Cavitations, also known as NICO (neuralgia inducing cavitational osteonecrosis) and IBD (ischemic bone disease), are diseases of the jawbone often associated with an extraction done in the past. This most likely results from a traumatic extraction or the lack of complete removal of the periodontal ligament. This disease progressively impairs the blood supply to the bone marrow in the jawbone (ischemia) resulting in bone death (osteonecrosis).
From a patient’s point of view, this can present itself by jaw discomfort, overall fatigue and other systemic health issues. Some patients having cavitations can also be completely asymptomatic for a long period of time.
The term “cavitation” is generally used to describe lesions appearing as empty holes in the jawbone. They are usually ischemic (no oxygen supply), necrotic (dead), osteomyelitic (infected bone), and they usually release toxins. These lesions are often found in old extraction sites, under or near the roots of root canal teeth, avital (dead) teeth, and/or wisdom teeth. The lesion may spread throughout the jawbone, penetrate the sinuses or totally encompass the inferior alveolar (jaw) nerve
The best way to diagnose a cavitation is by using a 3D x-ray known as a CBCT (Cone Beam Computed Tomography). This allows the treating doctor to evaluate the bone density in all the areas of the jawbone, especially where the wisdom teeth were placed. Sometimes, in addition to low bone density, the outline of the cavitation is clearly visible on that type of scan.
Research by Dr. Boyd Haley, Professor Emeritus of the University of Kentucky, shows that ALL cavitation tissue samples tested contain toxins that significantly inhibit one or more of the enzymes used in the energy production cycle. These chemical toxins (most likely from protein degradation or anaerobic bacteria) can produce significant systemic effects, i.e. stopping the Krebs cycle at any one of a number of parts of the cycle. The Krebs cycle is responsible for cellular energy production. This energy is what powers us in our day-to-day lives. Thus if you have no to poor energy production you will exhibit Chronic fatigue. And negatively affect the local blood supply in the jawbone enhancing the disease process.
Research has shown these toxins combine with chemicals or heavy metals, such as mercury, forming even more potent toxins. Research from German toxicologists indicates the jawbone may be a biological reservoir for chemicals and heavy metals (especially wisdom tooth sites). Clinically, it is easier to successfully detoxify the body of mercury after jaw cavitations and mercury fillings are removed.
The term NICO (neuralgia-inducing cavitational osteonecrosis) has been used when severe facial pain, neuralgia, headache, or a phantom toothache accompanies this disease. Although the presence of cavitations is a common occurrence, only a small percentage of the individuals with jawbone cavitations suffer from this pain component. However, even in the absence of pain or localized jawbone symptoms systemic symptoms can be extensive. Researchers and physicians as early as 1918 expressed concern about the systemic effects of cavitations. A growing number of contemporary dentists, physicians, and researchers are even more alarmed by the latest research.
There are many possible initiating, predisposing, and risk factors associated with jawbone cavitations. A single or combination of factors can influence the occurrence, type, size, progression, growth pattern or symptoms resulting from a NICO lesion. Each individual is unique and each NICO lesion is uniquely located in a particular jawbone area making diagnosis and treatment complex. One of the major initiating factors is likely dental trauma, which includes physical, bacterial and toxic components.
Initiating Factors and Treatment of Jawbone Cavitations
Physical Trauma
Extractions, dental injections, periodontal surgery, root canal procedures, grinding – bruxism, electrical trauma, metallic restorations, galvanism, high speed drilling, bacterial trauma, periodontal disease, cysts, abscesses root canal bacteria, avital teeth, improper debridement after extractions, infected wisdom teeth or tooth buds.
Predisposing Factors
A number of factors predispose people to cavitational type lesions. Clotting disorders such as thrombophilia, hypofibrinolysis and others (which may be undiagnosed) may lead to oxygen-depleted areas of bone. Age – research suggests up to 11% of older individuals may have major or complete blockage of arteries to the jaws. Radiation or chemotherapy for cancer, systemic disease such as rheumatoid arthritis, lymphoma or bone dysplasia, osteoporosis, lupus, sickle cell disease, homocystinemia, Gaucher’s disease, hyperlipidemia, hemodialysis, gout or antiphospholipid antibody syndrome. Inactivity (bedridden, paraplegic), deficiency of thyroid or growth hormone, occupational hazards such as variable atmospheric pressures can all be predisposing factors.
Risk Factors
Many different factors put an individual at risk for ischemic osteonecrosis/NICO including corticosteroid use, pregnancy, estrogen use, alcoholism, cigarette smoking, and pancreatitis.
Wisdom Teeth Extraction Sites
One source of data indicates that 45% of all jawbone cavitations are located in the third molar area where wisdom teeth have been previously extracted. These areas are particularly susceptible because they contain small terminal blood vessels (microvasculature) and osteonecrosis is a disease of such vessels. Injections for dental procedures are often given near these areas. When local anesthetic with vasoconstrictor (i.e. epinephrine) is used, the blood and thus oxygen supply to the bone in these areas is reduced. We recommend and use non-constricting anesthetics.
Prevention of Cavitations
Prevention involves the elimination or appropriate modification of initiating, predisposing, and risk factors. New technology, instruments, products and technological applications, may improve prevention and treatment and enhance the bone regeneration process. More research will improve the prevention, diagnosis and treatment of cavitations. Today, individuals can receive relief from local and systemic symptoms, diseases and pain by the surgical treatment of cavitations.
Recommended Treatment
Treatment of cavitations is to surgically scrape clean the area, removing all unhealthy bone and all pathology such as abscesses, cysts, etc. Draining the lesion and injecting homeopathic remedies or other substances into the lesion may increase the severity of the lesion. After removing the unhealthy bone, the goal is bone regeneration. Successful bone regeneration relies on an individual’s healing capacity and the elimination and treatment of predisposing/risk factors. This is not always possible. Failure to heal or reoccurrence of a lesion and the need for retreatment is always a possibility, no matter how well the surgery is performed. There are very few dentists who are trained to effectively diagnose and treat these lesions. Those who are not so trained are not qualified to diagnose this condition or confidently assure patients that they do not have cavitations.
Preparation
A prophylaxis (cleaning) is recommended before a cavitation surgery to reduce the bacterial load in the mouth. Several products, including enzymes, homeopathic lymphatic drainage remedies, natural antimicrobials, and healing nutrients that may provide nutritional and systemic support prior to and after the surgery are also recommended. It is important that all body detoxification pathways are open and functioning well; bowels, kidneys, skin, lungs, and especially the lymphatics. Electrolyte balance is important for detoxification and healing
Sedation
Oral sedation, Audio Analgesia (MillCalm) or nitrous oxide, can be important in the surgical procedure, especially in the removal of a large or extensive cavitation involving the alveolar nerve or the sinuses. MillCalm is the preferred route to deep relaxation as it is the healthiest. Conscious sedation helps the procedure pass more quickly and painlessly. The surgical procedure is more comfortable for the patients and easier for the surgeon. Blood pressure, heart
Surgical Procedure
After the patient is relaxed or sedated, local anesthetic is administered. A local anesthetic without vasoconstrictor is preferred, because it is the least toxic and least damaging. Additionally, homeopathic antibiotics and pain interrupters are administered. An incision in the gum and bone is performed. Once access is gained then specimens are removed for biopsy.
At times it is necessary to remove an avital or root canal tooth. The instruments and procedures are used to help prevent contamination of the open bone area and to remove the necrotic (dead), osteomyelitic (infected) and toxic bone. This can be a slow and tedious process, especially when the necrotic bone surrounds the alveolar nerve or extends into the sinuses.
After the necrotic bone is removed, the surgical site is irrigated with various solutions to aid in the removal of bacteria and toxins. To assist with bone regeneration, platelet rich fibrin alone or in conjunction with bone regenerative material can be placed in the surgical site. The area is closed with special sutures that help prevent bacterial growth. If there is extensive bone damage, a bone regenerative material and/or resorbable membrane to guide new bone growth may be placed.
Post Surgery
During and following surgery, intravenous vitamin C can assist with healing, cleaning up toxic materials and bacteria released into the bloodstream and detoxifying local anesthetics and IV medications. We provide this service or will coordinate with a nearby biological physician. Tenderness and soreness generally occur in the area of the surgery and can be controlled with pain medication. Some swelling and bruising may occur. The area may ache during the healing process. We recommend liquid diet the first day and soft foods the first week. Salt water and/or antimicrobial rinses (silver hydrosol), and continued oral hygiene are important. Sutures are removed 7-10 days after the surgery. If any indication of infection (swelling, fever, increasing pain) occurs, the surgeon should be contacted immediately. The number of areas treated during one surgery depends on the number of lesions to be treated and the individual.
Other adjunctive therapies post-surgically are: the use of low level infrared laser therapy (Anodyne) and oxidative (ozone) therapy. This is applied immediately post operatively and can be dispensed for continued daily home care for the next month. The frequency of light (860nm) emitted by the diodes was specially picked for the healing effects on the tissues. Tremendous amounts of research have been carried out on this particular system, which is why we have chosen to use it.
