Roots of a Dental Controversy

Rebecca Lindsay had a toothache. Dentists told the 36-year-old Irvine woman that her dental fillings were slowly poisoning her and that she should attack the problem at the source. Her teeth had to come out.

Over the next three months, the dentists, James Shen and his wife, Rily Young of Huntington Beach, extracted nine of Lindsay’s teeth -- and much of her jaw.

They didn’t stop there. They yanked 18 of her mother’s teeth after Lindsay referred her to them. “You just put your trust in doctors,” said Lindsay, a sales rep for a pharmaceutical company. “I thought, if I don’t do this, I can die.”

The treatment left Lindsay so disfigured that a new team of surgeons has since transplanted bone from her hips to reconstruct her jaw. New plastic teeth are allowing her to eat normal food. Now, she said, after years of shame about her appearance, “I am going to have to learn how to smile again.”

Lindsay and her mother, Lyndel McKay, 67, are suing the dentists for malpractice. They are among a long list of patients who have been subjected to “holistic” or “biological” dentistry, a controversial practice that urges wholesale extractions of teeth and surgery to remove “decaying jawbone.”

Shen and Young have denied the allegations. They are fighting the suits by Lindsay and her mother.

Many in the dental establishment consider holistic dentistry a fraud. They say there is no reason to pull people’s teeth to stop common ailments and that many holistic dentists do so solely to pump up their bills.

“It is hocus-pocus,” said Robert S. Baratz, a Boston physician and dentist, who has appeared as an expert witness in 18 cases against holistic practitioners before state dental boards. In all the cases, he said, the dentists either were reprimanded or lost their licenses.

In California, regulators have cracked down on some holistic practitioners, suspending their licenses and fining them. They say the practice has quietly existed for decades and acknowledge that there is little their overburdened departments can do. Patients often are willing participants in the treatment, and those who feel duped are embarrassed to come forward.

Two of the nation’s largest insurers recently targeted holistic dental treatments, declaring that they would not pay claims to dentists who scoop out chunks of patients’ jawbones. A few months ago, Blue Cross Blue Shield of Illinois stated that the procedure was not a recognized treatment and thus not covered.

Insurer Aetna Inc. came across similar claims a few years earlier and no longer honors them. “Unproven concepts should not be the basis for invasive dental surgical procedures,” the insurer stated in a warning to members, providers and claim handlers.

Lindsay said she did not know what was going on until it was too late. The Mississippi native moved to Irvine eight years ago with her husband, Al, so that he could attend Whittier Law School in Costa Mesa. In 2000, a tooth that had been treated with a root canal years before began bothering her, she said.

Lindsay went to see Shen and Young, who were recommended by her chiropractor. The couple, who practiced from a nondescript strip mall office, were licensed dentists with three decades of experience between them. Lindsay said the two asked her about her health history.

Lindsay said she told them she had battled aches and pains most of her life, including in her jaws and neck. Her father had passed away from cancer, and her mother had recently had a mastectomy because of breast cancer.

“I just thought they were being thorough,” Lindsay said during a recent interview at her attorney’s office in Century City. She has since moved to Colorado Springs, Colo.

Lindsay said Shen and Young told her that her silver fillings and root canal-treated teeth should come out. They showed her X-rays of her mouth with dark spots, which they described as infections. They also sent her home with booklets with titles such as “Root Canal Cover Up” and “Cancer: A Second Opinion,” which purported to make a connection between deadly illnesses and silver fillings and root canals.

Lindsay said the accounts in the booklets scared her. “I was very afraid of cancer,” she said. “I thought they could save me from cancer.”

She was so convinced that she got her husband to replace his silver fillings. Lindsay also flew her mother from Hattiesburg, Miss., to undergo treatment with Shen and Young.

But the treatments left Lindsay and her mother in pain and unable to eat, the women allege in their lawsuits.

Lindsay said dentures recommended by Shen and Young cut into her gums and made them bleed. She wanted implants, but the dentists would not discuss the treatment.

Finally, Lindsay sought another specialist. That’s when she learned the extent of what Shen and Young had done and that she would need a bone transplant. She decided to sue.

“I’m still in shock,” Lindsay said. “What was I thinking?”

Holistic dentists hew to a belief that much of life’s maladies begin with ailments in the mouth. They contend that common silver fillings are toxic because they contain mercury.

Federal regulators and the American Dental Assn., a professional organization that sets standards but has no enforcement power, say there is no evidence that silver, or amalgam, fillings cause illnesses. The fillings are still widely used across the globe.

It is difficult to say how many American dentists practice holistic techniques. An Internet search yielded dozens of dentists across the country who call themselves holistic or biological practitioners. One group called the Holistic Dental Assn., which advertises online and has a San Diego post office box, lists 17 members in California.

Most practitioners avoid scrutiny by state dental boards because patients seldom complain, experts and state officials say.

“We can’t go on fishing expeditions,” said Theresa Lane, a supervising investigator with the Dental Board of California.

The board’s nine investigators oversee more than 34,000 licensed dentists and investigate about 3,000 complaints a year, including allegations of negligence.

“We know they are out there and that they practice differently,” Lane said of holistic dentists. But she added, “We don’t get enough complaints, and until we get a complaint from the consumer, we don’t know what is going on.”

The state agency is seeking to revoke Shen’s and Young’s licenses, accusing them of gross negligence and practicing outside the scope of their dental license. The case followed a complaint by Mirjana Lukic, a 53-year-old homemaker from Escondido, who had 13 teeth extracted by the Huntington Beach dentists.

Lindsay’s case is among half a dozen malpractice suits filed against Shen and Young by attorney David Wilzig. Shen and Young have paid a confidential sum to settle Lukic’s suit.

In a telephone interview, Shen, who described himself as a holistic dentist, acknowledged that he and his wife treated Lindsay and her family, and extracted their teeth and parts of their jawbones.

“She had fabulous results and then she got hold of a greedy lawyer,” Shen said.

“I don’t care what science says,” he said about criticism of holistic dentistry. “My patients leave here feeling better. That’s their reality. You can’t deny that.”

The theory that the mouth is the source of many ailments has been around since the early 1900s, said Leif K. Bakland, a board member of the American Assn. of Endodontists and a professor of endodontics at Loma Linda University.

“When doctors couldn’t figure out what was wrong, they routinely extracted teeth,” he said.

In Lindsay’s case, Shen sent bones from her jaw to Jerry Bouquot, a professor at the University of Texas’ dental school in Houston. Bouquot diagnosed the tissue samples as having neuralgia inducing cavitational osteonecrosis, or pain caused by holes in the jaw.

Bouquot coined the term NICO and is the self-proclaimed national expert on it. The diagnosis is now popular among holistic dentists, but many mainstream scientists doubt that NICO exists.

Bouquot declined to be interviewed but released a statement through a university spokesman saying that he performs biopsies for anyone and that he does not consider whether they’re holistic dentists. Bouquot declined to detail the scientific evidence behind NICO.

Aetna and Blue Cross Blue Shield of Illinois said some patients began filing NICO claims in recent years.

Their investigations showed that the diagnosis had little support in science. NICO joined other ailments treated by holistic dentists not covered by dental plans, including the replacement of functional silver fillings with other materials.

Resin-based fillings, which are commonly used to replace amalgam, cost about $200 each. Many patients fork over their own money for the treatments. Lindsay and her mother spent close to $30,000, their attorney said.

Bakland, the Loma Linda professor, said many patients are so desperate that they will listen to anything.

In one such case, the Colorado board of dentistry revoked the license of a so-called alternative treatment clinic headed by Hal Huggins, one of the most prominent holistic dentists in the country, although he prefers the term “nontoxic dentistry.” He denied the accusations.

The board revoked Huggins’ license in 1996 for, among other things, practicing medicine -- not dentistry -- without a license and administering unnecessary treatments.

Two of Huggins’ patients were a 71-year-old man suffering from Lou Gehrig’s disease and his 67-year-old wife, who had liver cancer.

According to the board, Huggins prescribed a battery of tests and unconventional treatments, including acupressure, sauna and intravenous vitamin C, for the couple in 1992.

The couple’s amalgam fillings, crowns and root canal teeth were removed. They died from their illnesses within a year of visiting Huggins’ clinic.

The board found that none of the treatments were necessary and in the case of the woman “the treatment essentially rendered her a dental cripple.”

The treatment also did little to stem the couple’s incurable diseases. Huggins charged the couple $21,000 for the treatments, according to the board.

Huggins has denied the allegations against him and maintains he was the victim of a vast conspiracy by the American Dental Assn. to silence him because he challenged their conventional methods.

Despite losing his license, Huggins, 69, has built an apparently thriving consulting practice, coaching others to follow his methods, which include the proper extraction of silver fillings. Among his students: Shen.

Shen said he applied much of what Huggins taught him on Lindsay.

Lindsay’s suit against Shen is waiting for a court date.

For nearly five years, Lindsay couldn’t bear to look in her mouth and avoided smiling because of the gaping holes in her teeth, she said. She rarely ate solid food because she could chew only with her front teeth.

“I ate a lot of mashed potatoes,” she said, “and Jamba Juice.”