APPENDIX G
How Insurance Companies Influence Dental Care
This book has presented a legitimate and compelling scientific case supporting the consistent toxicity found in root canal-treated teeth, as well as the pathology found in a dental entity known as the cavitation. The case has also been made in this book that the common, and decidedly not rare, cavitation should be surgically debrided, just like a pocket of infection and necrosis should be debrided anywhere else in the body. Until powerful industries like the insurance companies are willing to support the scientific truth, the dental profession will continue to attack or ignore this evidence.
The insurance industry provides stark proof of this reality. As an example, a major insurance company (Aetna) decided that the surgical treatment of the cavitation, as found in the mouths of many people, was something for which it did not want to pay the treating dentist.
In addition to denying such reimbursement, Aetna also attempted to question the legitimacy of the pathology involved in the cavitation. It even recommended dental board action against any dentist treating this dental condition, a truly incredible overreach for an entity not performing the dental work. In so doing this company, as well as other insurance companies, have played a major role in causing modern dentistry to simply deny that the cavitation is both a commonly occurring and toxic dental entity.
Because of the influence that major insurance companies wield, it would seem that it is a lot easier for busy dentists to just dismiss the existence of cavitations and defer to those companies to decide the dental standard of care and the legitimacy of different aspects of dental science.
Aetna Insurance Company’s Clinical Policy Bulletin Number 0642 titled “Neuralgia Inducing Cavitational Osteonecrosis (NICO) and Ultrasonograph Densitometer to Detect NICO” is representative of the
immense pressure the insurance industry exerts against the extraction of root canal-treated teeth, the acknowledgment of the cavitation as a common and pathologic bone condition, and the need for the surgical debridement of the cavitation.
Excerpts from the policy bulletin will be followed with a point-by-point analysis.
Legitimacy of Cavitation Interventions
Aetna considers the surgical debridement of cavitations to be experimental and investigational, while questioning the clinical significance of NICO itself. NICO is the professional name ascribed to the subset of cavitations that cause pain. Although cavitations are very real, as discussed in Chapter 12 and shown in photos included in this book, the dental industry refuses to acknowledge the clinical significance of cavitations, and therefore it dismisses any need for treating them. Some dentists even deny their very existence. Here’s what the policy bulletin states about the subject:
Aetna considers surgery (including scraping of “infected cavities” and removal of root-canal-treated teeth) and/or any other therapies (e.g., rinsing the “cavity” with colloidal silver and administering chelation therapy and intravenous vitamin C) and bone graft replacement for the treatment of neuralgia inducing cavitational osteonecrosis (NICO)- related diagnoses to be experimental and investigational because the clinical significance of this syndrome is in question.
Counterpoint: Cavitations and NICO have been known for a very long time and this has been scientifically—as well as photographically documented—throughout this book. All of the cases that report resolution of pain after surgical debridement of cavitations further support that a cavitation is a real diagnosis. Further, most of the cavitations do NOT cause pain. So, classifying all cavitations as NICO is misleading, since by definition neuralgia means pain. Still, Aetna, the ADA, and most practicing dentists refuse to recognize that cavitations and NICO actually exist as pathologic conditions. Further, dentists and physicians who do treat NICO and cavitations can potentially be brought up on misconduct charges by state licensing boards with penalties of license revocation, while also facing accusations of insurance fraud.
Aetna is correct, however, in asserting that the administration of anything other than those medicaments routinely accepted in orthopedic surgery is not advocated. However, that is a distinct and separate issue from the surgical debridement of osteonecrotic bone.
Use of Devices to Diagnose Pain-Inducing Cavitations (NICO) or NICO-type Conditions
Since the clinical significance of NICO has been deemed “questionable,” diagnosis of this condition is also “questionable,” and therefore, is not sanctioned by Aetna. Here’s what the policy bulletin states:
Aetna considers the use of devices to image the jawbones to diagnose NICO or NICO-type conditions experimental and investigational because there is no adequate scientific evidence to support their clinical value.
Counterpoint: The authors of this book have never advocated the use of any device other than X-rays to diagnose cavitations. As has been shown, 3D cone beam X-ray imaging can now definitively detect cavitations where 2D X-rays might not.
Diagnosis of NICO and Claims of Cure for Systemic Diseases
Aetna and others try to discredit the significance of NICO by referencing a single study that supports its conclusion and by referencing the fact that some dentists make unsupported curative claims concerning removal of cavitations with this statement:
The clinical significance of “neuralgia inducing cavitational osteonecrosis” (NICO), or cavitational osteopathosis, has been called into question. Dodes and Schissel (2000) reviewed the history of this syndrome. They explained that the American Academy of Biological Dentistry and other proponents of NICO claim that facial pain is caused by infected “cavities” within the jawbones. In addition, some proponents claim they can cure such conditions as arthritis, heart disease, and pain throughout the body by removing these infected cavities from the patient’s jawbones. Unlike abscesses, cysts, or periapical lesions, these cavities are not apparent on X-ray films, but
are only purportedly detectable with an ultrasonograph bone densitometer.
Counterpoint: Ethical dentists who treat cavitations DO NOT claim that they can cure diseases such as heart disease, arthritis, and pain throughout the body. Yes, sometimes improvements in these conditions do occur after the debridement of cavitations. The reason this book recommends the removal of infected root canal-treated teeth and the debridement of cavitations is to remove sources of infectious and toxic stress on the body. If these dental foci were factors in sustaining or worsening any systemic diseases in the patients being treated, then improvements may occur.
Contrary to the claim of Dodes and Schissel, these lesions DO appear on 3D cone beam imaging. Why they are less apparent on 2D X-ray (although many still can be seen) has been explained in the chapter on cavitations. Perhaps Dodes and Schissel had not worked with 3D cone beam imaging on cavitated areas of the jawbone when they made their assertions, since their paper was published 14 years ago.
Treatment of Chronic Pain Attributed to NICO
Aetna and others suggest that the chronic pain attributed to NICO is simply a problem with nerves and not associated with the presence of infected and necrotic tissue in tooth extraction sites. They state:
Klassner and Epstein (2011) reviewed the literature for NICO, and stated that “the etiology, pathogenesis and treatment of NICO are speculative and not well defined, and the reported bone changes may represent variations of normal changes. As a result, one can argue that the symptoms of chronic pain attributed to NICO are better explained by established concepts of neuropathic pain; thus, they should be approached medically and not managed surgically.” The authors concluded: “Without a confirmed clinical diagnosis of localized bone pathosis, aggressive and invasive procedures are not warranted. Such interventions may have no effect or may even worsen the pain by increasing sensitization of the central nervous system.”
Counterpoint: The proposed cause of the neuropathic pain in NICO is the toxic elements within the cavitation itself damaging the nerves. Pain is just a symptom of the underlying pathology. The cavitation is the cause of the
toxicity resulting in neuropathic pain. Treating only the symptom (pain), without treating the cause (cavitation), makes no sense at all. Unless Klassner and Epstein have figured out how to make dead bone alive again, their claim that NICO should be treated medically instead of surgically is patently absurd. Further, there are an abundance of case reports showing resolution of pain after surgical debridement of NICO lesions. Contrary to their statement, there is diagnosis confirmation and documentation of bone pathology. It is unclear how Klassner and Epstein came to their conclusion. Although there is the risk of pain getting worse after surgery, this risk is minimal. All surgical procedures have risk. Perhaps most amazing is how Klassner and Epstein can make these ridiculous assertions with the existence of multiple pictures clearly documenting the necrotic breakdown that is part of the cavitation process, as demonstrated in this book. (See Chapter 12 and Appendix B.)
Extraction of Root Canal-Treated Teeth and Surgical Intervention in Treatment of NICO
Aetna and the AAE declare that both the extraction of root canal-treated teeth and the surgical intervention in the treatment of NICO are unethical and should be reported. They state:
In a position statement, the American Association of Endodontists (AAE, 2012) has stated that the association “cannot condone surgical interventions intended to treat suspected NICO lesions... In addition, the practice of recommending the extraction of endodontically treated teeth for the prevention of NICO, or any other disease, is unethical and should be reported immediately to the appropriate state board of dentistry.”
Counterpoint: This last statement says it all. The AAE refuses to recognize the diagnosis of NICO, cavitations, or the systemic disease risks of root canal-treated teeth.
It is true that some practitioners claim the ability to cure a whole host of systemic diseases by extracting root canal-treated teeth and surgically debriding cavitations. The authors strongly disagree with this practice and agree that this constitutes misconduct. However, that does not mean that removal of dead, infected root canal-treated teeth and/or surgical
debridement of dead and infected bone, as in cavitation surgery, is misconduct or fraud. It just means that just like a host of other medical conditions, direct causation cannot be proven. It is simply a procedure to remove dead and infected tissue from the body, something that is considered malpractice to avoid if those infections and pockets of necrosis are anywhere in the body outside of the jawbone.
By making a blanket statement denying the pathology of NICO lesions and the systemic risks of root canal-treated teeth, it would appear that Aetna disagrees with most, if not all, of the scientific research presented in this book. Furthermore, they deem any dentists who are aware of this research and appropriately extract root canal-treated teeth and debride cavitations as being unethical and deserving of having their licenses to practice revoked by their state licensing boards.
It seems that the AAE would rather protect its own interests, which is focused entirely on promoting the safety and the utilization of the root canal procedure, than the interests of the public. The AAE refuses to do any substantive research on the systemic risks of root canal-treated teeth, as well as cavitations, and instead it stands behind false models of safety while ignoring all of the evidence to the contrary.
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