It’s a dental version of Groundhog Day.
On March 14, 2005, a British man serving overseas in the military went to a dentist for root canal therapy. Ever since, he’s wakened believing it’s still March 14, 2005, and that he has a dental appointment later that day.
According to the recently published case report, though his long-term memory seems fine, he can only hold new memories for about 90 minutes. After that, new info vanishes.
In general each morning he is surprised to wake up in his mother’s house. He wakes up believing that he should still be in the military, stationed abroad. Every day he thinks it is the day of his dental appointment.
Through prompting by his wife, WO checks his computer each morning on which they have listed (and keep updated) key facts he should be aware of. Some events that have occurred since the onset of his condition in March 2005 continue to elicit genuine surprise or astonishment each time he sees or hears about them, such as the marriage of some family friend or that a family pet has since passed away. WO manages his daily life and generally remains oriented throughout the day via the use of continuous access to an electronic diary and prompts. Technically apt, he learned to use satellite navigation and a new digital camera proficiently, and he originally problem solve other tasks each time, such as how to turn on the power to his family’s new television. He drives himself to appointments through the use of satellite navigation and/or previous familiarity with the region in which he lives. Preserved ability to parent and deal effectively with emergencies has been demonstrated. His wife reported subtle differences in his ability to cope with stress or multiple demands on his attention, and he reportedly becomes more easily frustrated and intolerant and takes less interest in everyday family affairs, though his personality otherwise remains largely intact.
WO has remained completely oriented to his own identity, and that of his family, though he expects everyone to still be the age they were in March 2005. He has written down his children’s current schools and achievements, and wife’s new job. When office-based assessment sessions lasted more than 90 min, WO became completely disoriented to time and place, if kept from referencing his electronic calendar, appointment letter, or a clock. Though we have seen WO on multiple occasions, he demonstrates no recognition of ever having seen us before, and we must start afresh with introductions each time we meet. He is attentive socially, though requires his wife to answer questions regarding events since March 2005 that he has not otherwise written down and/or reviewed within the last hour or two. If asked, he may say, “I know I have a memory problem,” or “I think it is March 2005, but it is not….”
This condition of being able to remember the distant past but not more recent events is called anterograde amnesia and is a bit like what happens in an alcoholic blackout. It may be caused by benzodiazepine use or brain damage, but neither seemed to be the case for WO.
“Initially,” write the clinicians, the patient’s symptoms “were thought to be an atypical reaction to the anesthetic.” Yet there was no apparent cerebral damage. Both EEGs and brain scans came back normal. Their current thought is that there may be a breakdown of mRNA protein synthesis in his brain.
Of course, this is to look at it primarily from the perspective of neuropsychology. But what about the dental angle?
One overlooked possibility is bacteremia – bacteria in the normally sterile blood – which has been shown to occur rather often with root canal treatment (RCT). This should be no surprise, since root canal teeth are fantastic harbors of infection. Biopsy studies have shown that virtually all root canal teeth are riddled with pathogens and other toxins. It’s not just about bacteria from the original infection that ultimately prompted the need for RCT. As Dr. Verigin notes,
In a living tooth, the protein processes of these cells are continually bathed in intracellular fluid – dentinal lymph – from the pulp. When a dentist removes the pulp, however, they’re severed and remain within the dentinal tubules. Because there’s no longer any blood supply to them, they undergo necrosis – that is, they die and decay, just like the flesh of a putrefying corpse. The local biological terrain changes, and the microbes respond by degenerating into viruses, fungi, parasites and other pathological microbiota (i.e, “bad bugs”). Over time, their toxic metabolic waste migrates through the tubules and into the cementum, periodontal ligament and bone. From there, it finds its way into the general circulation, free to infect other organs.
Back in the 1960s, the late Patrick Stortebecker, once a professor of neurology at the famed Karolinska Institute in Sweden, conducted an important series of experiments that showed how pathogens can travel from the teeth to and throughout the brain. This and further research molded his understanding that infection in the jaws may play a significant role in psychological disorders, autoimmune conditions, seizures and other health problems.
Obviously, we can’t know if this is the case with WO. Still, his case serves as a reminder of the need to consider oral conditions when assessing systemic health problems. To neglect the teeth and jaws is to potentially miss important information for proper diagnosis and treatment.
So many patients we see in our office come to us after years of progressive or compounding illness, bouncing from doctor to doctor, each giving a different diagnosis. Finally, someone says, “Hey, let’s look at what’s going on dentally,” or the patient comes across a website, book or video that opens their eyes to the possibility of a dental connection. Often, their treatment must involve much more than dental work alone. Often, other work must be done first, before we can begin to address any specific dental pathologies.
But by including dental care within the total treatment plan, such individuals may finally find some relief after years of suffering.
To learn more, visit Dr. V’s Biodental Library.
Image by Gary Denness, via Flickr