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Focal infection theory is the historical hypothesis, popular in America from about 1910 to 1940, and drawing renewed interest since the 1990s, that diverse diseases and maladies of unapparent causation are instigated or escalated by an overlooked pocket of infection, usually of oral origin, in the patient's own body.^[1][2] The theory implies illness, whether local or systemic, seemingly noninfectious, as the putative infection may have persisted for years of normal health.^[1][3] Hasty diagnoses and surgeries—to remove mostly teeth and tonsils but also internal organs or gonads—drew the theory growing disrepute by 1940.^[2][4] Medical orthodoxy retains focal infection per se as indeed a confined infection, often subacute, that may cause distal or systemic disease, but deems this fairly scarce,^[2][5] mainly infective endocarditis.^[6][7] Specialists may implicate select, other diseases as well.^[8][9][10] By contrast, focal infection theory, which crystallized in the 1890s as "scientific medicine" emerged, implicated nearly any condition, including arthritis, atherosclerosis, cancer, and mental illness.^{[1][11][12][13]}

By 1895, Willoughby Miller, an American physician and dentist in Berlin, Germany, applying bacteriology, established dental disease's microbial basis, and evidenced oral bacteria in extraoral disease. In 1900, British physician and surgeon William Hunter's anecdotes drew "oral sepsis"—entrapped, fomented, by dental restorations—an "egregiously overlooked" incitement of nearly illness or malaise.^[13][14][15] In 1911, Frank Billings, an American medical leader, shared case reports—from collaborative, institutional researches in Chicago since 1903—of disease seeming resolved by tonsillectomy or tooth extraction.^[13] Also in 1911, dental X-ray first revealed signs of subacute infection of tooth roots. By 1919, American dentistry mostly abandoned root filling—"root canal" therapy, which, by extracting the tooth pulp, leaves the tooth "devitalized"^[16]—amid "mania for extracting" pulpless teeth.^[17] America's foremost dental researcher, Weston Price, discouraged overzealous extraction, but maintained that pulpless teeth normally seep microbial "toxins" causal of degenerative disease.

In the theory, microbial toxins may chronically seep, but microbial outflow awaits immune activity's lapse or decline. Then, per bacteriologist Edward Rosenow—a Frank Billings pupil recruited to research at the Mayo Clinic—elective localization varies the consequences. In sum, the primary focus, typically oral, may metastasize as secondary foci, extraoral, where organ properties and local conditions may permit microbial settlement and adapt microbial properties. In 1914, Charles Mayo published alongside Rosenow and Billings, in America's preeminent medical journal, JAMA, to spotlight oral foci. Also influential was Llewellys Barker,^[18] lead professor at North America's exemplar medical school, Johns Hopkins University's.^[19] Medical academicians cautioned that excision alone is often inadequate and sometimes is adverse. But many medical clinicians effectively abandoned patient care to focal extraction by dentists and surgeons.^[20] Even elective toothlessness—extracting normal, healthy teeth—entered preventive healthcare.^[13][21] From 1918 to 1932, psychiatrist Henry Cotton's antipsychotic surgeries removed all teeth, the colon, or the gonads, or such, but controlled study in 1922 found no improvement in surgical groups versus control groups. In 1940, a "critical appraisal" in JAMA publicized to general medicine the hazards, low success rate, frequent relapse, and sometimes worsening by excising alleged foci.

In 1938, British physician and dental scientist E Wilfred Fish, reporting new experimental findings to reinterpret prior bacteriological dental findings, renewed optimism about root filling. By 1949, the root canal specialty endodontics emerged va rigorous research and refined procedures to prevent foci.^[22] Despite also antimicrobial drugs' 1950s availability, bacterial L forms and biofilm sustain the tenability of focal infection theory. By 2000, its scientific evidence remained marginal, yet its "allergy" hypothesis aligned with metastatic immunologic injury by local autoimmunity or systemic inflammation.^[23][24] Focal infection theory's aspect mainstream by 2020 is that overt periodontal disease is common and, systemically inflammatory, incites or worsens diverse pathology, hence the concept periodontal medicine.^[25][26][27] Controversially, alternative dentistry alleges that sites of conventional tooth extraction often develop foci—"jawbone cavitations"^[28] that conventional dentists deem fictional—and that pulpless teeth remain routine foci, which latter debate endodontic scientists reopened^[21] via 1990s findings.^[29] Citing prior rebuttals, leading academic endodontists reasserted that pulpless teeth can be sterile.^[3][13] As of 2015, scientific evidence remained insufficient to conclusively appraise and advise as to root filling.^[21] But automatically extracting everyone's pulpless teeth is quackery, and acute pulpal infection untreated is focal infection readily fatal.^{[3][13][30][31]}

—

Allan Scott Wolfe, "Dental roentgenography in the light of clinical and pathological findings", Am J Roentgenology, 1922 Mar;9(3):186–193, particularly pp 187–188.

Weston Price, "The present status of our knowledge of the relation of mouth infections to systemic disease",

In 1882, the NDA offered a prize for the best original analysis of the cause of caries [p 11]. Koch and Miller [p 12]. C. Edmund Kells and J W Morton in 1896 [p 12]. (Search for "Dental Association" on page 19.) In 1908, the NDA established an enduring committee on scientific research. In 1908, NDA created a research commission that provided grants and established an institute in Cleveland, Ohio, in 1915. p 21. Ruth Roy Harris, Dental Science in a New Age: A History of the National Institute of Dental Research (Rockville, Maryland: Montrose Press, 1989), https://books.google.com/books?id=SJK9PO7wk-AC&q="Dental Association" , https://books.google.com/books?id=8BhqAAAAMAAJ&pg=PA379&dq=renamed

H G Chappel, "Focal infection", Journal of the California State Dental Association, 1917 Aug;2(8):167–176, lecture to the California State Dental Association, 6 Jun 1917. https://books.google.com/books?id=wo01AQAAMAAJ&pg=RA1-PA167&dq=focal+focus+oral

R B G, "Synopsis of lecture: Martin H. Fisher, M. D. (Delivered to the California State Dental Association, July, 1916)", Journal of the California State Dental Association, 1917 Jul;2(7):146–149.

Ruth Roy Harris, Dental Science in a New Age: A History of the National Institute of Dental Research (Rockville, Maryland: Montrose Press, 1989), https://books.google.com/books?id=SJK9PO7wk-AC&q="Dental Association"

F Somma, R Castagnola, D Bollino & L Marigo, "Oral inflammatory process and general health. Part 1: The focal infection and the oral inflammatory lesion", Eur Rev Med Pharmacol Sci, 2010 Dec;14(12):1085–1095. https://pubmed.ncbi.nlm.nih.gov/21375141

Andrew Scull, "Somatic therapies and twentieth-century psychiatry", in Toshihiko Hamanaka & German E Berrios, eds, Two Millennia of Psychiatry in West and East: Selected Papers from the International Symposium "History of Psychiatry on the Threshold of the 21st Century," 20–21 March 1999, Nagoya, Japan (Gakuju Shoin Publishers, 2003), p 203.

William P Cruse & R Bellizzi, "A historic review of endodontics, 1689–1963, part 2", Journal of Endodontics, 1980 Apr;6(4):532–535. https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/56_bellizzipartii.pdf

James L. Gutmann & Vivian Manjarrés, "Historical and contemporary perspectives on the microbiological aspects of endodontics", Dent J (Basel), 2018 Dec;6(4):49. https://www.ncbi.nlm.nih.gov/pubmed/30249009

Jerry E Bouquot & Robert E McMahon, "Charlatans in dentistry: Ethics of the NICO wars", J Am Coll Dent, 2003;70(3):38-41. PMID 14977380.

Georg F W Hegel , In 1806, living in Jena, now a German city, when Napoleon's army, French, arrived for battle the next day, wrote that "all of us here wish the French victory and success. The Prussians are suffering defeats they deserve." "This morning, I saw the Emperor Napoleon, that World Soul, riding through the town to a parade. It's a marvelous feeling to see such a personality dominating the entire world from horseback."^[32] Three months after Napoleon's army defeated Prussia's army there, Hegel wrote, "There is no better proof than the events occurring before our eyes that culture is triumphing over barbarism and the intellect over spirit-less mind."^[32]

Johann G Fichte, by then in Königsberg, later in Berlin, opposing French invasion, delivered his Addresses to the German Nation.^[32] Fichte joined the nationalist university volunteer corps in 1813, and died battling the French in 1814.^[32] Hegel, by then in Nuremberg, continued supporting French invasion and opposing German nationalism.^[32] Prussia, the strongest German state, unified Germany in 1871 by the Franco-Prussian War under Prussian "minister president" Otto von Bismarck and and King Wilhelm I, newy first chancellor of and the emperor of Germany. World War I quelled the "German Problem"—Germany's growing power and alleged national arrogance—until Adolf Hitler incited World War II.

Illmatic is the debut studio album of Queens, New York, rapper Nasir "Nas" Jones, age 20 at its April 1994 release by Columbia Records.^[33] Nas's album highly anticipated,^[34][35] its recording was aborted in February 1994 because^[36] circulation of bootleg copies was severely expanding since 1993.^[37][38] "A landmark release,"^[39] entering major distribution in 1994, Illmatic debuted on May 7 at #12 on the popular albums chart, the Billboard 200.^[40] Since late 1992,^[41] rapper Snoop Dogg and the "G funk" subgenre of Los Angeles had dominated the rap genre.^[34][39][42] Illmatic, upheld as hip hop's purist revival and as a new model of rugged authenticity, reinvigorated New York rap.^{[34][39][42][43][44]} The album's cover art, too, was deemed iconic and soon mimmicked.^[44]

Illmatic executive producer Faith Newman, as a new A&R director at Columbia Records, had sought Nas since his guest verse on rap group Man Source's 1991 song "Live at the Barbeque," but her effort to meet him was thrwarted.^[45][46] Nas, meanwhile, offering himself to rap labels, was always rejected.^[47] Yet while recording a verse for a track on MC Serch's debut solo album,^[34] the track's record producer, T-Ray, suggested Faith Newman for Nas, and MC Serch took Nas to her.^[47] Reportedly explained that he sounded like Kool G Rap,^[47] a "legend" but of mediocre sales.^[48] Nas's manager, MC Serch, took his demo tape to Columbia Records,^[49] where Faith Newman coveted Nas.^[35][47] Nas's album project drew record producers renowned in New York's rap tradition, including DJ Premier, Pete Rock, and Large Professor,^[34][43] who incorporated many jazz samples.^[42] The lone guest rapper is AZ, of Brooklyn, still unsigned at album release.^[34] The Source magazine rated Illmatic a full, and rare, "5 mics,"^[34] and called Nas the "Second Coming."^[47][50]

The Source's rating, 5 of 5, reserved for classics,^[42] was controversial,^[34] yet Illmatic drew nearly universal critical acclaim,^[34][51] as for poetical and intricate lyricism vividly depicting his Queensbridge neighorhood's environment and culture.^{[34][39][50][44]} Still, the singles charted marginally, "Halftime" the best, #8 on Billboard's Hot Rap Singles.^[34] And only "It Ain't Hard to Tell,"^[52] at #91 on April 30, entered the main popular songs chart, the Billboard Hot 100.^[40] Also, album sales lagged: gold certification in 1996, platinum in 2001, and double-platinum in 2019.^[34] By then, Nas was "grateful" but "tired" of recurrent celebration of Illmatic,^[53] often ranked the best rap album ever.^[34][54][50] In 2021, Illmatic, "culturally, historically, or aesthetically significant," was entered into the National Recording Registry.^[55]

Clinton Eastwood Jr. (born May 31, 1930) is an American actor, film director, producer, and composer. He costarred as cowboy Rowdy Yates, growing popular with TV viewers, in the Western series Rawhide's full span from 1959 to 1967.^[56] In cinema near 1965, Eastwood drew broad European fame but some American scorn as the singularly stoic, terse, and violent protagonist in Italian filmmaker Sergio Leone's Dollars Trilogy of Westerns.^[56] Eastwood's trilogy characters prompted a collective nickname, the "Man with No Name," and innovated the genre once the same three "spaghetti Westerns" opened in America in 1967. Across the 1970s and 1980s, Eastwood played the ruthless, antihero cop Harry Callahan in the five Dirty Harry films. Eastwood emerged as a household name globally, an American icon of masculinity.^[56] Elected in 1986, Eastwood served one term as mayor of California town Carmel-by-the-Sea.

In 1968, Eastwood starred in a war action film, Where Eagles Dare, and in another Western, Hang 'Em High. His own company, Malpaso Productions, produced both the latter and many of his films since 1967. Eastwood thus starred in, produced, and directed Pale Rider, which fantasy Western was released in 1985, as well as Heartbreak Ridge, a war film released in 1986. Still, the films starring Eastwood that were most successful commercially are comedies, the 1978 adventure film Every Which Way but Loose and its 1980 action sequel Any Which Way You Can.^[57] Eastwood meanwhile became widely perceived as too constrained by genre conventions to attain artistic excellence.^[56] In 1992, at age 62, however, he produced and released Unforgiven, another Eastwood star vehicle and Western, which dew him three Academy Award nominations, whereby he missed for best actor but won for best film and for best director.^[56]

As when hired to simply act in the 1979 prison film Escape from Alcatraz, he played the lead role in a 1993 political action thriller, In the Line of Fire, which received three Academy Award nominations, if none for Eastwood, in 1994. He then produced, directed, and costarred in a 1995 romantic drama, The Bridges of Madison County, whereby his costar Meryl Streep gained Oscar nomination for best actress. In 2005, at age 74, Eastwood became the oldest person to win an Oscar for best director, and won for best picture, while losing only for best actor, via the prior year's Million Dollar Baby, a sports drama wherein he plays a woman's boxing coach. For her role, Hilary Swan won as best actress, and for his, Morgan Freeman won as best supporting actor. The next thoroughly Eastwood film was his 2008 action drama Gran Torino, blending "Dirty Harry" with his caring personae debuted in Bridges and in Million.^[58] The Mule, in 2018, evoked similar.

Eastwood as pure director, not also acting, debuted by the 2003 mystery drama Mystic River, and continued by the 2006 war film Letters from Iwo Jima, the 2008 drama Changeling, and the 2009 sports biopic Invictus. Eastwood's film of largest opening, the 2014 war biopic American Sniper, set the record for largest January release ever. Cry Macho, a September 2021 release, performed poorly, perhaps since the Eastwood audience's age groups largely avoid theaters in the ongoing pandemic.^[59] Beyond four Academy Awards, his major accolades include four Golden Globe Awards, three César Awards, and an AFI Life Achievement Award. In 2000, also for lifetime achievement, the Venice Film Festival, in Italy, awarded him the Golden Lion. France, in 1994, made him a Commander of the Ordre des Arts et des Lettres. In 2007, this order of merit in art was supplemented by Eastwood's entry into France's highest overall order of merit, the Legion of Honour.

Clinton Eastwood Jr. (born May 31, 1930) is an American film actor, director, producer, and composer. In the Western series Rawhide's eight seasons, 1959 to 1967, he costarred as cowboy Rowdy Yates, popular with television viewers.^[60] His film acting began in 1955. Near 1965, he drew broad European fame but some American scorn playing the lawless, nihilistic bounty hunter central in Italian filmmaker Sergio Leone's Dollars Trilogy, which three "spaghetti Westerns" entered American theaters in 1967.^[60] Terse but wry, Eastwood's trilogy roles, collectively nicknamed the "Man with No Name," swiftly antiquated the Western genre's classic, idealistic norms. Across 1971 to 1988, Eastwood played the ruthless, antihero cop Harry Callahan in the five Dirty Harry films. Eastwood, a household name globally, had become an American icon of masculinity.^[60] Elected in 1986, he served one term as the mayor of California town Carmel-by-the-Sea.

In 1967, Eastwood cofounded Malpaso Productions, which has produced most of his films, including Hang 'Em High, the 1968 Western that imparted his newly menacing persona to a lawful U.S. Marshall, and the Dirty Harry films. Acting in or directing over a dozen similar films by 1978, he then starred in an adventure comedy, Every Which Way but Loose, which some critics scorned but which remained his top earner till about 2010, and was in theaters in 1979 when so was Escape from Alcatraz, a prison drama starring Eastwood. In the 1980s, his stardom declined, yet Eastwood remained a reliable theater draw. He starred in, produced, and directed Pale Rider, a 1985 fantasy Western, as well as Heartbreak Ridge, a 1986 action war film, the genre of his 1968 acting role in Where Eagles Dare. But whether acting or directing, the aging Eastwood was widely perceived as confined to the genre conventions that he himself had helped alter and define.

In 1992, the Eastwood vehicle Unforgiven, costarring Gene Hackman and Morgan Freeman, revised the Western anew, and in 1993 drew Eastwood three Academy Award nominations, his loss at best actor yet Oscars for best director and, as producer, for best film.^[60] He played the lead role in a 1993 political action thriller, In the Line of Fire, whereby others, while not Eastwood, drew three Oscar nominations in 1994. His sensitive persona debuted by his coproducing, directing, and acting in a 1995 romantic drama, The Bridges of Madison County, whereby his costar Meryl Streep drew Oscar nomination for best actress. In 2005, at age 74, Eastwood became the eldest ever to win an Oscar as best director, and won for best picture, while losing at best actor, via Million Dollar Baby. By this 2004 sports drama, Eastwood plays a weathered boxing coach who, allaying paternal regrets, trains a woman age 31, and Hilary Swank won Oscar as best actress while Morgan Freeman won as best supporting actor.

Eastwood's top earner is a thoroughgoing Eastwood film, the 2008 action drama Gran Torino, wherein a Korean War veteran purges his own subtle xenophobia by transforming into a grandfatherly "Dirty Harry" altruistic.^[61] The Mule, a 2018 crime drama partly true, stars Eastwood as a Midwestern farmer who, still driving at age 90, begins trafficking drugs from the Texas–Mexico border, but this film met some unfavorable review and allegation of xenophobia. While controversial themes in his 2004 film Million reopened debates about Eastwood's sociopolitics—now whether he departed the conservative to endorse the liberal—Eastwood during this decade shifted from acting toward directing. He was pure director of the 2003 mystery drama Mystic River, which drew several Oscar nominations, of the 2006 war film Letters from Iwo Jima, which, filmed in Japanese, was an Oscar nominee for best picture, and of the 2009 sports biographic Invictus, whereby Morgan Freeman and Matt Damon were nominated for Oscars in acting.

Eastwood directed the 2008 crime drama Changeling, starring Angelina Jolie, which drew mediocre reviews. Eastwood's curriculum vitae includes other noteworthy films even between his most famous. He directed the 2014 war biographic American Sniper, starring Bradley Cooper, which set the record for largest January release ever. By contrast, Cry Macho, starring Eastwood of age 91 in real life, performed poorly in theaters in September 2021, and the ongoing pandemic may have largely displaced the aging Eastwood audience from moviegoers.^[62] By then, the elderly actor appeared unlikely in the role except by his Eastwood mythic.^[63] Along with his four Oscars, his many awards include four Golden Globe and an AFI Life Achievement. In 2000, the Venice Film Festival, in Italy, issued him another lifetime award, the Golden Lion. He has won three César in France, where in 1994 he was named a Commander of the Ordre des Arts et des Lettres—France's highest order of merit in art—and in 2007 entered France's highest order of merit altogether, the Legion of Honour.

"The problem these feminists confront is systemic white male supremacy. Fourth wavers believe there is no feminism without an understanding of comprehensive justice that deconstructs systems of power and includes emphasis on racial justice as well as examinations of class, disability, and other issues" [Margie Delao, "A brief look at the four waves of feminism", TheHumanist.com, American Humanist Association, 4 Mar 2021]. Although some assert that movement has never vacillated or that feminism's fourth's wave is not still the third, the fourth began around 2010 via the internet's evolution and is "inherently intersectional" [Constance Grady, "The waves of feminism, and why people keep fighting over them, explained", Vox.com, Vox Media, LLC, 20 Jul 2018]. " 'Maybe the fourth wave is online,' said feminist Jessica Valenti in 2009." Feminists "meet and plan", hold "discourse and debate", and "perform activism", like #MeToo tweets, online, while the Women's March was "conceived and propagated online. As such, the fourth wave's beginnings are often loosely pegged to around 2008, when Facebook, Twitter, and YouTube were firmly entrenched in the cultural fabric and feminist blogs like Jezebel and Feministing were spreading across the Web" [Ibid.]. There was, nearly 150 years ago, "the first-wave campaign for votes for women, which reached its height 100 years ago, the second wave women's liberation movement that blazed through the 1970s and '80s, and the third wave declared by Rebecca Walker, Alice Walker's daughter, and others, in the early 1990s", "with women defining their work as distinct from their mothers'. What's happening now feels like something new again. It's defined by technology: tools that are allowing women to build a strong, popular, reactive movement online. Just how popular is sometimes slightly startling" [Kira Cochrane, "The fourth wave of feminism: meet the rebel women", TheGuardian.com, 10 Dec 2013]. The Feminine Mystique, in 1963, sparked the second wave [Jacob Muñoz, "The powerful, complicated legacy of Betty Friedan's 'The Feminine Mystique' ", SmithsonianMag.com, Smithsonian, 4 Feb 2021]. But the third wave emerged circa 1990 via theories of queerness and politics since the second wave had not squarely "blazed through the 1970s and 1980s" but instead had sustained feminism's internal "sex wars" across the 1980s [Elisa Glick, "Sex positive: Feminism, queer theory, and the politics of transgression", Feminist Rev, 2000 Spring;(64):19–45]. Around 1988, feminism took a "linguistic turn" via poststructuralism []. Poststructrual feminism rapidly quelled feminism's major disputes by displacing "female" from the meaning of woman, whereupon feminism developed radical theories of gender, race, and abuse []. In short, the second wave's mainstream were liberal feminists—mostly white females of middle class and college education who endorsed classically liberalist sociopolitics of capitalism, individualism, and "sexual freedom"—who were embattled by radical feminists and by social feminists by 1980 []. Liberal feminists, influenced by liberalism, urged women to, as it were, integrate and emulate as to men and thereby dissolve patriarchy. Radical feminists, influenced by structuralism, admonished or rejected men while rallying women to resist or defeat patriarchy []. Social feminists differed from radical feminists by being also Marxist and, beyond explaining females as the socially subjugated sex, also explaining women as an economically exploited class, within "capitalist patriarchy" []. Socialist feminism emerged in association with black feminism. But liberal feminism focused on subverting radical feminism's and religious antifeminism's conciding efforts to limit sexual liberties [Ellen Willis, "Toward a feminist sexual revolution", Social Text, 1992 Autumn;(6):3–21]. As to the "sexual revolution" since the 1950s, most liberal feminists deemed it male hypocrisy but a net benefit for women, whereas most radical feminists deemed it more male hypocrisy and oppression of women [Ibid.]. Meanwhile, a radical faction that outsiders later termed cultural feminism poetically argued that females are innately superior to males, and sought revised language to reorder society on female values or at least to purify female spheres of male values [John C. Williams, "Feminism and post-structuralism", Michigan Law Rev, 1990;88(6):1776–1991]. But none could universally define woman, and biological determinism would reinforce also masculinity [Warner 2016].

Structuralist philosophy holds that language proceeds by meaning attribution through "binary opposition"—whereby any idea is grasped by perceiving a dyad, or two opposites, like light/dark, or young/old, or adult/child, or man/woman, while any pairing relates the two as superior/inferior—how language purportedly organizes, operates, and maintains social, or power, relations. Poststructuralism adds that any term accrues meaning from a vast, potentially endless, series of networked binary oppositions whose semiotic direction is flexible and malleable. Poststructuralism thus holds that the consequential meanings of a term are ultimately indeterminate, never absolutely objective or literally undebatable. Poststructuralism holds that meaning thus varies and evolves, variably "constructing" social identities and thus "determining" personal values, beyond the "agency" of invidual volition, to "align" with the social "discourse" available, an altogether "discursive" process. But whereas legal poststructuralism held the indeterminancy to stymie legalism, as even a legal statute lacks an absolutely true interpretation, femininist poststructuralism applied indeterminacy to "deconstruct" allegedly patriarchal dichotomies false and then argue that feminist redefintions be accepted.

As to defining women's liberation, liberal feminists sought more agency as autonomy, whereas radical feminists sought reform of structure as imposition. Liberal feminists, being liberalist, depicted social structure as customs. Radical feminists, being constructivist, depicted social structure as discourse. Social feminists, being Marxist, depicted social structure as money. Poststructural feminism thus reexplained gender as not causing culture, but instead as caused by culture as constructed by discourse [Ibid.]. Many radical feminists had long held that psychological sex differences are constructed, and reexplained gender as a culturally conditioned peformance whereby femininity is forced upon persons born with female bodies []. Near 1990, poststructural feminism displaced femaleness from its central importance in feminism, whose ensusing radical theories of gender, race, and abuse unified many previously disparate feminists into a third wave [Ibid.] In 1991, feminists entered theory of international relations: "they argued IR had neglected studies of norms, ideas, and processes such as structural violence, including poverty, environmental injustice, and sociopolitical inequality" [Jacqui True, "Feminism and gender studies in international relations theory", Oxford Research Encyclopedia of International Studies (OUP, 2010)]. By 1994, the issue of "politically correct" speech, aiming for the most egalitarian, humanitarian, or unimpeachable sociopolitical stance, escalated into an American media craze/war [Harold K. Bush Jr., "A brief history of PC, withi annotated bibliography", Am Stud Int, Apr 1995;33(1):42–64]. By 2003, "PC culture" was America's new norm, whereby young women widely viewed feminism as pointless [Ashleigh Harris, "From suffragist to apologist: The loss of feminist politics in a politically correct patriarchy", J Int Women's Stud, 2003 Apr;2(4):91–99]. Young sociopolitical liberals singular exception to "PC" was their fandom for Chappelle's Show, largely satire on black and white Americans, debuting in 2003 []. Ben Folds in 2019, discussing his March 2005 cover of "Bitches Ain't Shit", indicated that he has no problem with "PC" []. Yet in May YouTube hosts footage from his "Bitches Ain't Shit" performance on April 3 in 2007. On that date, Don Imus, as FM radio's leading "shock jock" and who, employed by CBS, was nationally syndicated by MSNBC, quipped live that a Rutgers University's women's basketball players looked "tough" or like "nappyheaded hos" []. Nine days later, via activist pressure, Imus, a white man, was was fired, mainly accused of racism, not of sexism [Martha Saavedra, "Dilemmas and opportunities in gender and sport-in-development", in Roger Levermore & Aaron Beacom, Sport and International Development (New York: Palgrave Macmillan, 2009), p 148, note #6]. Yet in 2009, an elder feminist's article incidentally quipped that women allegedly face a new beauty standard unreasonable to have "the body of a Brazilian transsexual" []. At such interseciontal exclusion of transpersons of color generally of lower class, young feminists went to her Twitter page and harassed her off the platform, inciting her friend to write an article, rather, but this was even more transexlusionist []. Amid boycott threats, the publisher deleted the article from the internet, both elder feminists "learned" and recanted and apologized, and, arguably, feminism's fourth wave had begun []. Over the next several years, black feminists moved to feminism's fore [Keeanga-Yamahtta Taylor, "Until black women are free, none of us will be free", NewYorker.com, The New Yorker, 20 Jul 2020]. Black women sustained, it was argued, "direct conflict with the intertwined malignancies of capitalism—racism, sexism, and poverty" [Ibid.]. In fact, the Combahee River Collective, a small group of black, lesbian, socialist feminists in Boston in the 1970s, "believed that, if black women were successful in their struggles and movements, they would have an impact far beyond their immediate demands. As they put it, 'If Black women were free, it would mean that everyone else would have to be free since our freedom would necessitate the destruction of all the systems of oppression.' " [Ibid.] Dream Hampton in March 2020 commentarated, Bell Hooks's 1984 book, Feminist Theory: From Margin to Center, "critiqued the way mainstream feminism sidelines women of color." Hooks argued, too, "that feminism must become a mass-based political movement if it is to have a revolutionary, transformative impact on society,' " [Dream Hampton, "100 Women of the Year: 1984: bell hooks", Time.com, 5 Mar 2020]. In March 2020, commemorating her, Dream Hampton closed, "Today, as we push back against those who wish to stymie progress on every front, the clear way she unpacks what it means to be a black feminist, a praxis that requires we take on class and race and gender, could not be more important." [Ibid.]

Per a 2012 opinion, Ben Folds songs, altogether, "aren't terribly reassuring to feminist listeners." He had issued "Bitches Ain't Shit" in March 2005, when American popular culture was dominated by neoliberal consensus and its political correctness. The singular exemption from "PC culture" was, at the time, comedian Dave Chapelle's television show, largely racial satire, some white but mostly black, and its massive fandom among neoliberal whites. Feminism's third wave had emerged upon 1990 while upon striving for political correctness and , the political correctness ," endorsed by neoliberals and opposed by conservatives, escalated into a media craze/war by 1995. From the neoliberal consensus that emerged in popular culture, "PC culture" became American norm, whereby even women typically viewed feminism as pointless, by 2003. That year, comedian Dave Chappelle's eponymous TV show, mostly satire of fellow black Americans, debuted, and drew massive fandom neoliberal America's singular examption from the "PC" mandate. Epic Records issued the second Ben Folds album, Songs for Silverman, in April 2005, the month that Chappelle began filming his TV show's second season. But in May, disgruntled by snowballing maneuvering and manipulation by others since he signed his new Comedy Central contract, eight seasons for $50 million, Chappelle simply abandoned the show and vacationed in South Africa.

Chapelle's comment on the Oprah Winfrey Show,

neoliberal' which. a recent "linguistic turn," feminism resurged, after a 1980s lull, a third wave upon 1990, and advanced a new ethos, "the personal is political" []. Feminists' introduced to politics such concepts as "structural violence" , it feminst debates over whereby even young women widely regarded feminism as silly.

By 1980, feminism's second wave splintered as liberal feminists resisted shared efforts by many radical feminists and religious conservatives to limit sexual liberties [] Bell Hooks

its release in 2005, the Ben Folds cover of "Bitches Ain't Shit," feminism

In 2019, he commented that he had no problem with "PC" []. In the 1980s, during feminism's internal "sex wars" that splintered feminim's second second [], feminists had debated whether sexuality can, and resumed its neoliberal consensus or should, be "politically correct" []. Yet the term was a quip, selfconcious of one's own perhaps overzealous striving to align private activities with sociopolitical stance []. Upon 1990, as feminism's third wave began [], and entered theory of internaltion relations [], Newly adoped widely by feminists, poststructural philsophy unified previously diverse feminist factions by displacing biological femaleness from the center of feminism, which thus developed radical theorie of gender, race, and abuse [], altogether unifiying previously divere feminist factions []. Feminism's third wave, imparting theories of queerness and politics, emerged just after 1990. Thereupon, political correctness escalated to an American media craze/ward by in 1994 [].

Joanna Robinson, "Dave Chappelle finally breaks his silence about abruptly leaving Chapelle's Show", VanityFair.com, 11 Jun 2014.

Catherine A. Coleman, "Construction of consumer vulnerability by gender and ethics of empowerment", in Cele C. Otnes & Linda Tuncay Zayer, eds., Gender, Culture, and Consumer Behavior (New York: Routledge, 2012), pp 17–18.

Deborah Elizabeth Whaley, "The empty space of African American sorority representation: Spike Lee's School Daze", in Tamara L. Brown, Gregory S. Parks & Clarenda M. Phillips, eds., African American Fraternities and Sororities: The Legacy and the Vision (Lexington: University Press of Kentucky, 2005), pp pp 420–421. https://books.google.com/books?id=vv-dedyrffIC&pg=PA420&dq=Jigaboos+Wannabees

"Vanishing Act: Dave Chappelle", Time.com, Time USA, LLC, visited 18 Dec 2021. http://content.time.com/time/specials/packages/article/0,28804,1902376_1902378_1902441,00.html

Joanna Robinson, "Dave Chappelle finally breaks his silence about abruptly leaving Chapelle's Show", VanityFair.com, 11 Jun 2014.

David Zurawik, "Chappelle's disappearing act", BaltimoreSun.com, Baltimore Sun, 9 Jul 2006.

Harold K. Bush Jr., "A brief history of PC, withi annotated bibliography", Am Stud Int, Apr 1995;33(1):42–64.

Keeanga-Yamahtta Taylor, "Until black women are free, none of us will be free", NewYorker.com, The New Yorker, 20 Jul 2020.

Dream Hampton, "100 Women of the Year: 1984: bell hooks", Time.com, 5 Mar 2020.

Ashleigh Harris, "From suffragist to apologist: The loss of feminist politics in a politically correct patriarchy", J Int Women's Stud, 2003 Apr;2(4):91–99.

The Combahee Collective was a small core grouop that met for years, reading, writing, and organizing in Boston: "the only black lesbian, socialistfeminist organizaiton in the Boston area [p 124]. "Combahee member Mercedes Tompkins remarked, 'Within Boston, people looked to Combahee for anchoring around things—around the whole issue of race and culture." [p 125]. "The original Combahee members came together out of the National Black Feminist Organization meeting in New York." [p 123]. "The women of the Combahee River Collective named themselves after the campaign led by Harriet Tubman, who freed slaves near the Combahee River in South Carolina." [p 122]. "The group was always small and fluid, with no more than 15 active women in Boston" [p 121]. "Barbara Smith as the mos visible leader of the Combahee Collective, the most public representative of the gorup, and the primary author of their writings. In the document, they explicity articulated and anticapiltalast and socialist" [p 128]. "The Combahee River Collective, in conjunction with other black socialist feminist of the time, brought home to all feminists that race, class, and gender were indivisible in understanding the lives of the oppressed, a central tenet of. . . " [p 149].

In March 2005, the Ben Folds was issued amid an American sociopolitical climate of neoliberal consensus, whose "PC culture"

During the 1990s, a neoliberal consensus emerged. Despite a neoconservative emergence via 9/11 during 2001, the neoliberal remained culturally dominant and by 2003 its "PC culture" became American norm, whereby sex equality was widely taken for granted and even young women widely viewed feminism as silly. Ben Folds issued "Bitches Ain't Shit"

Kathleen Canning, "Feminist history after the linguistic turn: Historicizing discourse and experience", Signs, 1994 Winter;19(2):368–404. https://www.jstor.org/stable/3174803

Deborah Teasley, "Radical feminism: Definition, theory & criticism", Study.com, 25 March 2016, updated 21 Sep 2016. https://study.com/academy/lesson/radical-feminism-definition-theory-criticism.html

Linda Alcoff, "Cultural feminism versus post-structuralism: The identity crisis in feminist theory", Signs, 1988 Spring;13(3):405–436. https://www.jstor.org/stable/3174166

and its fandom swiftly became neoliberals' singular exception to political correctness

Socialist feminism, whose focus was the intersection of race, gender, and class, receded via poststructural feminism's emergence nearing 1990, whereupon feminism via queerness and political theories effecting a third wave. While feminists entered theory of international relations, "political correctness" emerged and dovetailed with new consensus neoliberal. Although 9/11 dovetailed with emergence of neoconservative rival [], neoliberal consensus otherwise continued []. Political correctness was American norm, whereby even young women widely viewed feminity as silly by 2003, the year of debut by comedian Dave Chapelle's television show, largely satire about black and white Americans. In 2005, the Ben Folds himself issued the "Bitches Ain't Shit" cover and Epic reissued his breakthrough album of 1997, and then Epic released his new album, Songs for Silverman, in April, when Chapelle began filming his own show's new season. Yet the very next month, Chapelle seemingly vanished []. What little Chapelle had recorded played on Comedy Central in 2006. 2007, Folds played on April 3. That day, Don Imus. In 2008, socialist

Amy Allen, "Feminist perspectives on power", in Edward N. Zalta, ed., Stanford Encyclopedia of Philosophy (Online: Winter 2021)

Sam Warner, "Structuralism, feminist approaches to", in Nancy A. Naples, Renee C. Hoogland, Maithree Wickramasinghe & Wai Ching Angela Wong, eds, The Wiley Blackwell Encyclopedia of Gender and Sexuality Studies (Malden, MA: Wiley-Blackwell, 2016)

Marian Staats, "A Very Short Summary ofPoststructuralist and Queer Feminist Theory and Practice", Hollace Graff's faculty webpage, Oakton Community College, updated 15 Feb 2012. https://www.oakton.edu/user/2/hgraff/140PoststructuralFeminismS12.htm , also registed at SemanticScholar.org on this date. https://www.semanticscholar.org/paper/A-Very-Short-Summary-of-Poststructuralist-and-Queer-Staats/14bc02544f9cfecb6413fc1a383c9c9ae0e6ede6

Joseph Nicholas DeFilippis, "A queer liberation movement? A qualitative content analysis of queer liberation organizations, investigating whether they are building a separate social movement", ETDS, Dissertations and Theses, 2015 Aug 13;2466, Ph. D. Program under Ben Anderson-Nathe, Social Work and Social Research, Portland State University,

https://doi.org/10.15760/ETD.2464 , https://www.semanticscholar.org/paper/A-Queer-Liberation-Movement-A-Qualitative-Content-a-DeFilippis/3516eab952180bb0e2a7a691a706b3cd29d600f0

"If anything, Chappelle's personal mission in comedy is to seek the truth, even if it hurts. He refuses to be constrained by political correctness and hurt feelings. Rather, he wants his audience to think, consider, debate, discuss, argue, and react to the world we live in." Michael Taube, "Conservatives for Chapelle", NationalReview.com, National Review, 30 Mar 2017.

Ken Tucker, "The Don Imus debate", EW.com, Entertainment Weekly, 20 Apr 2007. https://ew.com/article/2007/04/20/don-imus-debate

Chris Steffen, "Ben Folds on repeating mistakes, conjuring characters, and repeating mistakes", AllMusic.com, Netaktion LLC, 23 Aug 2019.

Ben Merlis, Goin' Off: The Story of the Juice Crew & Cold Chillin' Records (Berlin: BMG Books, 2019). https://books.google.com/books?id=2i2-DwAAQBAJ&pg=PT96&dq=The+Bridge

Unattributed authorship, "5 reasons why the coronavirus crisis needs a feminist response", OXFAM.org, visited 8 Dec 2021. https://www.oxfam.org/en/5-reasons-why-coronavirus-crisis-needs-feminist-response

United Nations Entity for Gender Equality and the Empowerment of Women, Beyond COVID-19: A Feminist Plan for Sustainability and Social Justice (Headquarters: UN Women, 2021). https://www.unwomen.org/en/digital-library/publications/2021/09/feminist-plan-for-sustainability-and-social-justice

Michelle Lokot & Amiya Bhatia, "Unequal and invisible: A feminist political economy approach to valuing women's care labor in the COVID-19 response", Front Sociol, 2020 Nov 6;5:588279. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022460

Ben Folds, " '2020' lyric video", benfoldsTV @ YouTube, 25 Jun 2020. https://www.youtube.com/watch?v=4znKUAMFY9A

Whereas the early 20th century's social movements prioritized material redistribution via social class, the 1960s new left, as it were, prioritized recognition and access via social identity, which priority endured in the mainstream "equality" movement of the 2010s. But this decade's queer "liberation" movement, newer, demanded both recognition and redistribution.

Chris Morris, "Haggard speaks out 'Like Never Before' " & Phyllis Stark, "Nashville Scene: Cash wins three Americana Music Awards", Billboard, 2003 Oct 4;115(4):46. https://books.google.com/books?id=EBEEAAAAMBAJ&pg=PA46&dq=Imus+Folds+Dixie

History.com Editors, "This Day in History, April 04, 2007: Radio host Don Imus makes offensive remarks about Rutgers' women's basketball team", History.com, A&E Television Networks, 13 Nov 2019, updated 1 Apr 2021. https://www.history.com/this-day-in-history/don-imus-offensive-remarks-rutgers-womens-basketball-team

But the "homogenizing aspects to the second wave" were "altered and transformed with their encounter with black American feminisms, Third World feminisms, etc.," and it was held "and that a third wave may entail" internal awareness and criticism "to interrogate the problematic aspects of previous modalities of feminism."

Tricia Rose, The Hip Hop Wars: What We Talk About When We Talk About Hip Hop—and Why It (New York: Basic Books, 2008), p 167. https://books.google.com/books?id=OLX8K6ujQEIC&pg=PA167&dq=Imus+chorus+2006

"The artsy white man at the piano can make it funny while making it sad, and the lyrics support both interpretations." [93-94] "Yet the more I watched performances of Ben Folds singing this song at concerts, the more I felt that this innocuous white guy performance masked a troubling experience," as the audience "seemed to be delighted to be able to laugh at the sad situation," and "Folds is trespassing into Dre's gangsta character," "performing the all-access pass granted him by his whiteness and inviting the audience to join him," "in order to point out that the song is both sad and funny." [94] "Before we learn race, age, or other identifying markers, we are taught gender—which is usually presumed to be equal to sex. As Judith Butler might explain, this is our first performance mandate." [94-95]

"and her 13-year-old daughter apparently loves the song" "and then there were a couple of other times, and someone wrote me one nasty letter." "I'm constitutionally by the song." If you can make rap lyrics sad.

Yet he also called it "a soulful melody—hich I think is one of the best melodies I've written -- and put it to that. What does that create?"

"Then we played it live, and it was very uncomfortable, but I go towards the discomfort." "a lot of people who were very critical of it. The most compelling argument I saw about it was between my friend Eef Barzelay of Clem Snide and Michael Doughty of Soul Coughing, and they were arguing with each other over the internet about it." Folds, providing no details, simply called it "really, really compelling, and it was very interesting."

It was rather "a different time" versuse times "pretty charged now." Perhaps in aging, "I don't want to have people feel uncomfortable. I don't mind discomfort, but I do mind people feeling bad about themselves. I don't want a group of people singing one thing, and you're one of the three brown people in the audience." "I don't want it, and I think my audience completely understands. I remember Dave Chappelle saying that he made certain jokes for a while until he started realizing there were some white people laughing a little too hard, and I thought about that, as well.

Questlove, impressed by it, sought Folds to speak about it: "he loved that I dignified Dr. Dre's work with a melody.

Despite the resistance, Ben Folds said, "I also know that there's something in it, and it wouldn't have worked if there wasn’t some soulness in there." The protagonist goes to jail, is released, and finds his girlfriend sleeping with his cousin, "and he's wrecked. So if he's saying all these things about women, maybe it's because he was damaged."

Environment

Amy Cook, a chair of threatre arts, assesses the Ben Folds versus the Dr. Dre versions, segued into Judith Butler's 1988 reexplanation of gender as both distinct from sex and a performance.^[64] Such constructivist views signaled radical feminisms until feminist consensus took a "linguistic turn,"^[65] called poststructuralism. This ended feminism's "sex wars" of the 1980s,^[66] when liberal feminists, still mainstream, vied to subvert theefforts by radical feminists sought, like conservative moralists, to restrict "sexual freedom."^[67] Poststructural feminism, viewing identities as "constructed" by available "discourse," male "power" and female "oppression" a "discusive" process, began feminism's third wave upon 1990.^[68][69]

Circa 2005, popular culture had whose "political correctness" mandate, opposed by conservatives, became a media craze/war in 1994.^[70] By 2003, "PC culture" was American norm, how young women widely viewed feminism as redundant and antiquated.^[71] Meanwhile, by serial TV shows' recent move toward cable networks, popular media contained ample racial satire, including the full word nigger.^[72] Massively consumed comedian Dave Chappelle's Show, debuting in January 2003, whose racial satire, mostly black, was accepted as social critique artistic.^[72] And radio "shock jock" Howard Stern at least slurred and belittled himself, too.^[72]

By contrast, radio "shock jock" Don Imus's persona was an alpha male, boorish and smug, who liked cowboy hats and country music.^[72] In October 2003, Ben Folds played in a Nashville along fellow headline act the Dixie Chicks, while elsewhere in Nashville, ___, a star in country music, was panning start a podcast rather alike Don Imus's show. During 2020, the Dixie Chicks shirked while Ben Folds announced effort to have his "Bitches Ain't Shit" removed from all streaming platforms, the Dixie Chicks, shirking the county Southern identity, changed named to The Chicks. In April 2005, the Ben Folds "Bitches Ain't Shit" entered the Billboard Hot 100, and Chappelle began filming his show's third season.

In May, however, Chapelle abandoned his TV show and absconded to vacation in South Africa. In 2006, he appeared on the Oprah Winfrey Show and explained,

Imus, in any case a wealthy and famous white man, age 66, had applied ghettoized blacks' idiom to slur some young black women via race, sex, and class.^[72]

In 2007, a Ben Folds performance of "Bitches Ain't Shit" at Michigan State University was recorded by a concertgoer, whose video of this joy occassion remained viewable on YouTube in 2021 since its upload the day after the April 3 show.^[73][74] Yet also on April 4, radio "shock jock" Don Imus, covering the college women's basketball championship game, quipped that the University of Tenneesee players "all look cute," whereas the New Jersey players of Rutgers University were, Imus said, "some tough girls," "tattoos," "some hardcore hos," "nappyheaded hos," "wooo."^[75] Outraged, black activists and liberal journalists, citing some of Imus's racist and antisemitic quips of the past, demanded that CBS cancel his show, already on air for some 30 years.^[72] MSNC cancelled its national syndication, CBS suspended it for two weeks, and, as major advertisers withdrew, CBS cancelled the show eight days after Imus's notorious remark.^[76] The players' coach had condemned it as "racist and sexist."^[77] Public debate focused on racism.^[72][78]

Vying for the 2008 presidential race, John McCain and Rudlolph Giuliani, both Republican, spoke willingness, but Barack Obama, a Democrat, spoke refusal, to reappear on Imus's show.^[72] Published in 2008, sociologist Tricia Rose's second book on rap music's culture called the genre "gravely ill."^[79] "The beauty and life force" in rap music, since her 1994 book's optimism,^[80] was "squeezed out, wrung nearly dry by the compounding factors of commercialism, distorted racial and sexual fantasy, oppression, and alientation" to meet, she declared, "the existing mainstream obsession with black men and women as ganstas, pimps, and hoes."^[79] Rose linked Imus's hos slur of April 2007 to the March 2006 Grammy win by a song on the movie Hustle & Flow's sountrack, the rap group Three 6 Mafia's song "It's Hard Out Here for a Pimp," which won as 2005's best original song, any genre, was the first rap song ever performed at the Grammy Awards, and occasioned one of these winners to proclaim the feat, as reported by Billboard magazine, "also representing for the black community."^[81]

Rose's 2008 book depicts the 2006 Grammy and the Imus 2007 turning points as though they trace to the "Snoop Dogg chorus of Dr. Dre, 'Bitches Ain't Shit,' The Chronic, 1992."^[81] Meanwhile, the 2008 economic collapse, contervailing the neoliberal consensus since the early 1990s,^[82] invigorated socialist feminism.^[83] Radical feminism also Marxist, it is a basis of black feminism, which theorizes that black queer women sustain via the "intersection" of race, gender, and class the complete array of "oppressions" by "capitalist patriarchy," why the "liberation" of black queer women entails the end of everyone's "oppression."^[84] The first feminist elected US president, if perhaps more liberal feminist than radical feminist, was Obama in November 2008.^[85] A few days later, uploaded to YouTube was a video of Columbia University women's a acapella choir's cover of the Ben Folds "Bitches Ain't Shit."^[86] Embodying sex/gender "counterasting," the choir's performance staged the class dissonance to expand from the middle class to instead the leisure class.^[87][88]

By 2009, internet selfpublication as online magazines and blogs, like Jezebel.com and Feministing.com, along emergence of smartphones and with social media, particularly the Twitter app, enabled and manifested feminsm's rapid resurgence. Feminism's fourth wave is centered on the internet, is singularly popular, and is "inherently intersectional."^[89] In 2012, in reaction to neighborhood patrolman George Zimmerman's acquittal of criminally killing a black adolescent male Trayvon Martin, a group of women formed Black Lives Matter, rooted in black feminism. By early March 2020, black feminism was being celebrated, or socialist feminism was at the fore of American popular culture.^[90]

Black feminist Bell Hooks was Time magazine's

Jen Carlson, "Hip hop's secret meeting", Gothamist.com, New York Public Radio, 19 Apr 2007, updated 7 Mar 2008.

Snoop asserted that "we ain't no old-ass white men that sit up on MSNBC going hard on black girls. Snoop urged, "Kick him off the air forever." "Shaheem Reid, "Snoop says rappers and Imus are 'two separate things': Talks new comp", MTV.com, MTV News, 10 Ar 2007.

noted that In the "racial recoking" via feminism during 2020, the Dixie Chicks would change the group's name to simply The Chicks. Yet at the August 2019 release of his celebrity memoir, Ben Folds had already retired "Bitches Ain't Shit"—which reputedly he had first done at the Bannaroo Music Fest—actually its second retirement.

Joanna Robinson, "Dave Chappelle finally breaks his silence about abruptly leaving Chapelle's Show", VanityFair.com, 11 Jun 2014.

David Zurawik, "Chappelle's disappearing act", BaltimoreSun.com, Baltimore Sun, 9 Jul 2006.

Rise and popularity (1890s–1930s)

Roots and dawn

Germ theory

In public records of London soon after 1600, teeth commonly ranked 5th or 6th among causes of death.^[91] Even near 1910, tooth infection's recent death rates were estimated from 10% to 40%.^[91] According to dentist C Edmund Kells in 1919, dentists had been extracting infected teeth to treat extraoral diseases for at least 100 years.^[92] In fact, Hippocrates, in ancient Greece, had reported cure of an arthritis case by tooth extraction.^[3] But until the 1870s, dentists explained that loss of tooth "vitality" allowed tooth decay.^[93] In the 1870s, dental researchers implicated instead acids—hence, a chemical process—but attributed them to human metabolism, and estimated that oral bacteria merely assist the decay.^[94]

Focal infection, as such, appeared in Germany in 1877, when Karl Weigert reported "dissemination of 'tuberculosis poison' ".^[95] In the prior year, Robert Koch, also German, launched medical bacteriology—the laboratory protocols to isolate one bacterial species in "pure culture" and perhaps confirm the species' pathogenicity^[96]—whereby Koch announced discovery of the "tubercle bacillus" in 1882. Thus motivated to adopt the germ theory of disease, American medical doctors traveled to Europe for study, especially "Koch's bacteriology".^[97] Among them, William Henry Welch, by designing the medical school of the newly forming Johns Hopkins University, introduced German "scientific medicine" to America in 1884.^[98]

Eventually, tuberculosis would be described as a paradigm focal infection—unnoticed for decades but eventually causing distal, systemic, and mental pathology^[99]—but an American physician and dentist, Willoughby D Miller, promptly applied bacteriology to research dental disease.^[100] Miller, studying in Berlin, Germany, first identified that the acids eroding tooth enamel are bacterial products.^[94] And upon culturing samples from infected tooth pulp, Miller injected the bacteria into mice, which developed distinctive pathology apparently according to bacterial strain.

As progressively more diseases drew an infectious hypothesis that led to a pathogen discovery, conjectures grew that virtually all diseases would prove to be infectious.^[97]

In 1890, American physician and dentist Willoughby D Miller, researching in Berlin, Germany, attributed a set of oral diseases to infections, and attributed a set of extraoral diseases—as of lung, stomach, brain abscesses, and other conditions—to the oral infections.^{[12][101][102][103]} The in 1894, Miller became the first to identify bacteria in samples of tooth pulp.^[104][105] Miller advised root canal therapy.^[3][12] Yet ancient and folk concepts, entrenched as Galenic principles of humoral medicine, found new outlet in medical bacteriology, a pillar of the new "scientific medicine".^[19] Around 1900, British surgeons, still knife-happy, were urging "surgical bacteriology".^[19]

Autointoxication

In 1877, French chemist Louis Pasteur adopted Robert Koch's bacteriology and soon applied it to develop the first modern vaccines, ultimately releasing rabies vaccine in 1885.^[106] Pasteur's proceeds from rabies vaccine funded his formation of the globe's first biomedical research institute, the Pasteur Institute.^[106] In 1886, Pasteur welcomed to Paris the emigration from Russia by international scientific celebrity Elie Metchnikoff—discoverer of phagocytes, mediating innate immunity—who received an entire floor at the Pasteur Institute, once it opened in 1888.^[107]

Metchnikoff was kater the Pasteur Institute's director, and a 1908 Nobelist in Physiology or Medicine. Metchnikoff believed, as did his German immunology rival Paul Ehrlich—theorist on antibody, mediating acquired immunity^[108]—and as did Pasteur, too, that nutrition influences immunity.^[107] Metchnikoff brought to France its first yogurt cultures for probiotic microorganisms to suppress the colon's putrefactive microorganisms, which allegedly fostered the colon's toxic seepage thereby caused systemic degeneration, the putative phenomenon termed autointoxication.^{[19][107][109]}

Metchnikoff likened the colon to a "vestigial cesspool" that stores waste, but is now unneeded.^[110] Partly thus inspired, abdominal surgery's pioneer, Sir Arbuthnot Lane, based in London, drew from clinical observations to identify "chronic intestinal stasis"—in lay terms, intractable constipation—and implicate it for "flooding of the circulation with filthy material".^[19] Reporting surgical treatment for it in 1908, Lane eventually performed total colon removal to treat it, but later favored simply surgical release of "kinks" in the colon. In 1925, abandoning surgery, Lane began promoting prevention and intervention by diet and lifestyle, securing his contemporary reputation as a crank.^[19][109]

Since 1875, in the American state Michigan, physician John Harvey Kellogg targeted "bowel sepsis"—an allegedly prime cause of degeneration and disease—at a huge health resort, the Battle Creek Sanitarium.^[19] Having, in fact, coined the term sanitarium, Kellogg yearly received several thousand patients, including US Presidents and celebrities, at the resort, advertised as the "University of Health."^[19] But in the 1910s, as North American medical schools strove for the German model—that is, "scientific medicine"^[111]—medical doctors who diagnosed "focal infection" were hinting a scientific basis versus the older, alleged "health faddists" like medical doctor Kellogg and like minister Sylvester Graham.^[19]

Medical adoption

Oral sepsis

In 1900, British surgeon William Hunter blamed many disease cases on oral sepsis.^{[12][112][113]} In 1910, lecturing in Montreal at McGill University, Hunter declared, "The worst cases of anemia, gastritis, colitis, obscure fevers, nervous disturbances of all kinds from mental depression to actual lesions of the cord, chronic rheumatic infections, kidney diseases are those which owe their origin to or are gravely complicated by the oral sepsis produced by these gold traps of sepsis."^[12]

Thus, Hunter apparently attributed oral sepsis to dental restorations.^[101] Incriminating their execution, rather, his American critics lobbied for stricter requirements on dentistry licensing.^[12] Still, Hunter's lecture—as later recalled—"ignited the fires of focal infection".^[114] Twenty years later, he proudly accepted the credit.^[14] And yet, read carefully, his lecture asserts a sole cause of oral sepsis: the dentist instructing the patient to never remove a partial denture for any reason.^[114][115]

Frank Billings

Rush Medical College joined the University of Chicago in 1901, whereupon Frank Billings, elected the American Medical Association's president in 1902, served as its dean till 1924.

In 1903, physician Frank Billings, the American Medical Association's 1902 president, began collaborative institutional researches on the relation of infected foci to distal and systemic disease infection.^[13] extraction.^[12][13] Since 1903, based in Chicago, Billings began 12 years of researches at Rush Medical College, among America's oldest medical schools, in teamwork with both University of Chicago faculty and Presbyterian Hospital staff, to examine the role of oral infections in distal diseases.^[97] In November 1911, sharing case reports whereby tonsillectomies or tooth extractions apparently resolved infections of distant organs,^[114] Billings delivered a lecture to the Chicago Medical Society, a lecture that a leading medical journal published in 1912.^[116] In September 1915, Billings lectured on four days in a row in California at Stanford University Medical School, yielding lecture republication in book format.^[117]

Edward Rosenow

Central in Billings's research team was physician and bacteriologist Edward C Rosenow. to focal infection theory the principle of elective localization, whereby particular bacterial species have affinities for particular tissue types.^{[114][118][119]} Differing tissues provide differing environments, whose own natures, in Rosenow's estimation, help determine which bacterial characteristics, if any bacterial characteristics at all, manifest at that site.^[118][119] In short, whereas American bacteriology's orthodoxy tenaciously maintained Robert Koch's early belief in bacterial monomorphism—the belief that each bacterial species is naturally distinct, approximately constant, and thus is morphologically as well as biochemically identifiable and predictable—Rosenow sided with the many other bacteriologists who espoused extreme pleomorphism, whereby a bacterium drastically changes morphology, biochemistry, and even species according to environment.^[120]

David J Hess, Can Bacteria Cause Cancer?: Alternative Medicine Confronts Big Science (New York & London: New York University Press, 1997), p 18.

Editorial staff, "Pleomorphism of among bacteria", Journal of the American Medical Association, 1921 Oct 8;77(15):1184. https://books.google.com/books?id=qxccAQAAMAAJ&pg=PA1184&dq=pleomorphism

Mainstream embrace

Since 1889, brothers William Mayo and Charles Mayo earned international acclaim for their surgical center, the Mayo Clinic, in Rochester, Minnesota, which by 1906 was performing some 5000 surgeries yearly, over 50% abdominal, a massive number at the time, with usually low mortality and morbidity.^[19][121] Though originally distancing from routine medicine and skeptical of laboratory data, the Mayo Clinic recruited Edward Rosenow from Chicago to help improve diagnosis and care and to enter basic research via experimental bacteriology.^[19][121] In 1914, Charles Mayo published alongside Rosenow and Frank Billings, in the Journal of the American Medical Association, to highlight to role of oral infection in distal and systemic diseases.^{[122][123][124]}

Although physicians had already interpreted pus within a bodily compartment as a systemic threat, pus from infected tooth roots often drained into the mouth and thereby was viewed as systemically inconsequential.^[125] But in focal infection theory, although a focal infection could become medically consequential once immune response prevented dissemination from the focus—but that immunity could fail to contain the infection, that dissemination from the focus could ensue, and that systemic disease, often neurological, could result.^[125]

At Johns Hopkins University's medical school, launched in 1894 as America's first to teach "scientific medicine", the eminent Sir William Osler was succeeded as professor of medicine by Llewellys Barker,^[126] who became one of focal infection theory's prominent proponents.^[19] Although many of the Hopkins medical faculty remained skeptics, Barker's colleague William Thayer^[127] cast support.^[19] As Hopkins' chief physician, Barker was a pivotal convert, propelling the theory to the center of American general medicine.^[19] Russell Cecil,^[128] famed author of Cecil's Essentials of Medicine, too, lent support.^[114] In 1921, British surgeon William Hunter announced that oral sepsis was "coming of age".^[14]

By 1930, excision of focal infections was held to undoubtedly underpin many chronic inflammatory diseases.^[20] But despite guidance that focal excision alone was often inadequate and could even worsen disease, many practicing doctors virtually abandoned patient care to surgery.^[20]

Dental adoption

As a natural phenomenon, radioactivity was discovered, initially as X-rays, in 1895. Dental radiography, dental X-rays, entered wide use in American dentistry in 1911, and enabled visualization of previously unsuspected cases of periapical disease.^[114] C Endmund Kells introduced the first dental focal infection theory, via oral infections, into general medicine, the advent of dental X-ra

In 1923, upon some 25 years of researches, dentist Weston Andrew Price of Cleveland, Ohio, published a landmark treatise in two volumes^[3][129] Dental textbooks would rely on into it into the late 1930s.^[130] In 1925, Price published a related article in the Journal of the American Medical Association.^[131] Price concluded the pulpless teeth routinely host bacteria producing potent "toxins".^[3] Transplanting the extracted teeth into healthy rabbits—or even steeping the extracted teeth in water, filtering the water, and injecting the water in the rabbits—Price and his researchers duplicated heart and arthritic diseases.^[3] As the American Dental Association Research Commission's first chairperson,^[132] Price was a leading influence on the dentistry profession's opinion.^[133]

An event highly anticapted in dentistry, Price's October 1925 debate with John P Buckley, another eminent American dentist, was decided in favor of Price's position "that practically all infected pulpless teeth should be removed" [italics added].^[134]

But in Price's own words of 1923, "we have come to the time when involved teeth can be so definitely differentiated from those that are not involved, or with sufficient limit of error, that we are not justified in condeming all of the teeth for fear they may be involved. I am seeing continually, patients who are suffering more from the inconvience and difficulties of mastication and nourishment than they did from the lesions from which their physician or dentist had sought to give them relief."^[135] In Cleveland, Price delivered talks to company mangers, who, according to Price, "have a glorious opportunity for saving money for your corporation by conserving working efficiency thorugh the prevention of focal infections" and who "shall be held in large part responsible for not only the physical efficiency but for the morbidity and tenure o life as well."^[136]

But dentists on both sides of the ensuing controversy over when to extract teeth could cite Price, himself espousing conservative intervention at focal infections.^[137]

C Edmund Kells, who pioneered dental radiology in 1896, likewise advocated conservative dentistry.^[138] By contrast, many dentists were "100 percenters", extracting every tooth exhibiting either necrotic pulp or endodontic treatment, and extracted apparently healthy teeth, too, as suspected foci, leaving many persons toothless.^[3][13] A 1926 report published by several authors in Dental Cosmos—the leading dentistry journal—advocated extraction of known healthy teeth to prevent focal infection.^[139] Root filling nearly vanished from American dental education.^[3][13] Some dentists held that root filling should be criminalized and penalized with six months of hard labor.^[13]

Psychiatric surgery

Near the turn of the 20th century, psychiatry's predominant explanations of schizophrenia's causation, besides heredity, were focal infection and autointoxication.^[140] In 1907, psychiatrist Henry Andrews Cotton became director of the psychiatric asylum at Trenton State Hospital in the American state New Jersey.^[141] Influenced by focal infection theory's medical popularity,^[19] Cotton identified focal infections as the main causes of dementia praecox (now schizophrenia) and of manic depression (now bipolar disorder).^[141] Cotton routinely prescribed surgery not only to clean the nasal sinuses and to extract the tonsils and the teeth, but also to remove the appendix, gall bladder, spleen, stomach, colon, cervix, ovaries, and testicles, while Cotton claimed up to 85% cure rate.^[141]

Despite Cotton's death rate of some 30%, his fame rapidly crossed America and Europe, and the asylum drew influx of patients.^[141] The New York Times heralded "high hope".^[141] Cotton made a European lecture tour^[141] while Princeton University Press and Oxford University Press simultaneously published his book in 1922.^[142] Despite skepticism in the profession, clinical psychiatrists sustained pressure to match Cotton's treatments, as some patients otherwise felt that they were being denied cure.^[141] Other patients were pressured or compelled into the treatment without their own consent.^[143] Cotton had his two sons' teeth extracted as preventive healthcare—although each later committed suicide.^[141] Psychiatrist Cotton himself died in 1933.^[141] During the 1930s, psychiatry mostly discarded theories of focal infection and autointoxication.^[140]

Criticism and decline (1930s–1950s)

Early criticism

Addressing the Eastern Medical Society in December 1918, New York City physician Robert T Morris explained that the theory's overzealous advocates, overinterpreting the available evidence, were driving divisions among doctors and uncertainty among patients.^[4] Scientists, by contrast, "taking all evidence judicially, will eventually give the medical profession the basic facts and what is valuable in the subject. Right now", Morris added, "one might utter a warning to the general medical profession against taking too active an interest in the subject".^[4]

In 1919, the National Dental Association—renamed the American Dental Association in 1922^[144]—held in New Orleans its annual meeting.^[138] At it, C Edmund Kells, the pioneer of America's dental radiology,^[138] delivered a lecture—published in 1920 in the association's journal^[92]—focusing on focal infection theory, and rebuking the "mania of extracting devitalized teeth".^[17] Kells acknowledged the reality of focal infections and dentisty's role in treating and inadvertendly causing them, but characterized these as old insights, and proferred evidence of pulpless teeth remaining uninfected for decades.^[17] Kells urged dentists to reject physicians' prescriptions of tooth extractions.^[145]

In 1925, on the Fourth of July, eminent dentist John P Buckley challenged Weston Price to a public debate.^[146] Combining it with dinner at $2 per plate,^[147] the Ondontographic Society of Chicago set it for Columbus Day, October 12.^[146] By seating capacity, thousands of hopeful attendees were declined.^[146] Still, the dental and medical communities anticipated definitive insight and guidance from it.^[146] Presenting first, Price spoke largely rhetorically, omitting relevant data, and diverted to his researches on calcium metabolism and dental degeneration.^[146] Buckley's presentation mostly tried to discredit Price.^[146] Then each debater, violating debate rules, used the rebuttal period to extend the original discussion.^[146]

At the Ontario Medical Association's 51st annual, in May 1931, Duncan Graham, Even medical endorsing focal infection theory criticized doctors for virtually abandoning medical care to merely order extractions.^[20]

Focal infection theory's elegance suggested simple application, but the surgical removals brought meager "cure" rate, occasional disease worsening, and inconsistent experimental results.^[12] And at Johns Hopkins University, Phyllis Greenacre questioned most of Cotton's data, and later helped steer American psychiatry into psychoanalysis.^[141]

Still, the lack of controlled clinical trials, a shortcoming apparent in hindsight,^[12] was typical in medicine—except in New York City.^[141] Around 1920, at Henry Cotton's claims of up to 85% success treating schizophrenia and manic depression, Cotton's major critic was George Kirby, director of the New York State Psychiatric Institute on Ward's Island.^[148] Accordingly, Kirby and two colleagues at the institute—psychiatrist Clarence Cheney and bacteriologist Nicolas Kopeloff—traveled from Ward's Island to Trenton, New Jersey, to investigate Cotton's practice.^[141]

Clinical research

R. S. Pentecost, "Focal Infection in the tonsils of adults suffering from sub-acute and chronic systemic disease: Analysis of results of removal in a series of 800 cases", Canadian Medical Association Journal, 1922 Dec;12(12):886–891. PMCID: PMC1706871  PMID 20314268.

In two controlled clinical trials with alternate allocation of Henry Cotton's patients, Nicolas Kopeloff, Clarence Cheney, and George Kirby concluded the among Cotton's patients, the surgical groups and the control groups manifested matching outcomes, better predictable by prior prognosis..^[141][149] Publishing two papers, the team presented the findings at the American Psychiatric Association's annunal meetings in 1922 and 1923.^[141][150] Antipsychotic colectomy vanished except in Trenton until Cotton—who used publicity and word of mouth, kept the 30% death rate unpublicized, and passed a 1925 investigation by New Jersey Senate—died by heart attack in 1933.^[141]

By 1927, Weston Price's researches had been criticized for allegedly "faulty bacterial technique".^[151] In the 1930s and 1940s, researchers and editors dismissed the studies of Price and of Edward Rosenow as flawed by insufficient controls, by massive doses of bacteria, and by contamination of endontically treated teeth during extraction.^[3] In 1938, Russell Cecil and D Murray Angevine reported 200 cases of rheumatoid arthritis, but no consistent cures by tonsillectomies or tooth extractions.^[3][152] They commented, "Focal infection is a splendid example of a plausible medical theory which is in danger of being converted by its enthusiastic supporters into the status of an accepted fact."^[12] Newly a critic, Cecil alleged that foci were "anything readily accessible to surgery".^[114]

The distinction between medical theory and medical practice.

Fish & endodontics

In October 1938, the American Dental Association held in St. Louis, Missouri, its 80th annual meeting, where the lecture by E Wilifred Fish, an English physician, dentist, and scientist,^[153] renewed optimism about root canals.^[3] When researchers have employed bacteriology, which cultures samples to grow bacteria, Fish noted, "organisms could regularly be cultivated from extracted vital teeth" and "almost every tooth extracted from a pyorrheic mouth, whether its pulp was alive or dead, continued to provide a massive growth of organisms from its apex, and even from inside the pulp chamber, on routine culture".^[153]  Thus, "the suggestion that these organisms were living in the surrounding tissues seemed irrestible. It can, however, be shown this is not the case", Fish argued.^[153]

As to the receding tissue and resorbing bone and receding periodontal pocket or an infected root's apex—despite the abnormal appearance on radiographs and the heavy infiltration by immune cells—"consistently failed to show the presence of organisms when examined under the microscope."^[153] Similarly, search for "organisms" by histology, which offers methods of tissue analysis, "was at best only rarely successful, and then merely to the extent of demonstrating the presence of a stray organism due to contamination or accident."^[153] Further, as to Fish's own experiments receently implanting bacteria into guinea pigs' jaws, Fish reported development of four zones, but bacterial cells only in the infection zone, central, whereas the other three zones surrounding it showed only tissue cells and immune cells.^[3]

So altogether, concerning areas near periodontal pockets and infected roots' apices, Fish concluded, "it is not true that there are any infecting organisms actually present in this resorbing bone or that there ever have been. The germs themselves are confined either to the debris of the pocket or to the nectrotic contents of the root canal. Only the soluble poisonous products of their activity invade the living tissues."^[153] Fish deemed this, ultimately, "a very important distinction, which, if it can be upheld, will not only profoundly modify our approach in treating mouth infections, but will also modify bacteriologic practice and affect the attitude of general medicine toward focal infection."^[153]

The tenet that surrounding tissue can recover once the infectious nidus is removed premised emerged of a new speciality, endodontics.^[3] But still in 1938, "root canals" performed in America commonly failed—retaining consensus infections—whereby focal infection theory motivated endontologists to develop new and improved technology and techniques.^[13]

End of the focal era

In 1940, Louis I Grossman's endodontics textbook Root Canal Therapy flatly rejected the earlier methods and conclusions by dental researcher Weston Price and especially by bacterial researcher Edward Rosenow.^[154] In general medicine, rather, it was the review and "critical appraisal" by Hobart A Reimann and W Paul Havens, publishing in the Journal of the American Medical Association's January 1940 issue,^[115] that was perhaps the most influential criticism of focal infection theory.^[12] Reimann and Havens recast British surgeon William Hunter's pivotal warnings, some 30 years earlier, as widely misinterpreted, and summarized that "the removal of infectious dental focal infections in the hope of influencing remote or general symptoms of disease must still be regarded as an experimental procedure not devoid of hazard".^[139] As medicine and dentistry also acquired sulfa drugs and the antibiotics—broadly effective antimicrobial drugs—a backlash to the "orgy" of dental extractions ensued.^[12]

K A Easlick's 1951 review in the Journal of the American Dental Association notes, "Many authorities who formerly felt that focal infection was an important etiologic factor in systemic disease have become skeptical and now recommend less radical procedures in the treatment of such disorders".^[155] Editorializing in October 1952, the Journal of the American Medical Association, signaling the era's end, summarized that "many patients with diseases presumably caused by foci of infection have not been relieved of their symptoms by removal of the foci", that "many patients with these same systemic diseases have no evident focus of infection", and that "foci of infection are as common in apparently healthy persons as in those with disease".^[156][157] Although some support extended into the late 1950s,^[158][159] focal infection vanished as the primary explanation of chronic, systemic diseases,^[26] and the theory was generally abandoned during this decade.^[160]

Editorial staff, "Focal infection", Journal of the American Medical Association, 1952 Oct 4;150(5):490–491. DOI 10.1001/jama.1952.03680050056016. PMID 14955464.

Hobart A Reimann, "Tonsils and focal infectixon", Journal of the American Medical Association, 1957 Mar 20;163(13):1179. DOI 10.1001/jama.1957.02970480083023.

Revival and evolution (1990s–2010s)

Despite the general theory's demise, focal infection remained a formal, if rare, diagnosis, as in idiopathic scrotal gangrene^[161] and angioneurotic edema.^[162] Meanwhile, by way of continuing case reports claiming cures of chronic diseases like arthritis after extraction of infected or root-filled teeth, and despite lack of scientific evidence, "dental focal infection theory never died".^[13] In fact, severe endodontic disease resembles classic focal infection theory.^[13][157] In 1986, it was noted that, "in spite of a decline in recognition of the focal-infection theory, the association of decayed teeth with systemic disease is taken very seriously".^[30] Eventually, the theory of focal infection drew reconsideration.^[160] Conversely, attribution of endocarditis to dentistry has entered doubt via case-control study, as the species usually involved is present throughout the human body.^[163]

Stealth pathogens

With the 1950s introduction of antibiotics, attempts to find a bacterial etiology of unexplained diseases seemed all the more unlikely.^[164] By the 1970s, however, it was firmly established that adverse environments, including antibiotics that target the bacterial cell wall, can trigger bacteria's switch to their L phase.^[165] Eluding detection by traditional methods of medical microbiology, bacterial L forms and the similar mycoplasma—and, later, viruses—became the entities expected in the theory of focal infection.^[164][165] Yet until the 1980s, such researchers were scarce, largely via scarce funding for such investigations.^[164]

Despite the limited funding, research established that L forms can adhere to red blood cells and thereby disseminate from foci within internal organs such as the spleen,^[166] or from oral tissues and the intestines, especially during dysbiosis.^[167][168] Perhaps some of Weston Price's identified "toxins" in endodontically treated teeth were L forms,^[169] thought nonexistent by bacteriologists of his time and widely overlooked into the 21st century.^[170] Apparently, dental infections, including by uncultured or cryptic microorganisms, contribute to systemic diseases.^{[171][172][173][174][169][168]}

Periodontal medicine

At the 1990s' emergence of epidemiological associations between dental infections and systemic diseases, American dentistry scholars have been cautious,^[160] some seeking successful intervention to confirm causality.^[3][175] Some American sources emphasized epidemiology's inability to determine causality, categorized the phenomena as progressive invasion of local tissues, and distinguished that from focal infection theory—which they assert was reevaluated and disproved in the 1940s.^[3] Others have found focal infection theory's scientific evidence still slim, but have conceded that evolving science might establish it.^[23] Yet select American authors affirm the return of a modest theory of focal infection.^[176][177]

European sources find it more certain that dental infections drive systemic diseases, at least by driving systemic inflammation, and probably, among other immunologic mechanisms, by molecular mimicry resulting in antigenic crossreaction with host biomolecules,^{[27][178][179]} while some seemingly find progressive invasion of local tissues compatible with focal infection theory.^[179] Acknowledging that beyond epidemiological associations, successful intervention is needed to establish causality, they emphasize that biological explanation is needed atop both, and the biological aspect is thoroughly established already, such that general healthcare, as for cardiovascular disease, must address prevalent periodontal disease,^[178][180] a stance matched in Indian literature.^[181] Thus, there has emerged the concept periodontal medicine.^[27][160]

Amid continuing research interest,^[24] Indian textbooks find focal infection theory established, if in more modest form than originally.^[26][182] Akshata et al have attacked the stigma and posed focal infection theory as a correct theory earlier misapplied and thereby discredited yet later refined as knowledge grew over time.^[174] In a paper winning an Indian prize, they clarify "that the oral cavity can act as the site of origin for dissemination of pathogenic organisms to distant body sites, especially in immunocompromised hosts", especially those "suffering from malignancies, diabetes, rheumatoid arthritis", or "undergoing other immunosuppressive treatment", and that "uncontrolled advanced periodontitis" "presents a substantial infectious burden for the entire body by releasing bacteria, bacterial toxins, and other inflammatory mediators into the bloodstream that then affect the other parts of the body", this altogether "a paradigm shift in thinking about the directionality of oral and systemic associations".^[174]

Dental controversies

Jawbone cavitations

During the 1980s, American dentist Hal Huggins, sparking severe controversy, spawned biological dentistry, which claims that conventional tooth extraction routinely leaves within the tooth socket the periodontal ligament that often becomes gangrenous, then, forming a jawbone cavitation seeping infectious and toxic material.^[28] Sometimes forming elsewhere in bones after injury or ischemia,^[95] jawbone cavitations are recognized as foci also in osteopathy^[95] and in alternative medicine,^[183] but conventional dentists generally conclude them nonexistent.^[95] Although the International Academy of Oral Medicine & Toxicology claims that the scientific evidence establishing existence of jawbone cavitations is overwhelming and even published in textbooks, the diagnosis and related treatment remain controversial,^[184] and allegations of quackery persist.^[185]

Biology dentisty dentists also espouse Weston Price's findings on endodontically treated teeth routinely being foci of infection,^[28] although these dentists have been accused of quackery.^[186] Conventional belief is that microorganisms within roots inaccessible regions are rendered harmless once entrapped by the filling material, although little evidence supports this.^[187] A H Rogers in 1976^[188] and E H Ehrmann in 1977^[189] had dismissed any relation between endodontics and focal infection.^[139] At dentist George Meinig's 1994 book, Root Canal Cover-Up, discussing researches of Rosenow and of Price, some dentistry scholars reasserted that the claims were evaluated and disproved in the 1940s.^[190][191] Yet Meinig was but one of at least three authors who in the early 1990s independently renewed the concern.^[139]

Boyd Haley and Curt Pendergrass reported finding especially high levels of bacterial toxins in root-filled teeth.^[192][169] Although such possibility appears especially likely amid compromised immunity—as in individuals cirrhotic, asplenic, elderly, rheumatoid arthritic, or using steroid drugs—there remained a lack of carefully controlled studies definitely establishing adverse systemic effects.^[139] Conversely, some if few studies have investigated effects of systemic disease on root-canal therapy's outcomes, which tend to worsen with poor glycemic control, perhaps via impaired immune response, a factor largely ignored until recently, but now recognized as important.^[139] Still, even by 2010, "the potential association between systemic health and root canal therapy has been strongly disputed by dental governing bodies and there remains little evidence to substantiate the claims".^[139]

The traditional root-filling material is gutta-percha, whereas a new material, Biocalex, drew initial optimism even in alternative dentistry, but Biocalex-filled teeth were later reported by Boyd Haley to likewise seep toxic byproducts of anaerobic bacterial metabolism.^[193][194] Seeking to sterilize the tooth interior, some dentists, both alternative and conventional, have applied laser technology.^[194][195] Although endodontic therapy can fail and eventually often does,^[187][196] dentistry scholars maintain that it can be performed without creating focal infections.^[3] And even by 2010, molecular methods had rendered no consensus reports of bacteremia traced to asymptomatic endodontic infection.^[13] In any event, the predominant view is that shunning endodonthic therapy or routinely extracting endodontically treated teeth to treat or prevent systemic diseases remains unscientific and misguided.^{[3][191][197]}