Dental Cavitations: Symptoms, Treatment, Surgery Cost, Definition, Diagnosis

Dental cavitations are a lesser-known yet significant oral health issue that can lead to chronic health problems. These cavities in the jawbone, often undetected, can harbor harmful bacteria and produce significant systemic effects. Understanding dental cavitations, their impact, and treatment options is crucial for maintaining overall health.

Key Facts

• Dental cavitation is a hollow area or pocket in the jawbone, often at the site of a previously extracted tooth involving dead bone cells
• Alternate Names: NICO (Neuralgia-Inducing Cavitational Osteonecrosis), jawbone osteonecrosis
• In many cases, cavitations are asymptomatic but may cause facial pain or contribute to chronic systemic issues
• Causes are often a result of incomplete healing after tooth extraction, especially wisdom teeth, or due to infections
• Specialized imaging techniques are often required for diagnosis, as regular X-rays may not always detect cavitations

Definition: What are Dental Cavitations?

A dental cavitation is a hole in the jawbone, usually where a tooth has been removed, and the bone has not healed properly. It often involves dead bone tissue and can become a site for chronic inflammation and infection. Contrary to what the term might suggest, dental cavitations are not cavities in teeth. Instead, they are areas within the jawbone, often at the site of previous tooth extractions, where the bone has not healed properly. These areas can become necrotic and serve as a breeding ground for bacteria, potentially contributing to chronic infection and pain. In some cases, cavitations may be connected to systemic health problems as they can harbor bacteria and toxins that affect overall health.

The Formation Process

The formation of cavitations can be attributed to several factors. After a tooth extraction, if the periodontal ligament is not entirely removed, it can prevent the bone cells from filling in the space, leading to a cavitation. Other risk factors include clotting disorders, decreased blood flow to the area, and infections like a tooth abscess. Over time, decreased blood flow can cause bone cells to die, creating a hollow space or cavitation in the bone.

Medical Terminology

Dental cavitations (or jawbone cavitations) are often referred to in the medical community as Neuralgia-Inducing Cavitational Osteonecrosis or NICO. The term osteonecrosis refers to the death of bone tissue, which is a defining characteristic of cavitations.

• Neuralgia: Refers to nerve pain
• Inducing: Means causing or bringing about
• Cavitational: Refers to the formation of a cavity or hollow space
• Osteonecrosis: Refers to the death of bone tissue due to lack of blood supply

Together, the term NICO describes a condition where the necrosis of jawbone tissue is associated with nerve pain.

Symptoms of Dental Cavitation

Most common symptoms of dental cavitation include:

• Chronic Facial Pain: Including conditions like trigeminal neuralgia or atypical facial pain.
• Systemic Symptoms: Such as chronic fatigue, inflammatory bowel disease, and other chronic health problems.
• Oral Symptoms: Bad breath, sinus problems, and symptoms often misdiagnosed as trigeminal neuralgia phantom toothache.

Anaerobic bacteria in the cavitation can produce potent toxins, contributing to systemic inflammation and disease. While initially local, cavitations can produce significant systemic effects if not addressed.

Diagnosis of Cavitations

• Clinical Evaluation: The initial step in the diagnosis of dental cavitation involves a clinical evaluation. The dentist will take a detailed medical history and perform a clinical examination. Patients may describe symptoms such as unexplained facial pain, pressure in the jawbone, or a history of unresolved infections.
• Imaging Techniques: Standard dental X-rays often fail to detect cavitations as they may not provide sufficient detail of the internal structure of the bone. More sophisticated imaging techniques are generally needed for the diagnosis:
  • Cone Beam Computed Tomography (CBCT): This advanced imaging technique provides a three-dimensional view of the jawbone and is more effective in detecting cavitations.
  • Cavitat Ultrasonography: This is a specialized device designed specifically to detect cavitations. It uses ultrasonic waves to create an image of the jawbone and can effectively detect hollow areas within the bone.
• Bone Biopsy: In some cases, a bone biopsy may be performed. In this procedure, a small piece of bone is removed from the suspected area of cavitation and sent to a lab for microscopic examination. This can confirm the presence of necrotic bone tissue and any associated infection.

Causes of Dental Cavitations

Dental cavitations can be triggered by various factors, often involving an interplay of local and systemic conditions.
Some of the common causes include:

• Poor Healing After Improper Tooth Extraction: Often when a tooth is extracted, some of the periodontal ligament is left behind (not entirely removed), and the surrounding bone does not heal properly. This is particularly common in wisdom tooth extractions.
• Infections: An area in the jawbone may become infected, like a tooth abscess, leading to the death of bone cells and formation of a cavitation. Bacteria can infiltrate the jawbone, leading to necrosis of the bone tissue. These bacteria may originate from periodontal disease, root canal infections, or other oral sources.
• Restricted Blood Flow: Anything that restricts blood flow to the jaw can contribute to the development of cavitations. This includes trauma, clenching, and grinding of the teeth, which can damage blood vessels.
• Systemic Conditions: Certain systemic conditions such as autoimmune disorders or hormonal imbalances may also contribute to the development of cavitations.

Linking Between Dental Cavitations and Chronic Diseases

There is a growing body of evidence suggesting that dental cavitations can be linked to chronic systemic diseases. The hollow areas in the jawbone may harbor bacteria, fungi, and toxins. These pathogens can release toxins that enter the bloodstream and may contribute to a variety of health problems, including:

• Cardiovascular diseases
• Rheumatoid arthritis
• Chronic fatigue syndrome
• Autoimmune disorders

Published Research on the Topic of Dental Cavitations

Several studies have shed light on the implications of dental cavitations. For instance, a study published in the Journal of Oral Science examined the presence of bacteria in jawbone cavitations and concluded that these could be reservoirs for bacteria contributing to chronic infections. Another study in the Journal of Oral and Maxillofacial Surgery focused on the relationship between dental cavitations and facial neuralgia, suggesting that addressing cavitations could alleviate neuralgia in some patients.
As dental cavitations gain more attention in the research community, it is likely that more studies will be conducted to further understand their role in both oral and systemic health.

Treatment of Dental Cavitations

Treating dental cavitations often involves surgical intervention, usually performed by a specialist in maxillofacial surgery. The cavitation treatment typically includes the surgical removal of the unhealthy bone tissue and any infected material. Local anesthetic is used to significantly inhibit pain during the procedure.
Options to treat dental cavitations include::

• Dental Cavitation Surgery (Curettage): This involves surgically opening the area over the cavitation and scraping out the necrotic tissue. The area is thoroughly cleaned to remove any bacteria or debris.
• Laser Therapy: Some practitioners use lasers to remove necrotic tissue. This can be less invasive than traditional surgery and may promote healing.
• Medication: Antibiotics may be prescribed to help control any infection present in the cavitation, though there is a growing concern over antibiotic-resistant bacteria strains.
• Supplemental Therapies: For chronic inflammation and pain management. Some holistic practitioners may recommend supplemental therapies such as ozone therapy, vitamin C infusions, or other treatments aimed at supporting the body’s healing processes.
• Post-surgical care: Crucial in ensuring the proper healing of the bone and preventing further complications. Treatment may also involve addressing systemic factors such as improving blood pressure control or managing clotting disorders to enhance blood flow to the affected area and promote healing of the jaw bone.
• Regular Follow-ups and Maintenance: Post-treatment, regular follow-ups are crucial to ensure that the area is healing properly and that no new infection is setting in.

In some cases, more advanced treatments may be required. This can include therapies to stimulate bone growth and health, ensuring the jawbone returns to a healthy state.

Dental cavitations and dental implants

For a patient seeking dental implants, the presence of bone cavitations can be a major concern. For a dental implant to be successful, it must integrate securely with the jaw bone. Cavitations, being areas of dead or unhealthy bone, do not provide the stable and healthy foundation necessary for an implant to properly osseointegrate. Placing an implant in or near a cavitation site where there is localized disease process instead of healthy bone can negatively affect success rate of the implant, therefore it’s advisable to have cavitation tissue samples tested before the procedure.

Bottom Line

Dental cavitations are a relatively lesser-known dental pathology – hidden pathological hollows in the jawbone that can have far-reaching consequences on an individual’s health. Due to the often asymptomatic nature of cavitations and the difficulty in detecting them through standard X-rays, specialized diagnostic methods are essential. It’s important for individuals who have undergone tooth extractions, especially of wisdom teeth, or who experience unexplained facial pain, to consult a dentist who is familiar with the diagnosis and treatment of cavitations. Oral surgeon can localize unhealthy bone tissue (infected tissue where disease process is present) and after proper diagnosis provide cavitation treatment to help you maintain perfect oral health.

This article is complete and was published on June 28, 2023, and last updated on December 29, 2023.