Volumes have been written about this subject, yet it is never discussed in undergraduate dentistry and only rarely discussed at any other time within dentistry. Dental associations claim that there is a profound lack of support in the scientific literature. Not True. There are many references which support the reality of this condition and the profound effects that they may have on health. A great compilation of these references has been put together by Dr Jerry Bouquet HERE.
Dentists are taught to take teeth out with specially designed pliers, called ‘forceps’. If you get the right shaped pliers, you can rip out just about any tooth. The patient tries to demolish the armrests of the dental chair and the nurse looks on supportively. Supportive that is, for the ‘poor dentist’ who is working so hard! When it is finally out, you will get a piece of gauze put over the hole in your jawbone and you will be told to close down on it. Preferably you will have paid the bill, left quickly, and been halfway home before the bleeding starts. There is nothing quite as barbaric, in medicine or dentistry, as taking a tooth out in this way. Then we barber/barbaric/dentists expect that the bony socket will heal, by filling in the hole with bone and the gum healing over the top. That is after all what we have been taught. Occasionally, this does happen even when the tooth is removed so brutality. There are better ways.
A massive amount of force is applied to the bone with forceps extractions. The areas of bone, that are so severely compressed, will die. It is called ‘compression necrosis’. Dead bone does not heal. This is one of the most common causes of dry sockets. The other is the root filling that was put into the tooth. Materials like formaldehyde will kill the surrounding bone. This bone cannot heal properly either.
Dentists are not taught to remove the periodontal ligament after the tooth is out. In fact, we are taught NOT to remove this ligament. This is the ligament that holds the tooth to the bone and surrounds the root of the tooth. When this ligament is left in the socket, it will be impossible for the bone to heal properly.
X-rays can be unreliable to diagnose the cavitations that are thus produced. This hole in the bone is lined by dead tissue. It cannot fill in and heal, as there are no living, bone-producing cells, anywhere to be found and no blood to supply them.
These holes have been given many names over the years;
- Jaw Bone Cavities
- Osteocavitation Lesions
- Pathologic Bone Cavities
- Odontogenic Trigeminal Neuralgias
- Alveolar Cavitational Osteopathies
- Trigger Point Bone Cavities
- Ratner Bone Cavities
- Roberts Bone Cavities
Cavitations are regarded as inconsequential by modern dentistry. Most dentists and even oral surgeons have never heard of them. The professors either prefer not to talk about them or are in complete ignorance themselves. This is remarkable considering that they were described by G.V. Black, the father of modern dentistry, in 1920. He gave us what is probably the first textbook description of jawbone cavitations. He called it “chronic osteitis” to distinguish it from osteomyelitis. He mentions “cavity” formation and slow death of bone “cell by cell”. [1] Black also comments on his treatment approach;
“The treatment of chronic osteitis is surgical and should be radical. The area should be opened freely, and every particle of the softened bone removed until good, sound bone forms all of the walls of the cavity.” … “Generally, when all of the softened bone is removed, the case makes a good recovery. … When several teeth were involved, I have generally extracted them.” [2]
Dr Black was not alone in his research, just as Dr Price’ was not alone in his. There is a plethora of published research describing these lesions and their effects on the body. [3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15]
Dr Jerry Bouquot is one of the world’s leading oral pathologists, who himself has taken much flack in more recent times, for making cavitations official. He answered one of Australia’s leading oral surgeons, who made claim that cavitations were nonsense and had no clinical significance.
Dr Bouquot replied;
“I initially thought that this disease occurred only in persons with trigeminal neuralgia. This is far from true. Many cases, perhaps most, are completely pain free, even though great marrow destruction occurs…this is also the case for osteonecrosis of other parts of the body. Also, for those patients with pain, it can follow a wide variety of pain patterns, including classic trigeminal neuralgia. … And, of course, we have no idea how many TN patients have a bone disease as an underlying association. To the best of my understanding, however, surgeons treating maxillofacial osteonecrosis or NICO are simply treating a BONE disease, which may or may not be painful or to refer pain elsewhere…just as might occur with a periapical infection. I cannot explain the TN connection, but there have been far too many cases reported and seen by myself to deny that some sort of connection exists. The atypical facial neuralgia/pain connection is much more readily explained. If you read any detailed discussion of ischemic osteonecrosis (avascular necrosis) of the hip, you will find a remarkable similarity between the pain symptoms and referral patterns of hip lesions as compared to maxillofacial lesions.”
These holes are another source of endotoxins, just as the dead tooth is. Of course, they and their bacterial manufacturers will spread through the body, acting as a source of Focal Infection.
They will also act as foci of Neural Interference, and in this way also produce disease states in distant parts of the body. Very often these neural ways will follow the acupuncture meridian that the cavitation is over. Sometimes, they can be very large and cover a few meridians.
Lower wisdom teeth are a very important source of cavitations, as they are often removed with a great deal of force and the surrounding necrosis will be set firmly in place. Why is this an issue? Firstly, this is the most common area to find a cavitation, in any part of the mouth. Thus, it becomes the most common neural interference of dental origin. The Small Intestine Meridian is the meridian which passes through this area. It is related to conditions like eczema, dystonia, migraine, tinnitus, epilepsy, arthritis and facial neuralgia. Oh! Did I forget to mention that it is the area that mostly affects the heart, and cardiovascular disease is often associated with cavitations in the wisdom tooth area? This is heart attack land. (See the EAV Charts Here for other neural connections.)
As one might expect, the PTOs are very concerned that the cavitation issue is given little credence, as they would then have to acknowledge that dead, root canaled teeth, may have some serious health issues. Here is what the American Association of Endodontists have to say in their Position Statement;
“… the concept of NICO gained notoriety decades later when it was used to describe bony lesions associated with symptoms characteristic of trigeminal neuralgia like facial pain.” Bouquot JE, Roberts AM, Person P, Christian J. Neuralgia inducing cavitational osteonecrosis (NICO). Osteomyelitis in 224 jawbone samples from patients with facial neuralgia. Oral Surg Oral Med Oral Pathol. 1992;73:307-19
Dr Bouquot was not the person who brought notoriety to this issue. He was just the easy, high-profile target. Since when does a serious medical condition ‘gain notoriety’? It is a reality whether the AAE wish to discredit it or not!
Most of the research that demonstrated the connection of Trigeminal Neuralgia to cavitations came through the well published work of Dr Eugene Ratner.[16],[17],[18] He demonstrated the link by surgically cleaning out the cavitations and noting the disappearance of TN in most cases. His work was groundbreaking and ignored by most current dental teaching.
Dr Ratner was able to map the areas of pain referral from cavitations in different parts of the mouth, to different parts of the body. These pains were all over the body, not just the head and neck. The disappearance of the pain after surgery, was how he was able to do this mapping. For example, some lesions in the upper jawbone referred pain to the front of the legs and to the big toe and also down the spine. Lesions in the mandible may refer pain to the groin and inside of the arms and the three fingers from the little finger. Many other relationships exist.
Ratner Pain Distribution from cavitations
Dr Ratner also examined the contents of many of these lesions. He found that various bacterial colonies exist, which were both aerobic and anaerobic, and one third of the organisms had not yet been identified. “… a unique microbiotic spectrum.” [19],[20],[21],[22]
Dr Ratner published his research in the 1960s and 70s. 50 years later the oral surgeons are still ignoring his work in favour of the acceptable treatment for Trigeminal Neuralgia, which is “BRAIN SURGERY”.
The AAE continue in their Position Statement;
“In addition, the practice of recommending the extraction of endodontically treated teeth for the prevention of NICO, or any other disease, is unethical and should be reported immediately to the appropriate state board of dentistry”
So much for a scientific approach and clinical integrity. Ethics in this industry is a joke!
Although the PTOs find it unethical to clean a socket and remove the periodontal ligament and infected bone from an extraction socket, it is clearly shown that this is the best way of preventing cavitations and allowing the bone to heal properly. They also claim that cavitations are rare because they cannot be seen easily on x-rays. They also claim that it is unethical to clean out these cavitations for the benefit of improving health. They also claim that root canal teeth are completely safe and are not related to the production of cavitations. They also claim that mercury from amalgam and fluoride in your drinking water are also perfectly safe.
The dental trade talk about good healing as observed on x-ray, to demonstrate that cleaning the cavity properly is not necessary.
“Complete radiographic healing occurs without postextraction curettage in teeth with periapical raidiolucencies and without preoperative or postoperative antibiotic therapy in most cases.” [i]
There is a vast difference between what is seen as good healing on an x-ray and what is really good healing histologically. X-rays do NOT show the real picture at a cellular or macroscopic level. This statement is typical of a trade organization that prefers to rely on ‘clinical observation’ & ‘General Knowledge’, rather than published science. Have a look a the letters to and from the Australian society of Endodontology.
An eminent and respected endodontist, Dr I. Bender, in 1997 made the following statements:
X-rays “may not detect the presence of inflammatory lesions or neoplasms causing bone destruction”.
“Often radiographs give negative results even when cortical bone is involved”
“Changes in angulation of the x-ray beam produced an increase, a decrease, or an elimination of radiolucent areas”
I. Bender J. Endo 23:1 1997 (published in their own Journal of Endodontics)
I was told once, by a colleague who I went to university with, that mercury amalgam was safe because it was “well tolerated on an x-ray”!
A study published in 1996, [ii] (Routine Dental Extractions Routinely Produce Cavitations), revisited extraction sites from112 patients. They were only looking for the numbers of cavitations found, rather than any disease relationships. The extraction technique was critically analyzed.
691 extraction sites, in 112 patients, (1991 – 1995. 19 – 83 years of age. 40 male, 72 female), clearly shows that cavitations are more the norm than a rarity. Third molar (wisdom teeth) areas were the most common. Remember that these are the areas associated with heart attacks in acupuncture relationships.
| Area | No of Extraction sites | No of CVs | % |
| 3rd molars Wisdom Teeth | 354 | 313 | 88 |
| 2nd molar | 50 | 35 | 70 |
| 1st molars | 73 | 60 | 82 |
| TOTAL Molar sites | 517 | 441 | 85 |
| Mandibular Non molars | 51 | 23 | 45 |
| All non molars | 174 | 95 | 55 |
| Overall regardless of site | 691 | 536 | 77 |
The researchers make the following comments. (Note CV is an abbreviation for cavitation)
‘…the most obvious reason for not finding a CV is not looking for it.’
‘A CV, obvious on radiological examination of the jaw, is definitely the exception rather than the rule.”
‘Taking at least one millimeter of good bone insures removal of both periodontal ligament and most of the bone directly bathed with the toxins produced by the mutant streptococcus in the dentin tubules.’
‘It is theorized that the use of antibiotics may convert the osteoblasts back into osteocytes, impeding a full healing of bone in the socket area.’
‘Simple manual curettage is discouraged, for the scraping required in the process can “push” much of the toxic products into the adjacent, good, cancellous bone, resulting in a greater chance of persistent or recurrent CVs, or simply a lack of primary healing after a tooth extraction.”
– (the bone should be removed with a large round slow speed bur and plenty of water. This removes the dead bone without pushing the toxins in deeper)
Regarding the periodontal ligament being allowed to remain in an extraction socket:
“…its continued presence in the extraction site effectively prevents the adjacent bone from biologically recognizing that the tooth has been extracted. Bone cells are not going to proliferate spontaneously and migrate through a membrane intended by nature to define their growth limits.’
‘At the upper portion of the extraction site, however, where there is no periodontal ligament, osteoblastic bone activity does initiate, and a thin cortex of bone will heal across the hole. This cap of bone is rarely more than several millimeters thick.’
‘Similarly, the mouth flora undergo metabolic transformations when oxygen deprived, and exotoxin production can be anticipated.’
This metabolic transformation is called Pleomorphic Change.
‘…the only successful treatment for necrotic tissue is debridement.’
‘Pathologically, CVs are focal pockets of gangrene in the jawbone, since gangrene is defined as necrosis due to obstruction of blood supply which may be localized or widespread, as in an entire extremity.’
The following diseases & disorders have been reported to be associated with osteonecrosis.
- Heart Disease
- Trigeminal Neuralgia
- Other atypical facial pains
- Referred pains anywhere on the body
- Cirrhosis
- Pancreatitis
- Arthritis
- Blood dyscrasias
- Disseminated intravascular coagulation
- Leukemia
- Sickle cell anemia
- Cancer
- Hyperlipidemia & embolic fat
- Hypertension
- Osteoporosis
- Atherosclerosis
- Anorexia nervosa
Wisdom Teeth Extractions
A word of warning to anyone about to have their wisdom teeth removed – DO NOT have a general anaesthetic for this. Use Local anaesthetic for pain control. The only reason that surgeons want to do it in hospital instead of under local anaesthetic, is financial. Why not take four of the suckers out in one hour instead of just the one that needs to come out in half an hour. You are charged by the number of extractions. Apart from the dangers of general anaesthetic and the extra cost of hospitals and anaesthetists etc., you will be subjected to four times the amount of pain and discomfort. This will be on both sides of your mouth and makes for a very unhappy camper. The GA also will lower your immune response to the trauma and the bacteremia, and your face might start to resemble a chipmunk. Most people take much longer to recover from this approach, than removing only the wisdom teeth on one side at a time, under local anaesthetic.
Another important reason to not have a GA, is that when you are conscious you can resist the forces that will be applied to your jaw. You can work with the dentist. Under a GA this is not possible, and you are then dependent on the surgeon being so gentle as to not compromise your jaw joint. This is a common cause of damage to this joint. Many TMJ problems are caused by extraction of lower wisdom teeth under general anaesthetic. They can take many painful years to resolve.
References
[i] Dental Extractions, Antibiotics and Curettage – First, Do no Harm. Michael J. Wahl DDS, Jean A. Wahl DMD & Margaret M. Schmitt DMD Global Journal of Medical research: J Dentistry and Otolaryngology Volume 14 Issue 1 Version 1.0 Year 2014
[ii] Cavitation & Extraction protocol Thomas E. Levy , MD, FACC, Hal A. Huggins, DDS, MS Journal of Advancement in Medicine, Volume 9, Number 4, Winter 1996
[1] Black GV. A work on special dental pathology. 2nd ed. Chicago: Medico-
Dental Publ Co, 1920.
[2] A work on special dental pathology. 2nd ed. Chicago: Medico-Dental Publ Co, 1920.
[3] Griffiths ID. Osteonecrosis. In: Scott JT (editor). Copeman’s textbook of the rheumatic diseases, 6th ed. London: Churchill Livingstone, 1986: 1207-1228.
[4] Jones JP Jr. Osteonecrosis. In: McCarty D (editor). Arthritis and allied conditions: a textbook of rheumatology, 11th ed. Philadelphia, Lea & Febiger,
1989, pp 1545-1562. (good general review by an internationally recognized expert)
[5] Arlet J, Mazieres B (editors). Bone circulation and bone necrosis. Proceedings of the Ivth International Symposium on Bone Circulation, Toulouse
(France), 17th-19th September, 1987. New York: Springer-Verlag, 1990. (the definitive work to date; this book sets the standards)
[6] Hungerford DS. Diagnosis and treatment of ischemic necrosis of the femoral head. In: Mc Evarts C (editor). Surgery of the musculoskeletal system, 2nd edition. New York: Churchill Livingstone, 1990: vol 3: 2757- 2794.
[7] Ono K (editor). Symposium: recent advances in avascular osteonecrosis. Clin Orthopaedics Related Res 277:2-138, 1992. (summary of research papers of the Second International Symposium on Osteonecrosis)
[8] Sweet DE, Madewell JE. Osteonecrosis: pathogenesis. In: Resnick D (editor). Diagnosis of bone and joint disorders, 3rd ed. Philadelphia: W. B.
Saunders, 1995: 3445-3494. (detailed review in the encyclopedic radiology text)
[9] Rywlin AM. Histopathology of the bone marrow. Boston: Little, Brown & Co., 1996:153-190.
[10] Jones JP Jr. Osteonecrosis. In: Koopman WJ (ed). Arthritis and allied conditions; a textbook of rheumatology, 13th edition. Baltimore: Williams &
Wilkins, 1997:1923-1942. (good general review by an internationally recognized expert, one of the first to recognize potential coagulopathies in
osteonecrosis)
[11] Glueck CJ, McMahon R, Bouquot J, et al. A preliminary pilot study of treatment of thrombophilia and hypofibrinolysis and amelioration of the pain
of osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85:64-73.
[12] Gruppo R, Glueck CJ, McMahon RE, et al. The pathophysiology of osteonecrosis of the jaw: anticardiolipin antibodies, thrombophilia, and
hypofibrinolysis. J Lab Clin Med 1996; 127:481-488.
[13] Shankland WE. Craniofacial pain syndromes that mimic temporomandibular joint disorders. Ann Acad Med Singapore 1995; 24:104-106.
[14] Bouquot JE, Christian J. Long-term effects of jawbone curettage on the pain of facial neuralgia; treatment results in neuralgia-inducing cavitational osteonecrosis. J Oral Maxillofac Surg 1995; 53:387-397.
[15] Bouquot JE, Roberts AM, Person P, Christian J. NICO (neuralgia- inducing cavitational osteonecrosis): osteomyelitis in 224 jawbone samples from
patients with facial neuralgias. Oral Surg Oral Med Oral Pathol 1992; 73:307-319.
[16] Shklar , Person, Ratner. Oral pathology and Trigeminal Neuralgia III J Dent Res. 1976;55(B):299
[17] Ratner. J Periodontol Oct 1968
[18] Ratner E., Langer., Evins M., alveolar Cavitational Osteopathosis manifestations of an infectious process and its implications in the causation of chronic pain. J Periodoontal 1986;57:593-603
[19] Ratner. J Periodontol Oct 1968
[20] Roberts A., Persons P., Chandran N. Hori J., Further observations on Dental Parameters of atypical facial Neuralgias. Oral Surg, Oral Med., and Oral Path 58(2) 1984
[21] Roberts A., Persons P., “Etiology and treatment of Idioathic Trigeminal and atypical facial Neuralgias. “Oral Surg, Oral Med., and Oral Path 48(4) 1979
[22] Stewart J “ Microbiological findings “ Manual for Residual Infection In Bone (RIIB) Indiana Univ. Medical Centre 1988