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Root Canal Treatment: A hidden risk to develop CANCER It all looks so simple, easy and healthy! BUT: it can promote CANCER !!! Mechanical and immunological Limitations 20% failure rate ! Instantly, due to anatomical, immunological and mechanical limitations (1) Root canal treated teeth are dead, containing side tubules No blood supply, no lymphatics, no nervous tissue - no immune system Great habitat for anaerobic bacteria (2,3) producing toxic metabolites (Toxins) leading to local and systemic diseases In the presence of anaerobic bacterias —> even higher failure rates (4,5) Bacteria —> Toxins !!! Liiterature: 1. Barone C et. al., Treatment outcome in endodontics: the Toronto study--phases 3, 4, and 5: apical surgery. J Endod. 2010 Jan;36(1):28-35. doi: 10.1016/j.joen.2009.09.001. 2. Richardson N, Morda Toxins Highly toxic and carcinogenic hydrogen sulfur compounds (Thioether/Mercaptane) metabolites produced by bacteria (6) Leading to irreversible blockage of many life important enzymes Each chewing cycle releases many bacteria and their toxins into your lymphatic system, surrounding tissue (local). From there onwards into your blood stream (systemic) (7) Toxins —> Immune Response !!!! Literature: 6. Persson S., Edlund MB., Claesson, R., Carlsson J., The Formation of hydrogen sulfide and methyl mercaptan by oral bacteria. Oral Microbiology and Immunology 1990 August; Vol. 5 (4): 195-201 7.Lechner, J., Mehrdimensionale Systemdiagnose des wurzelgefüllten Zahnes. ZWR-Das Deutsche Zahnärzteblatt 2012; Vol. 121(12): 640-644 Immune response Silent chronic infections around dead teeth,spread to adjacent bone structures causing chronic inflammation —> unspecific immune response (8,9,10) Local macrophages release inflammatory markers/cytokines (TNF alpha, Interleukine 1,8,10, RANTES/CCL 5) which circulate through the blood —> effect becomes systemic (11,12,13,14,15) Local signs: jaw cavitation (15) Systemic signs: chronic inflammation (low pH), cell proliferation (16) Quelle: Dr. H. Reuver ZMK/Jg28/4-Apr2012 Immune Response —> Cell Proliferation !!! Literature: 8.Sousa EL et. al.,Macrophage Cell Activation with Acute Apical Abscess Contents Determined by Interleukin-1 Beta and Tumor Necrosis Factor Alpha Production. J Endod. 2014 Sep 6. pii: S0099-2399(14)00576-7. doi: 10.1016/j.joen.2014.06.019. 9 Martinho FC et. al., Signaling pathways activation by primary endodontic infectious contents and production of inflammatory mediators. J Endod. 2014 Apr;40(4):484-9. doi: 10.1016/j.joen.2013.10.022. 10. Marciel KF et. al.,Cytokine expression in response to root canal infection in gnotobiotic mice. Int Endod J. 2012 Apr;45(4):354-62. doi: 10.1111/j.1365-2591.2011.01983.x. 11.Hernadi K et. al., Elevated tumor necrosis factor-alpha expression in periapical lesions infected by Epstein-Barr virus. J Endod. 2013 Apr;39(4):456-60. doi: 10.1016/j.joen.2012.12.028.12.Marton IJ et. al.,Differential in situ distribution of interleukin-8, monocyte chemoattractant protein-1 and Rantes in human chronic periapical granuloma. Oral Microbiol Immunol. 2000 Feb;15(1):63-5.13 Martinho FC et. al., Antigenic activity of bacterial endodontic contents from primary root canal infection with periapical lesions against macrophage in the release of interleukin-1beta and tumor necrosis factor alpha. J Endod. 2010 Sep;36(9):1467-74. doi: 10.1016/j.joen.2010.06.012. 14. de Brito LC et.al.,Immunological profile of periapical endodontic infections from HIV- and HIV+ patients. Int Endod J. 2014 Jul 29. doi: 10.1111/iej.12345. 15.Lechner J et. al., RANTES and fibroblast growth factor 2 in jawbone cavitations: triggers for systemic disease Int J Gen Med. 2013 Apr 22;6:277-90. doi: 10.2147/IJGM.S43852. Print 2013.16.Tripi TR et. al.,Proliferative activity in periapical lesions. Aust Endod J. 2003 Apr;29(1):31-3. Cell Proliferation/Cancer Jaw cavitation: RANTES/CCL 5 Cytokines: IL 1 beta, IL 8, IL 10, TNF alpha uncontrolled cell proliferation —> Cancer ! Target organs (17-23) Breast, Pancreas, Liver, Lung, Bladder, Cervix Literature: 17. Lechner J et. al., Hyperactivated Signaling Pathways of Chemokine RANTES/CCL5 in Osteopathies of Jawbone in Breast Cancer Patients-Case Report and Research. Breast Cancer (Auckl). 2