sensitise in an allergic sense, various tissues of the body." "A later diffusion of these products on reaching the sensitised tissue may call forth an allergic reaction." Considering that the above article was published in 1951, it may be claimed in the late 90's that this too is old research. For this reason the first section of references associated with the this article are taken mainly from the last 40 years of Medline data bases after combining the search requests 'focal infection' and 'dentistry'. Henig and Eliezer state in their paper "Brain Abscess following Dental Infection" ; " The elimination of infection from human tissue is a necessary goal based on fundamental biological principles. It is even more essential in an environment in which the natural defence mechanisms of the body are unable to function. Such an environment is the root canal of a tooth." This statement is published in the Journal of Oral Surgery in 1978. Although the authors believed at the time that it is possible to sterilise a tooth (since disproven) their statement underlies the basic principles of Focal Infection Theory. What is most interesting from this search is the number of reviews of the literature which have been done in this time. Some of the latest being in 1997. Published case reports include the following disease states as
being directly related to Oral infections:
It is not my intention to do a formal literature review of focal infections, but merely to present you with a list of references, which of themselves validate the reality of focal infection from dental origins. It is my hope that the dental profession will acknowledge this reality anåd reassess certain treatment concepts, which currently disregard the published literature. All references are available in Medline.
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