My Letter To ASE

12 April 1997

Dr Ralph Reid

Brisbane

Dear Dr Reid,

I am writing with a request for information which I hope you, as president of the Australian Society of Endodontology (Inc.), will be able to supply.  I am a practicing general dentist in Sydney and have a great interest in the area of Endodontics.  My queries are in relation to the patient education pamphlet;

“Relax- there is no need to lose your tooth…ENDODONTICS (Root Canal Therapy) can save it for you”.

 1)  In paragraph 2 it is written “Once the tooth is fully formed the main source of nutrition for the tooth comes from the tissues surrounding the root.”

Could you please supply the references for this statement?  Would you also be kind enough to explain to me exactly how the tooth is nourished from its surrounding tissues.  Is this via the blood supply, the lymph or by osmosis?

2)  In the third paragraph it is written;

“Therefore, a tooth can function normally without its pulp and can be kept indefinitely.  After endodontic treatment the tooth is pulpless, but it is NOT a dead tooth.” 

Again I would appreciate references to support this statement.   By suggesting that the tooth is not dead, one can only assume that it is alive.  For this to be so it must have some vascular supply.  If I am not mistaken the very procedure of Root Canal Therapy is to remove the blood supply.

3) The statement (7th Paragraph)  “During endodontic treatment, the infected or damaged pulp is removed from the inside (i.e. root canal) of your tooth.”

Is it necessary to remove all infected dead pulp tissue from the tooth?  If not please supply references which describe the fate and effect of remaining infected tissue. 

If so please supply the references which demonstrate that all necrotic and infected tissue can be removed from the tooth.

4) The 8th Paragraph states: “The root canals are then cleaned, sterilised and shaped to a form that can be completely sealed.”   Firstly I again request references to support this statement.  Next would you be kind enough to explain to me;

  • the procedure and medication recommended by the society which does sterilise a tooth.
  • how is sterility of the tooth determined?  Is it necessary to take a swab of the tooth for culturing.  If so should this be aerobic or anaerobic.
  • if anaerobic testing is required could you please inform me of the correct procedures.
  • please supply references which demonstrate the complete sealing of a root canal.

5)  Paragraph 11 talks of the sedative dressings and temporary fillings which are used to ‘settle’ the tooth “and destroy any remaining bacteria”.  References supporting this statement would be appreciated.  Would you also list for me the medicaments which are currently recommended to achieve this outcome. 

They also talk about dressings which “and destroy any remaining bacteria”

I appreciate that you may not be the author of this pamphlet and that this is indeed quite a large request.  I believe though, that if I am to pass this pamphlet on to my patients, I would like to be in a position to be able to verify each of these statements by published, peer reviewed scientific papers.  

If you are unable to furnish the answers to this request I would appreciate it if you could point me to the author of this paper.  I thank you in advance for your response.

Sincerely

Dr Robert Gammal BDS

Reply From The Australian Society of Endodontolgy

Dear Dr Gammal,

The committee made the following recommendations which are passed on for your Information:

  • The pamphlet was written by a committee of specialist endodontists as a public service to dentist’s patients.
  • The pamphlet was then circulated to all specialist endodontists in Australia for their comments, additions, etc before final printing.
  • The material was based on the committee members’ general knowledge of endodontics and not on specific references.
  • The statements are universally accepted by endodontists world-wide and by the dental Profession in general.
  • There are no controversial issues raised in the pamphlets (this was intentionally avoided by the committee)
  • NO specific references were used to write the pamphlets
  • ANY textbook on endodontics could be used to justify the statements made in the pamphlets.

I hope this information is of some help in showing where the pamphlets have come from.

Yours sincerely ……  

(My Emphasis)

My comments on the reply;

The response comes from their ‘Educational Committee’.  These people are not named, and their identity remains a secret to this day.  The committee of specialists who wrote the pamphlet are also not identified.  The standard of education that they are presenting is clearly definable.

‘The material was based on the committee members’ general knowledge of endodontics and not on specific references.’ 

The education committee could not find one reference that could support any of the statements in this brochure.  These are the top specialists and teachers in this area of dentistry. When push comes to shove in a court room, these are the people who make decisions about the work of the GP.   If their general knowledge is not based on science or published research, than what is it based on?  Perhaps it is based on their clinical observation which is firstly just a little bit biased, and secondly is finished when the job is done and the patient leaves.  There is no dental follow up let alone medical follow up. 

Just because these statements are accepted by other endodontists worldwide, or country wide, does not make these statements correct.  Just because a group of people are brain washed into accepting whatever the professors tell them, also does not make this information correct.   The arrogance of this statement still shocks me every time I read it even years later.   If these untouchable heros of root canals do not need to reference their teachings and statements, then why should I or anyone else have to present references.  This is an insult to everyone’s intelligence.  It is an insult to the scientific process and to the integrity of any so called profession. 

The statement that this general knowledge is ‘accepted by the dental profession in general’, is a warning.  ‘Don’t step outside the line as we are now watching you’, is the implied message.  Paranoia or healthy scepticism – you can decide.

The comment that any text book of endodontics can be used to verify these statements is potentially correct. The trouble is that only one group of people routinely read textbooks of endodontics.  They are dental students, who have a very strong vested interest in graduating.  They do not have the time or knowledge to criticize the big GOD that wrote the book.  As well textbooks are never peer reviewed.  They are usually pathetically referenced.  Textbooks are always biased to the current paradigm or they would not be used as text books, with which to indoctrinate the students. 

Their comment that there were no controversial issues raised in the pamphlet is only acceptable if you ignore the fact that almost every comment made in the pamphlet is a lie, and that you are happy to accept these lies.  If the lies are OK, I wonder what this committee would call a controversial issue.