A jawbone cavitation is a hole in the bone that cannot be detected through visual inspection and is poorly detected by radiographs. The term “cavitation” was coined to describe the result of a disease process in which the lack of blood supply to an area of bone resulted in a hole or “hollowed out” portion of the jawbone or other bones in the body. Dr. G.V. Black (The Father of Modern Dentistry) described this process as early as 1915. He investigated how this disease produces extensive jawbone destruction without causing redness, swelling or increasing the patient’s body temperature. This disease progressively impairs the blood supply to the bone marrow in the jawbone resulting in osteonecrosis (bone death). The cause might be a biofilm form of bacteria that is antibiotic resistant and adheres to blood vessels. The released toxins and by-products from these bacteria, combined with cellular material, might be responsible for the lesions. Dr. Black recommended surgical removal of this dead necrotic tissue to promote healing of the jawbone. Today Ozone treatments are used to counter the disease once there is access to the cavitation by means of extractions.
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.
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 of Jawbone Cavitations
Physical Trauma As you will see, almost anything that can disrupt the tissue we call bone can act as an initiator.
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.
Initiating Factors Toxic Trauma, dental materials, root canal toxins, anesthetic by-products, vasoconstrictors in anesthetics, chemical toxins, bacterial toxins, other toxins.
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.
For a sufferers viewpoint see this book, available in the office. Beyond Amalgam by Susan Stockton.
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.
Diagnosis of Cavitations Diagnosis – the first step in successfully treating cavitations (NICO). Currently, a diagnosis is made using a panoramic type x-ray ( 2D or 3D). This large x-ray produces an image of the upper jaw, lower jaw, teeth and sinuses. A panoramic x-ray does not always detect early stages of osteonecrosis in the bone, but many lesions can be seen on this type of x-ray.
Diagnostic Blocks A relatively simple technique used to locate and confirm the presence of a NICO lesion. Here a few drops of non-vasoconstrictive anesthetic is injected into the gum tissue over a suspected site. Several minutes are allowed to pass and the pain pattern is evaluated for change. By doing this slowly and sequentially one can gain a greater awareness of the condition and location of the source lesion.
Occurrence of Cavitations/NICO – the CAVITATTMBob Jones, the inventor of the CAVITAT
TM (an ultrasound instrument designed to detect and image cavitations) has scanned several thousand sites where wisdom teeth had been previously extracted. He reported finding cavitations of various sizes and severity in approximately 94% of these sites. He reported finding cavitations under or located near 100% of root canal filled teeth scanned in both males and females of various ages from several geographic areas of the United States.
Preparation – Oral Once the diagnosis is made and the need for surgical treatment determined, the patients need to be prepared. Naturally, the oral cavity is the most germ-laden area of the body. Plaque, calculus, or periodontal disease only increases the severity of the problem. Prior to surgery the patient’s mouth, including the teeth, gums and tongue need to be as clean as possible. This may require a professional hygiene appointment at a dental office and diligent home care including brushing, flossing, rinsing, irrigating, and tongue scraping.
Oral care products containing fluoride, alcohol, and sodium lauryl sulfate should be avoided.
Preparation – Systemic There are 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. In some cases, limited antibiotics may be needed. 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, healing.
Surgical ProcedureAfter 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 (IV-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 holistic 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.
