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Biological Dentistry

NICO-CAVITATION-FDOJ

Dead Bone Tissue

In this article, I will talk about NICOs (also called FDOJ or cavitation) seen in the jawbone, which is one of the important topics of biological dentistry. Cavitations are not taught to us in school, so they are not known in general dentistry. However, it is an important topic since studies have shown that it may be associated with systemic disorders and may lead to conditions such as toothache or trigeminal neuralgia, the cause of which cannot be found. Since they can occur especially after tooth extractions, I recommend you to read this article if you have had or will have a tooth extraction before.


What is NICO – Cavitation – FDOJ?

In fact, cavitation is the name given to the cavities seen in the bone, known in the field of orthopedics. It is especially seen in the knee and hip region. Even in the 1920s, researchers found these cavities in the jaw bones, but the first researcher to study them in detail was Jerry Bouquot (1), an oral pathologist with more than 300 articles. Bouquot mostly worked on patients with neuralgia, that is, pain caused by nerves. Therefore, he named these bone areas NICO, which means “Neuralgia-inducing cavitational osteonecrosis”. “Osteonecrosis” here means a dead bone. Cavitation is a cavity or hollow.




Later, another dentist, Johann Lechner, who also did a lot of work in this field, realised that these lesions were not only seen in patients with neuralgia, but that most of them were asymptomatic. He believes that these lesions are misnamed because bone tissue meets fatty tissue where it should be and does not always cause neuralgia. Instead, it is called “Fatty degenerative osteolysis in jawbone”. This can be explained as fatty degenerative osteolysis in the jawbone.

When we open these areas surgically, we encounter a bone that easily disintegrates. It may contain soft tissue or fat drops floating on the blood. Normally, there are also fat cells in the bone, but here they are visibly more abundant. Bouquot suggests that these fat cells may have come together due to the lack of blood supply (2).


Why NICO – FDOJ – Cavitations Matter?

As mentioned above, they already cause pain in some of the patients and affect the quality of life badly. These patients may have to use heavy medications unnecessarily. Sometimes, unnecessary root canal treatments and extractions are performed, assuming that the pain is caused by the teeth.

But are they harmless when they do not cause symptoms? We can find the answer to this in Lechner’s studies. Lechner showed that a very high amount of an inflammatory cytokine called RANTES/CCL5 was found in cavitations (35 times higher than normal). Cytokines such as TNF-α and IL-6, which we normally expect to see in inflamed areas, were found far below the level seen in healthy jawbone (3). A very interesting picture… In other words, there is no inflammation that we are normally used to. There is a different type of inflammation and it is called “silent inflammation”. In addition, the absence of cytokines such as TNF-α and IL-6 here causes the immune system not to be informed that there is a problem here, and the problem grows silently because it is overlooked.

What is the cytokine RANTES / CCL5 seen in FDOJ / NICO lesions? Rantes is a “chemokine” that signals inflammatory cells such as T cells, basophils and monocytes to come to the site. It is involved in acute inflammation as a natural part of the process and is involved in many diseases. However, it has been observed that it can have damaging effects in many chronic diseases such as rheumatoid arthritis, multiple sclerosis, chronic fatigue syndrome, and in some types of cancer such as breast cancer, stomach cancer, pancreatic cancer by enabling the migration of cells that facilitate the inflammatory process (4). It is observed that the amount of RANTES/CCL5 increases in the blood or cerebrospinal fluid depending on the region where the disease is observed. It is even thought to play a role in cancer metastasis (5).

Therefore, it is suggested that when such a cavitation with high amounts of RANTES occurs in the jawbone after tooth extraction, it activates the signalling mechanism that feeds inflammatory processes in the body. Lechner has many studies on the relationship between different diseases and FDOJ. I think it is an important finding that RANTES levels in the blood decrease when cavitations in the jawbone are physically cleaned(6).


How are NICO – Cavitation – FDOJ lesions diagnosed?

In very advanced cases, it is possible to see the lesions even on X-rays. Sometimes they can be detected in 3D tomographs. It is also possible to diagnose with the dental ultrasound device developed by Lechner, which is only used in Germany and Switzerland (as far as I know).



The X-rays belong to my own patients.



How are NICO – Cavitation – FDOJ lesions treated?

Before explaining why these lesions occur and how they can be prevented, I would like to talk briefly about how they are treated, because I think the importance of prevention can be better understood when you realise that treatment is not simple.

Unfortunately, it is not possible to cure these lesions with an external medication because they are areas that do not bleed and therefore do not feed. Some people have tried to apply ozone by entering the area with an injector, but it was not successful.

Therefore, this area needs to be surgically opened, curetted (scraped clean) and filled with blood in order to remove the dead bone and regenerate healthy bone. In order to support this process, the application of ozone to the opened and cleaned area and the placement of PRFs obtained from the blood taken from the patient in the area are procedures that are applied as standard in biological dentistry and which I also apply in my clinic.

However, the environment that causes this lesion to form in the bone also needs to be corrected. To understand how we can do this, let’s look at the theories about the causes of cavitations. I will then talk about how we can promote bone healing…

Below you can watch a video of how I performed the operation [if it doesn’t scare you 🙂 ].



 





Why does NICO – Cavitation – FDOJ occur?

Cavitations occur 95% of the time after tooth extraction. A small proportion of them can be caused by the bud of the 4th molar behind the wisdom teeth in some people.

One of the most important causes is thought to be insufficient blood supply or clotting problems in the area. In his studies, Bouquot found that 73% of patients had hypercoagulability (blood clotting tendency is higher than normal). Examples include stroke survivors who are prone to clotting. Bouquot also saw that in NICO cases, that is, in cases where cavitation is accompanied by pain, the pain decreased when he used blood thinners. However, he says that since the doses given were experimental, they were very high doses and could not be used for more than a month, so they could not be treated in this way.

According to Lechner, bone healing is impaired by imbalances in cytokines and hormones (7). Normally, there are stem cells waiting to differentiate in the bone marrow and they can differentiate into bone cells or adipocytes (fat cells) according to the orders they receive (8). Here, factors that cause stem cells to differentiate into adipocytes may affect the healing after tooth extraction and lead to the formation of FDOJ. These factors include vitamin D deficiency, inadequate expression of osteocalcin (vitamin K2 is required for its production), high dose glucocorticoids, estrogen deficiency and diabetes (8). Although estrogen deficiency increases the tendency of stem cells to transform into fat cells, its excess facilitates the formation of cavitation as it increases the tendency of blood to clot (9).

Lechner also mentions in one of his articles that the vitamin D receptor – VDR – can be inactivated by various bacteria, which can impair bone metabolism. Some of the infections that can inactivate the VDR are tuberculosis, borreliosis, chlamydia, herpes, Epstein-Barr, cytomegalovirus and aspergillus infections. When the VDR is inactivated, 1,25 (OH) D, the active form of vitamin D, rises too high and works to support osteoclastic activity, i.e. bone destruction. While 1,25 (OH) D is high, 25 (OH) D measured in blood tests remains low. Lechner said that in such cases, vitamin D supplementation would not work and would even be counterproductive (10). Trying to get vitamin D from the sun and foods as much as possible is actually the ideal, but if this is not possible, I think it would be better to use vitamin D supplements in many cases. In addition, the use of vitamin D and K2 may also help to balance. In addition, if there is a suspicion of infections of the type I mentioned above, it may be important to investigate this before the cavitation operation, especially for those with serious chronic diseases.

In the book titled “Toxic Tooth” written by maxillofacial surgeon Robert Kulacz and cardiologist Thomas Levy, alcoholism, hypothyroidism, autoimmunity and hypersensitivity, systemic lupus erythematosus, antiphospholipid syndrome and maxillary sinus infection were shown among the systemic conditions that predispose to cavitations (9).





How can NICO – Cavitation – FDOJ’s be prevented?

As I mentioned above, since they are most commonly seen after tooth extractions, it is important what to do before, after and during tooth extraction.

Things to Consider Before Tooth Extraction

(Actually, our subject is cavitations, but we can take these factors into consideration for the success of all surgical procedures involving bone).

Since the systemic condition is closely related to bone metabolism, trying to correct chronic diseases, hormonal imbalances, vitamin mineral deficiencies as much as possible should be the first preparation for surgical procedures. Of course, if you have a chronic disease, I am not saying that you should not undergo surgery without correcting it. In most cases, this is not possible. But for example, there are methods such as paying more attention to your diet for a few months before surgery, exercising, etc. that change the course of many chronic diseases in a positive way and are in your hands. In the case of a non-urgent oral surgical procedure, I think it would be better to coincide the procedure with a period when your general health is more stable, perhaps when some corrections are made with a functional medicine doctor.

Apart from this, I can list the general recommendations we give as preparation for surgery as follows:


      • D3K2, magnesium, vitamin A, zinc and vitamin C supplements


      • Apart from these, a good quality multivitamin can be taken in the two months before the operation to meet other possible deficiencies. (I do not like iron and calcium in multivitamins. It is also important that the vitamins in it are selected from high bioavailability and non-toxic forms. I like the Goodday brand 2PD multivitamin in Turkey, which has these features – I have no agreement with them).
      • Anti-inflammatory nutrition – Avoid packaged foods, processed foods, simple carbohydrates and foods that you know are bad for you as much as possible.
      • Pay attention to adequate protein intake. Try to get at least 0.8g of protein per kg of body weight each day. The amount you need to take increases according to your level of physical activity. I believe that animal protein sources will be more beneficial (eggs, liver, red meat, fish, organic chicken, etc.).
      • Eat healthy fats, limit omega 6 intake.
      • Include practices to regulate your circadian rhythm in your life. This is very important for the correct functioning of your hormones. Remember that bone metabolism is affected by circadian rhythm.
      • Exercise. You can choose any exercise that you can sustain. Our goal here is to increase microcirculation and lymph drainage.







Things to Consider During Tooth Extraction

In many sources (internet articles, not scientific papers) on cavitations, the causes of cavitations during tooth extraction are the incomplete removal of the periodontal ligament around the tooth root and the use of local anaesthetics containing vasoconstrictors that constrict blood vessels. Let’s look at these substances:


    • It is said that the periodontal ligament surrounding the tooth root in a healthy tooth, which continues to be present when the tooth is extracted, disrupts bone formation. I have not heard Bouquot or Lechner mention this, but it is mentioned in “Toxic Tooth”. Nevertheless, after tooth extraction, I clean the area both with hand tools and with a device called a piezosurgery device, which works by vibration and does not damage soft tissues such as vessels and nerves. I do this in order to remove infected tissues, to create bleeding areas in the thick cortical bone with low blood supply and to eliminate the periodontal ligament.


    • It is recommended to use local anesthetics that do not contain “vasoconstrictors” (usually adrenaline) because they reduce the blood supply to the area. (Obviously, it is very difficult to work with these anesthetics because their effects are very short). However, the literature shows that epinephrine (adrenaline) actually reduces blood supply. In addition, when the vasoconstrictors are gone, oxyradicals are released into the area and this can lead to a very unhealthy jawbone (2).


After extracting the tooth and cleaning the extraction cavity, I apply ozone to the area within the framework of the biological dentistry extraction protocol. With this, we aim to clean the microorganisms that may be present in the area and increase blood supply (11).

Finally, we obtain PRFs from the blood taken from the patient just before the extraction with a special centrifuge device and place them in the extraction cavity. According to a systematic review and meta-analysis published in 2021, PRF applied after wisdom tooth surgery reduces the likelihood of postoperative pain and inflammation in the bone and promotes soft tissue healing (12). PRF does this with elements such as leukocytes, platelets and growth factors.


Things to Consider After Tooth Extraction

The two most vital items you should pay attention to after tooth extraction are not rinsing your mouth and not spitting. Depending on the time of the procedure, it is very important to follow this rule on the day of the procedure and the next day. In order for the wound healing to be healthy, the blood clot must hold on to the extraction cavity. Therefore, avoid doing things such as mouth rinsing, constant spitting, pulling and looking at the cheek if you have had an operation where the gum is cut. Avoid using straws that will create a vacuum effect and smoking (as you can guess, the vacuum effect is the most innocent part of smoking!) Do not consume granular foods that can escape into the extraction area for a few days. In summary, we need to take care of the blood clot formed here after the procedure because this clot will heal the area.

Rinsing the mouth alternately with saline and lugol water for 1 week after the procedure will help wound healing and help prevent the wound from becoming infected (you can only leave it for the first evening and pour it out of the mouth very gently because we said that there should be no rinsing and spitting, let’s remember. Or you can start the next day if you have not eaten).

Other rules to be followed after tooth extractions (applying ice, etc.) I do not write in order not to distract our subject too much.

In order to form healthy bone in the extraction cavity, you can continue to apply the list I recommended for the pre-procedure in the post-procedure period.

Take care to rest for 3-4 days after the procedure and avoid physical activity. However, exercising in the following period will be beneficial for the blood supply of the tissues.

Again, due to its positive effects on circulation, LLLT or red light application is a support that those who have the opportunity can benefit from (I recommend you to try to get plenty of daylight instead). In addition, I observe that my patients who take high doses of vitamin C (IV or liposomal, but especially IV) on the day of the procedure and the next day have a more comfortable post-procedure period.

Various supplements to increase blood supply and other methods to increase tissue oxygenation can also be considered in risky patients.





To Summerise

If the extraction cavity does not heal properly after tooth extraction, it can have systemic consequences or make it difficult for your existing chronic diseases to heal. The formation of fatty tissue instead of bone in the extraction cavity may be caused by systemic factors related to your general health and mistakes during and after extraction. Taking care of your general health before tooth extractions and bone surgeries and acting in accordance with the rules during the operation period can support bone healing and prevent this type of complication.




Resources

1 – https://www.researchgate.net/profile/Jerry-Bouquot

2 – https://wordofmouth.iaomt.org/s01-e05-jerry-bouquot-dds-msd-neuralgia-inducing-cavitational-osteonecrosis-nico/

3 – https://pubmed.ncbi.nlm.nih.gov/30519117/

4 – https://journals.sagepub.com/doi/full/10.4137/BCBCR.S15119?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org

5 – https://pubmed.ncbi.nlm.nih.gov/17914389/

6 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044077/

7 – https://www.dovepress.com/osteoimmunology-of-tumor-necrosis-factor-alpha-il-6-and-rantesccl5-a-r-peer-reviewed-fulltext-article-CCIDE

8 –https://medscimonit.com/abstract/index/idArt/897044

9- Kulacz, D. R., & Levy, M. D. J. D. (2014, November 1). The Toxic Tooth: How a root canal could be making you sick (1st ed.). Medfox Publishing.

10 – https://www.dovepress.com/the-vitamin-d-receptor-and-the-etiology-of-rantesccl-expressive-fatty–peer-reviewed-fulltext-article-IJGM#ref52

11- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092153/

12 – https://pubmed.ncbi.nlm.nih.gov/32950350/


 

Do Bacteria In Your Mouth Affect Your Blood Pressure?

Do Bacteria in Your Mouth Affect Your Blood Pressure?

You may have heard of the effect of Nitric Oxide (NO) in lowering blood pressure. NO, which is produced in the sinuses and inhaled when we breathe through the nose, has a blood pressure-lowering effect by dilating the blood vessels. When you breathe through your mouth, you are deprived of this NO. This is only one of the benefits of nasal breathing.

Bacterias in mouthAccording to recent studies, the bacteria in our mouth also contribute to NO production and have such an effect on blood pressure. The nitrate we take with food reaches the mouth with saliva and is converted into nitrite by some bacterial groups and makes an important contribution to the NO cycle in this way (1).

For example, in one study, participants were made to use chlorhexidine mouthwash for 1 week, and at the end of this one week, it was observed that both the oral flora became less diverse and blood pressure values increased. Other similar studies were also conducted and similar results were obtained. When the use of mouthwash was stopped, the values started to decrease to the old level within a few days(2). In fact, the difference between the blood pressure values in this study does not seem very high at first glance. And chlorhexidine is a mouthwash that is only used for a short time. So the issue I want to draw attention to here is not the use of chlorhexidine.

The point I want to draw attention to is this: bacteria in the mouth are not creatures that we should normally fight and destroy. They have various tasks, just like intestinal bacteria… Some of these tasks have systemic consequences as I have shared here. Of course, in some cases it may be necessary to use antibacterial agents to get rid of pathogenic bacteria. However, the bacteria living in a healthy mouth are important for the continuity of this health. Therefore, I believe that we need to change our understanding of oral health as only oral hygiene. We should take good care of our oral bacteria just like intestinal bacteria. We should try to create an environment where the species that work in our favour are happy. We can do two things for this:

Firstly, we can avoid oral care products that contain harsh chemicals unless there is a special reason. We can create an oral care routine that is as natural and gentle as possible.

Secondly, and more importantly, if we have a dietary habit that feeds disease-causing bacteria, we can abandon it. Frequent consumption of simple carbohydrates, which create an acidic environment in the mouth, allows harmful bacteria to take control. Bacteria that work for our benefit have difficulty in this environment, while pests declare their sovereignty. When we resort to antibacterials to deal with these pests, we enter a vicious circle… The only way to break this cycle in order to benefit from the blessings of a balanced ecosystem is to welcome friendly bacteria…

 

Resources:

  1. https://www.sciencedirect.com/science/article/abs/pii/S0891584909000288?via%3Dihub
  2. https://doi.org/10.1016/j.freeradbiomed.2012.11.013
 

Is Tooth (Tartar) Cleaning Harmful?

“They say it is harmful to have dental tartar removed” is probably one of the most frequently heard words by dentists. It is not right to process the teeth while standing still, yes. However, once the deposits on the teeth are petrified with minerals in the saliva, it is not possible to remove them with a brush. Sometimes patients say that it breaks spontaneously, but in this case, of course, there is no clean surface left behind.

What’s inside these stones? Minerals, protein-polysaccharide complexes, epithelial cells, leukocytes and microorganisms… Pay attention to the content… Of course, an inflammatory response develops in the gingiva directly adjacent to this structure. Tissue damage occurs due to both the direct activity of microorganisms and the destructive enzymes that result from the inflammatory response (1). It is possible to see this damage directly with the eyes. Below is the image of the gingiva that comes out just below when the tartar is removed. This is the picture seen only when the stone is removed without touching the gums.

 

 

Gingivitis can have serious consequences, including tooth loss, but the problem may not be limited to the mouth. It is thought that gingivitis may be associated with heart diseases, diabetes, low birth weights, rheumatoid arthritis and many other systemic problems. There are different theories about this. According to someone, the patient has a predisposition to these problems and they occur independently of each other. According to another theory, signals caused by this inflammation in the gums (cytokines, etc.) spread throughout the body through circulation. A third theory says that bacteria themselves enter the circulation and cause problems, and there are studies showing that these bacteria are found in clots from heart attack survivors. In a fourth theory, antibodies produced against bacteria attack the body itself due to “molecular similarity” (2). Did all this remind you of another painting? This situation always reminds me of “leaky gut” and the events that occur as a result. Then we can talk about a kind of “leaky gum,” right?

Going back to the initial question… There may be some chance of scratching your teeth while cleaning your tartar (this is also a bit related to how the cleaning is done). However, the damage caused by not cleaning it is many times more than this. If the stone is formed, it can be brushed with paste, baking soda, etc. we cannot completely clean it with methods. As I said, even if some of the stones are gone, the problem will not be solved completely because the remaining surface will not be smooth. That’s why teeth need to be cleaned completely with special tools. You should also know that this cleaning will not guarantee that you will be stone-free for 6 months. Bacteria plaque can become petrified even in as little as 24 hours. This time can vary from person to person, depending on the structure of saliva and some factors related to the microbiome. But as a result, it is your duty to protect the cleaning.

So how can we protect it? Short method: using a toothbrush and dental floss. When you brush and floss properly, you can control the formation of tartar because you prevent the accumulation of plaque on the surface of the teeth. However, there is another method that looks at the situation more holistically and will benefit not only oral and dental health but also the whole body: Eating healthy!

According to the “Ecological Plaque Hypothesis”, which tries to explain the reason for the occurrence of caries and gum diseases, a change in environmental conditions may bring about the disease by causing disruption in the balance of dental plaque microflora (3). The usual suspect in creating this change is excessive consumption of processed carbohydrates. In a diet far from processed foods, the acid formed by natural complex carbohydrates taken is at a level that saliva can tolerate. However, if simple carbohydrates that are processed frequently are started to be consumed, the acidic environment that forms will turn into an environment where rotting bacteria can live comfortably and our protective bacteria cannot resist. The situation is similar for gum health… Both the sticky nature of processed carbohydrates and changing the profile of the gingival fluid increase plaque accumulation. The metabolic changes created by the increasing accumulation reduce the redox potential (electron uptake potential), the pH rises and a suitable environment is created for the reproduction of the disease-causing bacteria that were previously few in number. If the deficiency in the defense system of the person is added to these, consuming sugary foods will indirectly affect this place, then it will be easier for pathogenic microorganisms to gain weight. Continuous high blood sugar levels also increase oxidative stress and trigger inflammation in the gums as well as in other regions (4).

The following studies, which I have taken from an article examining the relationship between diet and oral health and systemic diseases, are a few examples to see the relationship between gum diseases and today’s diseases that develop due to excessive consumption of processed carbohydrates:

“There is a relationship between diabetes that develops as a result of abnormal blood glucose metabolism and periodontal disease indicators in both children and adults (Tsai et al., 2002; Lalla et al., 2006). reduced the risk of disease development (Merchant et al., 2003). Obesity, which is an indicator of excessive consumption of fermentable carbohydrates, has been found to be directly proportional to the increased risk of periodontal disease (Perlstein and Bissada, 1977; Saito et al., 1998, 2005; Alabdulkarim et al. ., 2005; Dalla Vecchia et al., 2005; Reeves et al., 2006). (5) “

In the same article, it is emphasized that tooth and gum problems may actually be an alarm bell for future systemic diseases. A drink containing 50 grams of sucrose per day increases the gingival pocket depth in just 4 days (Cheraskin et al., 1965), the removal of processed carbohydrates from the diet reduces gingival bleeding within a few weeks, on the other hand, the development of systemic chronic diseases takes years, in this respect it is It is said that meat problems should be seen as a harbinger of systemic chronic diseases.

In another article, let’s talk about systemic factors that facilitate the formation of tartar. For now, let’s finish this article with a brief summary: Once the tartar is formed, it is not harmful to clean gingivitis, but it is necessary. Afterwards, it is the responsibility of the person to protect the cleaned teeth. The quick method for this is an effective brushing and flossing habit. On the other hand, considering gingivitis as an indicator of chronic systemic problems that may occur in the future, immediately reviewing the diet and reducing the amount of processed, simple carbohydrates and the frequency of eating is the most important step to be taken.

Another article I liked about how important nutrition can be in oral and dental health was “Brushless, Paste Free, Mouth Healthy in the Stone Age”. You can read it here …

Resources:

  1. https://journals.sagepub.com/doi/abs/10.1177/08959374940080022001
  2. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-0691.2007.01798.x
  3. https://journals.sagepub.com/doi/full/10.1177/0022034517735295
  4. https://www.ncbi.nlm.nih.gov/pubmed/28266114
  5. Hujoel, P. (2009). Dietary Carbohydrates and Dental-Systemic Diseases. Journal of Dental Research, 88(6), 490–502. doi:10.1177/0022034509337700 

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Root Canal Treatment Discussion

The documentary Root Cause, which claims that root canal treated teeth may be one of the underlying causes of chronic diseases, has created a heated debate on root canal treatments. These claims are actually not new, but are based on experiments conducted by Weston Price in the early 1900s. When W. Price extracted root canal treated teeth and placed them under the skin of rabbits, he observed that the rabbits developed the same problems as the person from whom the tooth was extracted. Price’s studies were criticized as not being done in a sterile environment because they were very old, but the controversy did not end.

Why can root canals be problematic?

Firstly, because the canal structure can vary so much, it is very difficult to clean them perfectly. For example, molars are “mostly” considered to have three canals, maybe 4 canals, and treated. However, there may be other canals connecting and branching with each other. In the photo below, these mixed morphologies of the canals are shown in color.

Complex morphologies of dental canals depicted in color

  • The second and main problem is the thousands of microtubules that make up the structure of the tooth. Even if we clean the main and side canals perfectly, the tooth itself consists of thousands of tiny canals. In a living tooth, there is a fluid flow in these canals. In a dead tooth with root canal treatment, this disappears. This area becomes an ideal environment where microorganisms can settle. I have shared a drawing below so that you can visualize the microtubules.

microtubules present in the tooth structure

The photo below shows electron microscope images of the microtubules and the microorganisms inside them. microtubules and microorganisms inside them

  • These microorganisms in both main and side ducts and microtubules can produce gases such as methylmercaptan and thioether. These gases are thought to stimulate the immune system and cause the response to be systemic (1)

Some studies suggest that root canal treated teeth can cause diseases in the body. For example, clots taken from 101 patients who suffered a heart attack were analysed and 78.2% were found to contain bacteria found in root canal treated teeth. (2). In addition, the bacterial DNA in these thrombi was 16 times higher than in the blood of the patients.

Dental canal anatomy illustration showcasing intricate structures and connections

However, before making a direct decision about root canal treatment, it is necessary to consider some other points.

Root Canal Treatment and Failed Root Canal Treatment

In most of the studies on root canal treatment and systemic diseases, root canal treated teeth with chronic inflammatory areas at the end of the roots were used. Not root canal-treated teeth that looked “successful” on X-rays… The study I gave an example of above was one of them.

Even if the fact that microtubules cannot be cleaned and filled is also valid for looked successful root canal treatments, there are not many published studies on these.

Are the Channels Considered Successful Really Successful?

In conventional dentistry, X-rays are used to interpret the condition of the root canal treated tooth. In recent years, it has become clear that X-rays are very inadequate in detecting these pathologies compared to tomography images. Therefore, a “successful” appearance on the X-ray does not necessarily mean that the root canal treatment is problem-free.

Comparison of 2d opg and 3d dvt techniques:The x-ray image on the left may suggest that the tooth is unproblematic. However, in the tomography on the right, we can easily see the inflamed area at the tip of the root.

The following study(3) compared root canal treatment in patients with and without systemic disease. It states: “In the group of 98 people with systemic disease, chronic lesions were also detected in 95% of all root canal treatments counted (tomography was used).

root canal treatment in patients with and without systemic disease.

In the same study, root canal treatments in a control group with no health problems were also less favourable: 444 of the 656 root canal-treated teeth detected on 631 CT scans had chronic inflammation at the root tip. The high rate of “unsuccessful” root canal treatments is probably due to the use of tomography in the diagnosis.

In other words, root canal treatments associated with systemic diseases may be unsuccessful root canal treatments, but their rate may be higher than we think.

Which of them started it?

There are many more studies showing that chronic inflammatory root canal treatment is more common in patients with systemic diseases (4, 5, 6, 7). But based on this relationship, can we say that root canal treatment has caused these problems? Or is there a basis for the failure of root canal treatment in people with these diseases? Whatever the condition that causes systemic diseases, does it also cause root canal treatment to fail?

There are studies suggesting that the formation of such a lesion at the tip of the roots may be related to genetic predisposition(8, 9). In the study in the photo, a genetic change of the type that increases inflammatory responses was observed in people with clinically unsuccessful root canal treatments.

genetic change of the type that increases inflammatory responses

Conclusion

For now, I would like to end by briefly writing my comment in order not to extend the article further. When we look closely at the root canal treated teeth, we can see that they are not the kind of environment that we want to harbour in the body. On the other hand, we cannot say “Root canal treatments cause diseases in everyone” with the data we have. You know how some people smoke, do not sleep properly, eat poorly, and while you approach all of these issues meticulously, you feel unhealthier than that person… There may be a similar situation with root canal treatments. The person may have an advantageous structure that manages to keep the problems that the canal may cause under control. Or everything has not come together yet! The glass has not overflowed… We do not know. Some biological dentists are definitely in favour of extracting all root canal treated teeth. Not only among dentists but also among oncologists, cardiologists and doctors from other specialities. On the other hand, there are also physicians who believe that we have not yet reached the point and that further research is needed. The IAOMT (International Academy of Oral Health and Toxicology), which has a very clear stance on amalgam fillings and fluorine, does not make a clear recommendation on root canal treatments.

Therefore, I think that many factors such as the patient’s general health status, expectations, replacement procedures, not only X-ray but also tomography images of the tooth, etc. should be evaluated in order to decide whether or not to perform root canal treatment, whether or not to extract the canaled teeth. I also believe that the patient should be informed about this issue and his/her consent should be obtained before the procedure is performed.

For this purpose, measures such as raising awareness of the society especially about nutrition, making regular check-ups a habit in the society, educating patients about the symptoms that can provide early diagnosis and giving regenerative treatments more chance can be taken. Root canal treatment can be avoided as much as possible where it is not necessary (For example, a crowded tooth to be crowned for aesthetic purposes can be treated with orthodontics if it is foreseen that it will go to root canal).

I will try to share more detailed information about all these measures in the following days…

References
  1. https://www.ncbi.nlm.nih.gov/pubmed/25864743
  2. https://www.ncbi.nlm.nih.gov/pubmed/23418311
  3. https://www.omicsonline.org/open-access/impact-of-endodontically-treated-teeth-on-systemic-diseases-2161-1122-1000476.pdf
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448330/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164509/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856634/
  7. https://www.ncbi.nlm.nih.gov/pubmed/26174809
  8. https://www.ncbi.nlm.nih.gov/pubmed/21419289
  9. https://www.ncbi.nlm.nih.gov/pubmed/29306532 
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Question – Answer: Should Amalgam Fillings Be Removed?

I announced a few weeks ago that I would answer the questions I received on my Instagram account. I decided to share the answers on my website, too, so that they may also be reached by a web search.

The first question I answered, as I thought it could serve as a basis for this subject, was:

“The dentist that I asked to have my amalgam filling removed said that this was not necessary, the amalgams could expose me to high amounts of mercury only during placing and removal, and it would not cause a health problem once it’s set, and that there is no scientific studies on this subject. Are these true?”

My answer is:

The highest amount of mercury is released from amalgam fillings while it is being placed and is removed, this is correct and it’s the reason why we are against its use as a filling material and we take precautions while removing them. But the mercury in the filling is still being released after it sets. The amount of mercury released from the fillings increases by chewing, brushing, teeth grinding, drinking hot beverages, etc. The photo shows the daily mercury intake from amalgam fillings determined by 17 different studies (the horizontal white lines are the ranges found in these studies). The red lines are reference limits set by the California Environmental Protection Agency and the American Environmental Protection Agency. You can see that the daily mercury intake from amalgams shown by different studies is much higher than these limits. Indeed, according to the World Health Organization, we can’t even talk of a safe minimum daily exposure for mercury!

So as long as you have amalgam fillings in your mouth, you are constantly exposed to mercury. It is estimated that 80% of the mercury vapor taken from the fillings is distributed throughout the body through the lungs, and this mercury accumulates particularly in the brain, kidney, liver, lung and gastrointestinal tract.

There are established associations between mercury and the following diseases

Allergies, Alzheimer’s, ALS, antibiotic resistance, heart diseases, chronic fatigue syndrome, kidney ailments, multiple sclerosis, mouth lesions, Parkinson’s, gum diseases, depression and anxiety, suicidal tendency, reproductive disorders, Autism autoimmune diseases (1).

And it is thought to be associated with more than 250 symptoms such as

Hearing difficulties, forgetfulness, headache, metallic taste, insomnia, coordination disorder, twitching / tremors, excessive shyness, social phobia, and irritability (2).

There are many studies showing improvement in ALS, chronic fatigue syndrome, dermatitis, fibromyalgia, MS, mouth lesions and other health problems after removal of amalgam fillings. I should also mention that in some studies which show improvement in symptoms, the removal was done without taking any precautions. Even in such cases, after a period of aggravation of the symptoms, the patients experienced improvements to their conditions in the long run.

So in my opinion, removing a source of toxicity from your body is more favourable than wasting your precious resources on it.

Resources
  1. https://iaomt.org/resources/dental-mercury-facts/amalgam-fillings-danger-human-health/
  2. https://iaomt.org/resources/dental-mercury-facts/mercury-poisoning-symptoms-dental-amalgam/

Genetic Predisposition To Mercury Toxicity

While some people observe that their health problems begin after amalgam fillings are made or removed without taking the necessary precautions, others can feel healthy even though they have had amalgam fillings for years.

Of course, everyone’s criteria for being healthy can be different. Someone whose body gives serious alarms is so accustomed to living with these symptoms that they consider themselves healthy.

However, it would not be wrong to say that not everyone exposed to mercury has the same problems. Some people seem to cope with mercury or other toxins more easily, while in others these types of toxins can cause many health problems.

Why are some people more affected by mercury than others?

There may be many reasons for this: the amount of toxins that are exposed, whether this amount accumulates over time or is exposed at once, exposure to more than one toxin at the same time and increasing the effects of each other, such as pathogenic bacterial toxins present in the body.

Another reason that is getting more and more attention is that certain aberrations (polymorphisms or SNPs) in a person’s genetic sequence make that person more susceptible to the effects of toxins.

The introductory part of the article describing a study conducted on members of the American Dental Association in 2015 included the following comment:

“One of the major challenges in performing the risk assessment of mercury is that, despite exposure to similar mercury levels, […] there are huge differences between members of communities in terms of mercury measured in hair (Canuel et al., 2005).” In other words, although people seem to be exposed to the same amount of mercury, the amount of mercury they can throw out can be different. Let’s continue… “Although the source and dose of mercury may explain to some extent the difference in mercury content between individuals, differences in the absorption, distribution and elimination processes (in other words, toxicokinetics) of mercury may also play an important role in the formation of this distinction. Mercury toxicokinetics can be affected, for example, by changes in functional enzymes and proteins that transport, oxidize or reduce mercury (Gundacker et al., 2010).” (1)

As a result of her study of 500 children in 2013, Woods said:

  • Abnormalities in genes (SNPs) that enable the body to produce metallothionein increase the susceptibility of children to mercury neurotoxicity.
  • The relationship between mercury and neurobehavioral performance was observed mostly in boys.
  • In children with 2 metallothionein SNPs, the adverse effect of mercury on performance was measured at the highest level. (2)

Now let’s look at what metallotionein does in the body:

Metallothioneins are small proteins containing sulfhydryl groups that bind to zinc, copper, iron, cadmium, mercury, and other metals (3). With these properties, they not only regulate zinc metabolism, but also act as a natural chelator in the body and play a role in removing toxic metals from the body (4).

In an experiment to better understand the role of metallothioneins, the researchers silenced the mice’s MT-I and MT-II genes. While this appeared to have no developmental effects in the mice, they became more susceptible to cadmium poisoning. On the other hand, increasing MT genes increased their resistance to cadmium (5).

In short, even a difference in a gene that produces only one protein can adversely affect the excretion of metals and therefore mercury, leading to the accumulation of too many toxins for the body to cope with.

You can find other genetic variations that come to the fore in mercury research in my previous article titled “Facts About Amalgam Fillings“.

If we’re genetically unlucky…

We now know that our genes are not destiny. Epigenetics has shown that environmental factors can play a huge role in how genes are expressed. The environment you create for your body can control your genes’ on-off switches. Many factors such as what you eat, sleep, getting sunlight, spending time in nature, having good social relationships, and breathing properly can make this environment better. You may think these are irrelevant, but each one of them makes it easier for the biochemical events in the body to run smoothly.

Of course, while trying to increase the body’s ability to cope with toxins, let’s also remember that we should reduce the toxins we are exposed to from the outside as much as we can and lighten the burden of the body…

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Resources:

  1. https://www.ncbi.nlm.nih.gov/pubmed/26673400
  2.  https://www.sciencedirect.com/science/article/pii/S0892036213001669
  3. N.V. BHAGAVAN, in Medical Biochemistry (Fourth Edition), 2002
  4. Susan L.-A. Samson, Lashitew Gedamu, in Progress in Nucleic Acid Research and Molecular Biology, 1997
  5. https://www.sciencedirect.com/science/article/abs/pii/S007966030861034X

Amalgam Removal for Pregnant Women, Breastfeeders and Those Who Want to Have a Baby

“Can amalgam be removed in pregnant and breastfeeding women?”, “I want to have a baby, how long after amalgam removal should I get pregnant?” These are questions I get frequently… I tried to answer them in this article. While doing this, I also gave examples of some studies on the removal of mercury. I think these examples contain interesting information not only for pregnant women, breastfeeders and those who want to get pregnant, but for anyone who has questions about amalgam fillings. Therefore, I think it is a paper that both patients and physicians can benefit from.

IAOMT (International Academy of Oral Health and Toxicology) has created the SMART protocol, which consists of very detailed precautions for the removal of amalgam fillings without harming the patient, physician and auxiliary staff (I have explained the details and points to be considered in this article). If you examine this protocol, you can see that all the ways the patient may be exposed to mercury are calculated and very meticulous measures are recommended against it.

Despite all these measures, IAOMT says we cannot claim that mercury will never be exposed even if the SMART protocol is followed. Some sources in Turkey taking measures much less than they claim Although you might be exposed to no mercury and vice versa. I think that IAOMT’s suggestion that pregnant and breastfeeding women should not be removed is due to this risk. The question may arise: Is it more mercury that a person with a lot of amalgam in his mouth gets more mercury from fillings every day or is it mercury that can be exposed during the process even if it is removed with precautions? It is difficult to answer this question. This will most likely depend on some minor details during the process (whether the rubber-dam was sealed, did the fillings come out in large pieces, was an oxygen mask that covers the nose completely, etc.) and the number and size of the filler to be removed. Nevertheless, despite the possibility of any malfunction during the procedure, it may be considered safer not to remove any amalgam in pregnant and breastfeeding women.

According to researcher Andy Cutler, who has also been damaged by amalgam fillings and so he has researched how mercury can be removed from the body and proposed various methods, this is not the only reason why pregnant and breastfeeding women are not removed. Andy Cutler suggested that a few months after all the amalgams in the mouth have been removed, you will be going through a period in which the mercury in the tissues will be removed more intensively because the mercury you are exposed to every day is no longer there, and therefore, disassembly should not be done. He says that the mercury circulating in the body during this excretion period can pass into the placenta and milk. For this reason, he says that not only during pregnancy and breastfeeding, but also before getting pregnant, a certain amount of time must pass after all the fillings are removed. In this way, it is aimed not to damage the baby not only from the mercury that comes from the fillings on a daily basis, but also from the mercury that has accumulated in the tissues over the years and is thought to be released into the blood after removal.

Unfortunately, I do not have any sources to verify this discontinuation theory other than the experience of those who followed the Andy Cutler protocol. There is a possibility that the symptoms that are thought to be experienced by these people during this period may also occur for other reasons. However, the following study showing long-term blood and urine values ​​after dismantling may help us evaluate this idea (1).

Here, the following graphics were obtained by taking blood and urine samples at various times within 1 year after dismantling of people who used rubber dam in the mouth during amalgam removal. The graph showing the blood values ​​shows a very small increase in the following months, so Andy Cutler may have a point. However, even this increase is below the initial values. So even if there was such a period, it did not affect the blood levels of the people in this study much, and did not even approach the initial level. I don’t know if it would have been a different image over longer periods of time. (By the way, although the initial blood mercury values ​​of the patients without rubber dam were lower than the values ​​of the other group, how did they increase during the procedure!)

Blood mercury values measured before and after amalgam harvesting. Straight line indicates those in use of rubber covers and dashed lines indicate those that are not.

The curve in urine values is a little different … (In those using rubber covers, although the level is higher after dismantling, the increase rate is better than those without cover). . I think that the reason for this may be that the mercury level, which rises suddenly in the blood after the removal of the rubber cover, changes the distribution of mercury to the tissues and the functioning of the mechanisms required for its removal.

Blood mercury values measured before and after amalgam harvesting. Straight line indicates those in use of rubber covers and dashed lines indicate those that are not.

So, what should be the time to wait before getting pregnant after amalgam removal?

Again, according to Andy Cutler, after all amalgams are removed, at least 18 months should be waited. Andy Cutler made this suggestion, assuming that 12 months of this period passed with the chelation method he created and that it was only expected in the next 6 months, and even added that this period could be longer in patients with poor conditions. In general, he thinks that when you wait for a while after dismantling, you will first go through a period of feeling good, then you will go through the throwing period I mentioned above and you may experience some symptoms during this time and then the symptoms will resolve. That’s why she suggested that you get pregnant only when you go through these periods and feel better. Although his general recommendations are like this, it is worth remembering that Andy Cutler generally works with people who have suffered serious damage from amalgam. So this may not be the case for everyone. How a person’s detox systems work, their genetic makeup, diet and lifestyle, and perhaps the supplements they may take may result in a prolongation or shortening of this period.

We know from cadaver studies that once exposure to mercury is present, it can still be found in tissues even after 17 years (2). Although blood levels are reduced with chelation agents… Therefore, the purpose before pregnancy is not to reset the mercury accumulated in the tissues, but to stabilize the mercury circulating in the body.

In the graphs above, it is seen that blood and urine mercury levels drop below their initial levels within 100-150 days after the procedure and follow a more straight line at the end of the first year.

Another example of how quickly blood mercury levels dropped comes from the findings of the 1970s accident in Iraq. In the incident in Iraq, farmers began to eat wheat and barley, which were distributed to them to plant and contain methyl mercury (!!!) as a preservative. A few months later, hospitals started to be filled with patients coming with serious health problems.

In a study conducted during this accident, the time required to halve the blood level of mercury was found between 40 and 105 days (3)

According to the study that Chris Shade cited (4) (but I could not find the original), this period was up to 120 days for vulnerable groups. (I would like to underline that these times are not for the blood level to fully recover, but to halve the initially measured amount.)

The graph on the right shows that some of the poisoned people have a blood half-life of up to 120 days.

Of course, mercury levels increase so much in this type of poisoning that even when half of the mercury is removed from the body, the remaining amount is still very high. Still, they are important examples in helping us understand the duration of mercury clearance.

In my opinion, despite all this information, we still cannot talk about a clear time that can be recommended to everyone. This time can vary with the amount of mercury exposed, how well the person’s detox systems are working, supportive diet and lifestyle interventions. Therefore, it may be more accurate to determine this period individually. The mercury levels in their circulation will not be the same for someone who has a single filling, who has it removed very meticulously, who does not have obvious health problems, someone who is haphazardly removed 8 grain fillings, and who is already struggling with health problems.

If a tooth with amalgam needs urgent intervention in a pregnant or breastfeeding person?

Of course, if a problem develops in the tooth that cannot be postponed (such as the risk of breaking part of the amalgam filling and swallowing the remaining part), the pregnancy and breastfeeding periods cannot be expected to end. In this case, in addition to the meticulous implementation of the SMART protocol I mentioned above, it is recommended that the mother expresses and expels the mother’s milk for 3-4 days from the procedure, and that enough milk should be milked and stored before the procedure (The time to be milked is said to reflect the opinion of Chris Shade. I read it as 3 days in a source and 4 days in the Andy Cutler group). It is also worth remembering that the mercury released during dismantling can be minimized by wrapping around the amalgam filling without touching it and trying to remove it in large pieces.

Resources
  1. Ref. Berglund, A., & Molin, M. (1997). Mercury levels in plasma and urine after removal of all amalgam restorations: The effect of using rubber dams. Dental Materials, 13(5-6), 297–304. doi:10.1016/s0109-5641(97)80099-1 https://www.ncbi.nlm.nih.gov/pubmed/9823089
  2. https://www.ncbi.nlm.nih.gov/pubmed/8793247
  3. Bakir, F., Damluji, S. F., Amin-Zaki, L., Murtadha, M., Khalidi, A., Al-Rawi, N. Y., … Doherty, R. A. (1973). Methylmercury Poisoning in Iraq. Science, 181(4096), 230–241. doi:10.1126/science.181.4096.230 https://www.ncbi.nlm.nih.gov/pubmed/4719063
  4. https://www.youtube.com/watch?v=20b7y9tTY3E&t=1360s

Is It Possible to Remove Heavy Metals by Sweating?

Sweating is known as a good way to remove toxins and is considered among the general recommendations for detox. So how effective is sweating when it comes to heavy metals? When he hears round words like me, “Do we accept it as true because it is repeated thousands of times, or is it really like that?” If you are one of those who think, this article, which I will talk about research on sweating, may be of interest to you. I recently wrote this article on greenmedinfo.com, on an article by its founder Sayer Ji. However, in his article, he emphasized that sweating does not only help to regulate body temperature, but is also important in removing toxins, while I shared the points that caught my attention from a study that I reached from the bibliography of the article and compiled many studies.

In a nutshell

The amount of heavy metals excreted by perspiration in individuals in the studies was generally higher than the amount of heavy metals detected in their urine and blood. In some individuals, while heavy metals were detected in sweat, it could not be detected in blood or urine. Exercise, sauna or sweat-stimulating drugs were used to make the participants sweat.

Meanwhile, Sayer Ji, in his article, included studies showing that bisphenol-A (BPA) and phthalates, which are found in plastics and are associated with many health problems, are also higher in sweat than their amounts in urine and blood serum. Even here, while these substances could not be detected in the urine or blood of some participants, they were detected in the sweat. So sweat can also be a good excretion method for these substances.

Now back to heavy metals. The results of the studies that caught my attention from an analysis of more than 20 studies that measured mercury, lead, cadmium, and arsenic are as follows (2):

Mercury:

  • In a study conducted in Canada, in which 10 healthy individuals and 10 individuals with chronic problems were examined, we can say that the average blood, urine and sweat mercury levels were close to each other even though they were slightly higher in sweat (0.61, 0.65, 0.86 mcg/L, respectively). However, while the number of people who detected mercury in all three samples was 16, only mercury was found in sweat in the remaining 4 people. In other words, if these people had blood and urine mercury tests for diagnostic purposes, the result would be negative, and it would be thought that they did not have mercury in their bodies.
  • In a case shared in 1978, the treatment of a worker who was exposed to mercury vapor for an hour a day while working at a place that produced thermometers for 13 years. The patient, who became incapacitated in the last 6 months, was first given various chelation agents for two months. Then, sweating and physiotherapy sessions were applied every day for a few months. During the treatment, it was observed that mercury was removed from the sweat by measurements. At the end of the treatment, the amount of mercury measured in the blood, urine and sweat decreased to normal levels without any side effects in the patient (3).

Lead:

  • In the Canadian study I mentioned above, the average amounts of lead in sweat, blood and urine were found to be 31, 0.12, 1.8 mcg/L. Here, we see that the amount of sweat excreted is quite high. Lead was detected in all three samples in all participants. Lead is everywhere!
  • In 1991, a very interesting study was conducted in England. Two volunteers drank lead chloride once or twice, for a total of 20mg! What kind of science is this? Or were they two researchers willing to even drink poison to complete their doctorate? We do not know these… But as a result, this lead compound, which was measured in the acute period, was not excreted much in sweat this time. It reached its highest level in the blood 4 hours after ingesting lead. It maintained this high level in the first 24 hours and gradually decreased over the next few weeks. Similar amounts were also detected in the urine. I was so intrigued by this work that I opened it and read it and realized that this was not actually the first time! There are many other works. In one of these, a researcher had 16 -initially- healthy subjects drink nickel! And after that, he could not see a significant breakthrough in sweat. Although there is an increase in nickel in the blood and urine… Our researchers who drink lead have drawn the following conclusion, taking into account other previous studies: These types of heavy metals are more common in blood and urine, since they have not yet penetrated into the tissues in the acute stage. When it is exposed chronically, accumulation in the tissues increases, and therefore it’s excretion with sweat also increases (4).
  • In a study conducted in Germany in 1986, the amount of lead thrown by aerobic endurance training (rowing) was found to be higher than the amount of lead thrown by shorter but more intense training (cycling) (values ​​measured in blood). So, according to this study, sweating for a longer period of time may be more advantageous than sweating at the same (or more?) rate over a shorter period of time.

Cadmium:

  • In Canada, in the study I mentioned above, cadmium could be detected in all samples, including blood, urine and sweat, in only three of the participants, while cadmium was detected in the sweat of 17. So sweat can be a good method for detecting cadmium. Considering the average amounts detected, it is seen that cadmium is excreted better with sweat than other ways. Average amounts in blood, urine and sweat, respectively: 0.03, 0.28, 5.7 mcg/L.
  • In the study in which 28 lecturers volunteered in the USA, the amount of cadmium detected in sweat ranged from 11-200mcg/L, while it was between 0-67mcg/L in urine. There is no such thing as too much cadmium in the urine of those who have too much cadmium in their sweat. From this, we can conclude that a urine test performed alone does not always reflect the situation in the body.

Arsenic:

  • They compared a group in Bangladesh who had arsenic poisoning and showed skin symptoms, another group exposed to arsenic in drinking water, and a third group who had never been exposed to arsenic. As expected, the sweat arsenic content of those exposed to arsenic was several times higher than those that were not exposed. There was no difference between the arsenic poisoning group and those who received arsenic from drinking water. I wondered if there is a maximum amount of arsenic that can be excreted in sweat, or if the arsenic taken with drinking water is too high, perhaps because it spreads for a long time, although it does not cause skin symptoms… seen to be thrown. This shows that, as with other heavy metals, our need for these vitamins and minerals increases with arsenic toxicity.
  • Again, in the Canadian study, arsenic was detected in 17 of the 20 participants. This time, the most arsenic was measured in the urine. (Average amounts are 37mcg/L, 3.1mcg/L, 2.5mcg/L in urine, sweat and blood, respectively)

I think we can draw two important conclusions from these findings:

First; Routinely practicing sweating through exercise, sauna or other means can reduce the body’s heavy metal load more than we think over time. As I said at the beginning of the article, we say “Sweating removes toxins,” but when we suspect heavy metals, the first detox method that comes to mind is usually taking chelation agents or supplements. I can’t compare the amount of metal excreted with these agents with the amount excreted through sweat, but even the mildest and the most herbal ones can have side effects. Therefore, sweating seems like a safer method to me compared to trying to get rid of the heavy metal accumulated in the tissue into the blood. As I said, I can’t compare their effectiveness, but I think that at least applying it in addition to other methods can speed things up.

The second conclusion we can draw is that sweat tests may be a new alternative to blood and urine tests, which generally do not work very well in measuring body accumulation. There are other tests such as hair, erythrocyte, intracellular spectrophotometer analyzes (oligoscan, zell-check) used to measure this load. Although hair tests are found to be more reliable than urine and blood, sometimes they may not reflect the situation directly and it may be necessary to interpret the mineral ratios. Zell-check, on the other hand, although it is a very practical test, is criticized by some researchers as inaccurate (5) (6). In short, a method that everyone considers valid has not yet been found to fully understand the heavy metal load in the body. Therefore, measuring the amount in sweat can be another method we can apply.

If you can’t sweat…

Unless you have an inherited or acquired disorder that damages the sweat glands, skin or nerves, the inability to sweat may improve over time. It has been stated that sweating may become more difficult, especially in people who are exposed to toxins, since the autonomic nervous system’s ability to balance body temperature may decrease(2). In order to regulate this, correction of biochemical processes with the help of nutrition and food supplements, as well as methods to stimulate lymph drainage and exercise before sauna were recommended (2) . Examples of methods that stimulate lymph drainage are massage, dry brushing, trombone jumping, and all sorts of other exercises. Unless you’ve been a regular exerciser, don’t expect great results on your first workout. It has been observed that those who exercise regularly for a longer period of time sweat better. Therefore, it is necessary to give the body some time to adapt… And of course, drinking plenty of water is another trick for sweating. When you drink plenty of water and insist on exercising, you will gradually find that you can sweat more easily. Let me write as a small reminder that you should also pay attention to your diet in order to compensate for the increased mineral excretion when you sweat.

Why and How to Do Mercury Detox?

Mercury is one of the most toxic chemicals that can underlie the chronic problems we have, and sometimes even start them. Mercury, entering the body in various ways, accumulates in our tissues and organs, causing biochemical events to be disrupted. According to the World Health Organization, “Mercury has a toxic effect on the nervous, digestive and immune systems, lungs, kidneys, skin and eyes.” It should not be forgotten that the last organizations that utter such statements are the World Health Organization and similar organizations. That’s why it is worth noting that this warning is a bit mild to many researchers, and the problems caused by mercury can be much more serious. (You can find my article on amalgam fillings and hence mercury damage here.)

According to some researchers, everyone is exposed to mercury without exception due to environmental pollution, so everyone should detox regularly. However, some people are exposed to much higher amounts of mercury, which may be due to:

  • The presence of amalgam (gray) fillings in the mouth or the removal of these fillings without taking any precautions (During disassembly, high amounts of mercury are released and this mercury can accumulate in the organs. You can read this article for the correct removal technique.)
  • Frequently consuming large fish (More mercury accumulates in fish such as tuna and swordfish, which are at the top of the food chain.)
  • Vaccines (Some vaccines contain mercury as a preservative.)
  • Being in an environment where some items that contain mercury, such as thermometers, light bulbs, are broken
  • Occupational exposure (Being a dentist, dentist or mining profession)

Let us remind you that mercury has different forms. We are most exposed to elemental mercury and methyl mercury. Elemental mercury is found in amalgam fillings. Since it evaporates very easily, it is mostly taken from our lungs. Mouth temperature, chewing, brushing, teeth grinding, etc. When the factors are added, the amount of mercury taken increases. Some of the mercury in the fillings turns into methylmercury and is swallowed. Since elemental mercury dissolves very easily in fat, it can pass through the blood-brain barrier and reach the central nervous system and the unborn baby by passing through the placenta. Mercury crossing the blood-brain barrier is trapped there ionized and begins to have neurotoxic effects. It can stay in the brain for so long that it can be detected here even years after exposure (1).

Another source of exposure to the methyl mercury form is fish. The mercury found in seas – due to pollution – is converted into methyl mercury by plankton. Mercury is stored in the bodies of fish that eat plankton, and the total amount of mercury accumulated increases as the bigger fish eats the smaller fish. We, who are at the last step of the chain, get all that savings when we consume big fish. Methyl mercury is mainly absorbed from the gastrointestinal system. When it enters the circulation, more than 90% of it binds to hemoglobin by entering the erythrocytes. 10% of the methyl mercury load in the body is again in the brain and it gradually turns into an inorganic form. It causes the death of nerve cells in the brain, damage to glial cells, and damages the cerebral and cerebellar cortex. Methyl mercury can also pass through the placenta to the fetus and accumulate in the baby’s brain, causing the damage I mentioned. (one) Although some sources say that the half-life of mercury in the body (the time required for half of it to be excreted from the body) is 20-90 days, autopsy studies have shown that this is not true and mercury can be detected even 17 years after exposure to mercury (2).

For these reasons, it is not enough to simply remove the source of mercury and wait for the body to expel the mercury in time to repair the damage caused by mercury in the body. Especially for those whose detox systems do not work well and who have a lot of mercury accumulation, it is necessary to support the body in various ways and use chelating agents and binders in order to remove mercury from the places where it is stored, especially from the brain. I must say that doing mercury detox is not as easy as mentioned in some social media accounts and blogs. Especially for those who are already battling many chronic conditions, starting a random detox product can do more harm than good. There are patients who experience adverse side effects and worsening even with the lightest protocols. That’s why I recommend you to think and research very well before seeing and using any product in Instagram stories. Mercury detox means activating mercury from the organs it has settled in and making it circulate in the body. As a result of this action, mercury can worsen the situation by being transported from an organ where it will do less harm to an organ where it will do more damage (for example, it can come out of adipose tissue and settle in the brain). So it’s not a job to be taken lightly! Therefore, I will not suggest you a specific protocol in my articles on mercury detox. Instead, I will outline the prominent protocols on this subject and address the criticisms made. Some of these protocols are:

  • Andy Cutler protocol
  • Dietrich Klinghardt protocol
  • Chris Shade / Quicksilver method
  • TRS and similar nano clitilolites
  • Boyd Haley – Emeramide (OSR)
  • HMD
  • IV chelation methods (Almost no one recommends it anymore, but I’ll talk about why it’s dangerous.)

When I write the protocols you will see that there are some common points in all of them. One of them is that you cannot remove mercury from the body in a short time, it is not right to do so. You need to be patient to get rid of the mercury that has accumulated in your body for years. Otherwise, the body may not be able to deal with the large amount of mercury released from the organs. Another common point is that most of the protocols suggest measures to support detox systems and organs in addition to the chelation method used. Before going into the details of the protocols, I am thinking of talking about our detox systems. Because no matter which method you choose, I think that if you make some systems work better in your body, as much as the toxic load allows, the possibility of experiencing the mentioned side effects will decrease. I am waiting for your comments about the points you want me to write and your contributions… See you in the next article …

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Safe (SMART) Mercury Amalgam Removal

It is known that mercury gas released during the removal of amalgam fillings and mercury particles scattered around pose a danger to the patient, physician and the environment (1). I have written a detailed article before about the damages that mercury can cause.

Due to these damages, it has been suggested to take some precautions to prevent the penetration of mercury into the body of the patient and the physician and at the same time to minimize the damage to the environment. IAOMT (International Academy of Oral Medicine and Toxicology), the organization that brought these measures together within the framework of the researches carried out to date and their own experiments, called this application “Smart Protocol”.

Let’s look at these measures recommended to be taken during amalgam removal in terms of patient, physician and environmental safety (1,2):

In terms of the patient:

  • Amalgam removal is not recommended for pregnant women and breastfeeding women.
  • Before the procedure, the patient should rinse his mouth and gargle with activated carbon, chlorella, bentonite, zeolite or similar agents that are said to hold mercury. Although this sentence reflects the general protocol proposed by IAOMT, I use only activated carbon, based on my own research. According to some opinions, chlorella can do more harm than good because it is poorly attached to mercury. According to another experiment, zeolite, which is famous for heavy metal retention, is extremely unsuccessful in this regard (6). There are opinions arguing that bentonite is similar to zeolite. Apart from these, there are also physicians who recommend that a cotton impregnated with the selected agent be placed on the floor of the mouth during the procedure (3). According to some protocols, this chelation agent is given to the patient before the procedure. In my practice, the patient first takes the activated charcoal capsule or tablet and then rinse the mouth with its liquid form.
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  • The contact of the amalgam particles with the mouth should be prevented by applying a rubber dam to the mouth of the patient. In addition to this rubber cover, I think that a gingival barrier, which is in gel form and cured with the lights we fill, will provide better sealing, and I do my application in this way.
  • Positive pressure air or oxygen should be given to the patient in order not to breathe the ambient air.
  • There should be a vacuum device that filters the mercury, as in the photo below, in the immediate vicinity of the mouth.
  • The patient’s hair, face and body should be covered. It was observed that the fragments removed during amalgam removal could jump up to the patient’s chest and knee. Covering the patient will prevent amalgam particles from being carried to the patient’s home through their clothes.
  • During the procedure, a strong aspiration should be provided above and below the rubber cover.
  • Disassembly should be done under plenty of water irrigation, and the filling should be prevented from getting hot and emitting more mercury vapor.
  • It should be aimed to produce amalgam in as large pieces as possible.
  • If possible, the room should be ventilated during the procedure and the windows should be opened.
  • At the end of the procedure, the patient should rinse his mouth again with plenty of water and the binding agents mentioned above and gargle.

From the Perspective of Physicians:

  • The physician should wear a special protective gas mask that can filter mercury vapor, goggles,  bonnet  in addition to the measures such as gowns and gloves that he routinely uses. In my opinion,  fabric masks that are said to filter mercury “smoke” are not enough. We need masks that filter gas, not smoke.

In the Name of Avoiding Environmental Pollution:

  • In order to prevent the disassembled amalgam from harming the environment through the waste water pipe, it is recommended to place a device that can separate the amalgam in the waste water system (4).
  • If amalgam can be removed in one piece, it should be stored in x-ray solution or in a lidded container in water, it should be collected and eliminated by authorized units (5).

The Period Before and After Amalgam Filling Removal

Even if the amalgam fillings are removed properly, some additional protocols may be required to remove mercury from the patient’s body before and after the procedure. Since these protocols will need to be tailored to the patient, ideally, the dentist evaluates the patient with a physician who can administer mercury detox.

In order to remove the mercury that has accumulated in the tissues over the years, both the detox systems must work well and the mercury must be extracted and removed from the tissues with chelation agents that can bind mercury.

Unfortunately, it is not possible to talk about a consensus among doctors about the agents to be used for chelation. Some “natural” products such as chlorella and coriander are widely used for heavy metal detox. recommended chelation agents in basic training I have attended so far in Turkey was always them. But personally, I find it quite remarkable to point out that these are not strongly bound to mercury, and therefore it moves mercury from one place to another. It is difficult to ignore the numerous stories of patients whose health has deteriorated even more with such agents. Apart from these, it is worth mentioning that fast chelation methods using high doses of agents such as DMPS and DMSA are also mentioned. That is why I want to emphasize again and again that one should be careful about chelation and not be taken lightly.

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