The Root Cause – Dental Documentary on Netflix

Position Paper From Buxton Cosmetic Dentist Nicholas K. Roy, DMD, MAGD

The “Root Cause” was a documentary released by Netflix in 2019, exploring the science and systemic connection to root canal therapy. It was pulled 29 days later, as Netflix recognized the poor scientific backing to most claims in the documentary. This is a position paper for my patients to understand my point of view.

Do root canals cause cancer? This potential correlation and many other connections are explored in this documentary. As a dentist and die-hard scientist of all things explained and unexplained, I want to share my professional view on this controversial and potentially viral (in the digital sense) topic. 

What does the film “Root Cause” attempt to address? There has been evidence (strength of which is suspect at times) that is suggestive that root canals (root canal therapy or treatment) can have a negative impact on the human body on the whole. This is a very significant accusation that will take decades to resolve, regardless of the outcome and validity of the current claim. 

What are my thoughts from a 10,000-foot view? I think the connection, if present, will not likely be the cure for cancer or therapy that changes people’s lives as outlined in the documentary. But could this connection be important enough that we should continue to learn more? Absolutely. Will I have my two root canal-treated teeth removed? Absolutely not. 

NOTE: From this point forward, the abbreviation “RCT” will indicate either root canal therapy or root-canaled teeth. 

What are my reasons for thinking there might be a connection?

It is true that a tooth is an organ that is different than the organs of the rest of the body, in that once it loses blood and nerve supply, its normal internal functions cannot be restored. Hence, it might behave differently once it “dies.” 

1. It is true, that in our office, my colleagues and I routinely see cavitations on our 3-dimensional x-ray surrounding previously RCT teeth. Although not ubiquitous, it is very common. Although the science does not link such x-ray evidence to systemic conditions, I won’t be surprised when strong data does make this connection.

2. The BaleDoneen^® Method. I attended a conference in 2015 where Drs. Bale and Doneen shared their views on cardiovascular health. They are medical doctors that have identified several factors that increase our risk for heart attacks and strokes. Their scientific supporting evidence is very strong. You can learn more about their method at https://baledoneen.com and also read their book on the topic also found on their website. But the relevant topic here is that they require, as part of their diagnosis, a 3-dimensional x-ray to evaluate for cavitations surrounding RCT teeth. If present, they recommend the teeth to be removed. You’ll see why later on in this essay.

3. As a practicing dentist, I do feel that despite the best of efforts, root canal treatment does leave bacteria within the root canal system. But I’m not convinced that small amounts of bacteria left in a non-vital tooth will cause cancer somewhere else in the body, as the data and evidence just isn’t overwhelming, yet. The reasoning here will be discussed later on.

4. I do think that certain people are more susceptible to certain things than others. As analogized in the documentary, why do some people develop lung cancer after smoking, while others do not? As with all medical conditions, such reasoning can be mind-boggling. But from my professional and scientific perspective, I can say with confidence that all conditions are multi-factorial, meaning no one thing causes most medical conditions. It’s a perfect storm of genetics, environment, lifestyle, and aging. What am I trying to suggest? It’s that determining causality (cause and effect) in medicine has been, and will always continue to be, a VERY significant challenge. It’s human nature to want to blame one thing, but such approaches often lead people astray.

What are my reasons for thinking there might NOT be a connection?

1. First and foremost, hearing one or two stories about how someone gets “cured” from removing teeth, as seen in the documentary, can be a very damaging approach to drawing scientific conclusions. The world is filled with examples where the human mind tries to make connections between cause and effect, such stories can provide a false sense of causality, which helps no one. 

2. Documentaries are an entertainment-first form of television. It is very well known that “documentaries” often use “emotional tactics” as a method to increase their viewership. The original author’s initial motive might’ve been altruistic, but in order to sell their message, they use various techniques to increase the emotional attraction to such issues. At the end of the day, a Netflix documentary is NOT science, but entertainment. No one checks the veracity of their claims, so it is very important to search for the truth in these forms of “entertainment”. Ultimately, this “documentary” was removed from Netflix because it contained so much mis-information. 

3. My dental training left me with one very strong approach to scientific perspectives: “Only do something, if science has proven it to be effective.” In medicine and dentistry, we call this evidence-based medicine/dentistry. Despite the reasons in the previous section, the history of science/medicine/dentistry is filled with examples of things that made sense at first glance, only to be proven wrong by evidence years later. It is very possible that this is one of those moments.  

4. The life expectancy of the industrialized world has gone up exponentially in the past century. But, during this time period, we’ve been saving millions of teeth through RCT. If there was a direct effect, wouldn’t it be reasonable to think our life expectancy would go the other way? Something to consider.

5. Lastly, a few words on the work done by Dr. Price, where he implanted infected teeth into the skin of rabbits, is somewhat strongly suggestive of a connection. But what the authors of the documentary are overlooking, is the fact that his scientific methods were highly flawed, and that data was discounted many decades ago. Nonetheless, the connection continues to be touted by proponents of his theories. The “scientific method” has stood the test of time, and should not be removed in evaluation of any “theory,” no matter how convincing otherwise. 

Some other important points to consider:

Not all RCT teeth are the same. In order to fully understand this issue, it is important to note that as with most issues, it’s not a “black and white” issue, but instead, a gray issue with lots of factors. One of these factors is the “state” of the tooth when the RCT is completed. Some teeth necessitating RCT are barely infected, and are much easier to “clean” than others. On the other hand, some of these teeth exist with infection for years before being treated, suggesting a very infected root system. My professional point of view, after doing hundreds of RCTs, is that such teeth are very different than teeth that get RCT much earlier in the infection process.  

To explain why this might be important, let’s take a look at why root canals are done in the first place. The first scenario is when the nerve gets infected within the tooth. We call this irreversible pulpitis (inflammation of the nerve pulp) and can result in RCT. This situation results in root canal treatment where the canal system is not overwhelmed by infection. Why is this? Because in pulpitis, the nerve, blood supply, and drainage systems are all present, at least in part, to help contain the infection. Therefore, when RCT is completed under such conditions, the body is more likely to heal without a remnant “cavitation.” Contrary to this is when the inside of the tooth completely dies (becomes necrotic), and the internal defense mechanism is absent, bacteria can flourish. This often results in an abscess in the bone surrounding the tip of the tooth (called a cavitation). This type of infection can pester for years without any symptoms, all while, the infection is multiplying into the little nooks and crannies within the smaller canals. If a RCT is rendered on such a tooth, the outcome is not likely the same as the “pulpitis” tooth mentioned earlier in this paragraph. Although data suggests that the treatment outcomes between a “pulpitis” tooth and a “necrotic” tooth are not statistically significant, I’d say otherwise. But that’s just my anecdotal opinion. What is my point of bringing all of this up? It’s that some teeth that have RCT might actually be fine. Although all RCTs have shown to possess some levels of infection, it’s entirely possible that if the levels are low enough, the body deals with it without consequence. Take home message to this point: Not all RCT teeth are created equal. This may (or may not) have an impact on the connection. We’ll just have to wait and see what the science tells us. But from my point of view, this matters if/when one considers the tooth-systemic connection. Something to discuss with your dentist, as each clinical scenario is complex and requires their professional interpretation. 

What is this meridian thing all about? 

It has been surmised for centuries that teeth are connected to other organs in the body, through “energy fields” called meridians. At first glance, this may seem crazy. But in reality, the concept underlying this is very similar to the concepts used in acupuncture and reiki, both of which are recognized treatment modalities in medicine, even western (modern) medicine. Developed millennia ago, acupuncture, reiki, and other “Eastern medicine” treatment modalities have survived the test of time, so much so, that they are making a resurgence. For the record, I am not an expert in the fields of Eastern medicine, or even how teeth are connected to other organs. But I am open to the fact that such energy-based medicine exists, and can have a positive impact, and should not be discounted. What I will say to the contrary, is that I don’t think everyone who has liver disease has a tooth that correlates to it that must be infected and removed. There are hundreds of millions of people who have no organ issues, but have highly infected teeth. If it was a causal relationship, it would be much more obvious. But is it contributory? Maybe, but likely to a small extent. 

As with most things, meridians and other more abstract connections in the human body might play a role, just a small role. With that said, in some people, it might be the one “straw that broke the camel’s back” and be the treatment modality that finally helps, as illustrated in the documentary. As a result, the conclusion is that such treatment “cured” the person. Such conclusions can be dangerous, and such scenarios exist throughout medicine and society. Think about fad diets. What works in one person, then becomes the “next best thing.” But over time, the vast majority of people do not respond to eating only “snowflakes and pine needles,” as an embellished example. But if one person ate such an exotic menu, and it seemed to work, they’d be shouting to the roof tops that they found the answer everyone’s been looking for! This kind of scenario happens all the time and could result in much detriment, and in medicine, this kind of reasoning can be life-threatening. What is my conclusion about this meridian thing? It’s likely relevant, albeit minimal, and definitely not the entire explanation to this story. 

Body’s defense mechanisms. 

Before continuing on, I must present a concept, and that is the fact that the human body does a phenomenal job “containing” infections. If we were to think that “dead” teeth actually do ooze bacteria, then we have to wonder what the body does to this infection. Without getting into the physiology of the immune system, suffice it to say that the “border patrol” of the human body is quite amazing. Although “some” dead teeth might deserve to be removed, most are likely “contained” by our body’s immense immune response. If bacteria simply “oozed” into our bloodstream, we’d see so many more issues. 

Zirconia Implants. Are they truly better? 

At the end of the documentary, the film briefly discusses the fact that titanium dental implants can cause disruption of health, but that zirconia implants do not, at least to a much lesser extent. This is a very bold statement that lacks any scientific backing. The claim is likely based on the fact that zirconia is not a metal, and is less likely to affect the “meridians” discussed before. Zirconia implants are very new and they come with complications, as they are not as durable as their titanium counterparts. When it comes to implant dentistry, it is important to use a company or system that has stood the test of time. The reason for this is that as technology changes, it is much harder to fix, modify, or add to an implant from an “obscure” company. The result is the possibility of needing to remove the implant down the road in order to modify something. At this point in the zirconia implant arena, it’s far too early. 

Costs associated with RCT

Without spending several paragraphs and charts on this topic, suffice it to say that as a dentist, we profit more from people who remove teeth instead of saving them with RCT. This is because saving a tooth via this “time-tested” method preserves the structure and function of the entire oral cavity. A missing tooth drastically increases the overall costs associated with dental care. What am I getting at? Most dentists (99.9%) feel so strongly about RCT, that they recommend it in the face of less financial considerations compared to the removal of the tooth and subsequent treatment as the result of a missing tooth. 

Risk Analysis

Having had this conversation with many patients, the deciding factor often comes down to risk analysis. What does this mean? Risk analysis is taking the quantified risk of having a RCT versus a quantified risk of an alternative treatment, such as an extraction. In my opinion, most people that need RCT would introduce more “quantified risk” by removing the tooth, even if choosing an implant to replace the tooth. This is because countless scientific studies have shown that nothing is better than a natural tooth. I’ve seen it time and time again, that removal of teeth simply opens the door for more issues. As with any decision, it is imperative to consider all factors, which is why any decision should be in conjunction with a professional, not a decision based on a “documentary” or “Google search.” 

Conclusions from A Buxton Dentist

Ok, what am I to do now? Should I extract all of my teeth that have root canals? Should I go to a holistic dentist that is the “only” one qualified to deal with such issues? Here are my suggestions:

1. Take care of your teeth in the first place, to hopefully avoid having to make such a decision.

1. Do not take much of the documentary with too much seriousness, as the author of the documentary was not a dentist, and the “dentists” in the film were not touted as experts in anything beyond basic dental science. Although they may have a few valid-sounding points, no one checked their credentials beyond a basic dental degree.

1. Do not expect that your top 3 medical issues are a result of a RCT or cavitation. If there was that strong of a causal relationship, it’d be far more obvious.

1. Have an open mind and keep up to date with the science, not Netflix documentaries or Google searches. 

1. Find a dentist that is evidenced-based and can provide you with the research that is relevant to your issues. 

1. Find a dentist with access to a 3-dimensional x-ray unit, for a thorough investigation of your oral cavity, so that a fully-informed decision can be made.

1. Consider the risks associated with extracting a tooth, even one with potential infection, as it is entirely possible that the risk might outweigh the benefit. This includes higher risks for malocclusion, decreased chewing efficiency, bone loss, and much more. Such a decision should be weighed with many factors, not just one seen on a documentary.

1. If you don’t feel your dentist knows much about this topic, consider providing them with a copy of this position paper and/or the texts and books in the reference section.

Credentials and References:

It’s important that anyone reading this know my credentials and sources of my views. 

1. 11 years of clinical dentistry, involving root canal therapy, all phases of dental surgery, implant placement, and cavitation surgery.

1. Over 1300 hours of continuing education.

1. M.A.G.D. – Master’s in the Academy of General Dentistry, a designation allotted to less than 2% of U.S. dentists, signifying a dedication to continuing education in the field of dentistry.

1. Over 120 hours of post-doctoral continuing education in endodontic therapy, the science and treatment of root canal-infected teeth.

1. Over 5 years of 3-dimensional x-ray evaluation and subsequent treatment, with our in-house 3-D x-ray unit.

1. BaleDoneen Method and book, “Beat the Heart Attack Gene” by Amy Doneen M.D. and Bradley Bale, M.D.

1. Cohen’s Pathways of the Pulp. 9th edition.

1. “The Root Cause” Netflix documentary.

1. Cancer: A Second Opinion. Josef Issels, M.D.

1. Journal of Endodontics (JOE), the leading scientific resource for the science of the diagnosis, treatment, scientific advances, and theory of root canal therapy.