Unexplained Dental Pain Explained: Tooth Extractions, Cavitations and the Periodontal Ligament

Removing a tooth is certainly an unfortunate event for a patient both physically and emotionally. However, having the tooth properly extracted may prevent health related complications from occurring in years to come.

There are two important steps to follow when removing a tooth: First, it is imperative to remove the entire tooth. Avoid leaving any root tips behind. These can lead to chronic, low grade infections that can fester within the jawbone.

Second, once the tooth is extracted, thoroughly remove the periodontal ligament. This is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits. A surgical round bur is used to remove one millimeter of bone as thoroughly as possible from the entire bony socket area, excluding the apex.

If the periodontal ligament is not carefully removed from the socket after the extraction, the surrounding bone receives no notification that the tooth is gone. The continued presence of any portion of the ligament gives the biological message to the surrounding jawbone that all is well and no new bone growth is needed.

This void that occurs within the surrounding bone is called a cavitation. A cavitation refers to a toxin-containing hole in the jawbone, that often develops because of incomplete healing after a routine tooth extraction. The contents of cavitations are always necrotic, dead or dying material.

Cavitations have many scientific names such as ischemic osteonecrosis, chronic non-superative osteomyelitis, and neuralgia inducing cavitational osteonecrosis (NICO). This is not so much an infection in the bone, as a necrosis or gangrene (dead tissue) in the bone marrow, as a result of impaired blood flow (ischemia).

Although the term cavitation is not commonly used in conventional dentistry today, it was initially described in 1915 by Dr. G.V. Black, who is considered the godfather of modern dentistry.

He described a cavitation as bone necrosis, or “chronic osteitis,” resulting in hollowed-out lesions found at the sites of old extractions. The bone was usually softened initially by the progressive cellular death of cancellous bone, until an actual hole resulted. He even went on to describe the appropriate way to treat such lesions, which was essentially a surgical debridement.

During the next 60 years, Black’s findings were either ignored, forgotten, or not given proper acceptance. They were never integrated into dentistry nor taught in any dental institutions in this country. In the 1970s, however, cavitations were “re-discovered” and correlations with previously unexplained pain syndromes were suggested.

Patients with atypical facial neuralgia and trigeminal neuralgia of unknown cause were often found to have cavitations at the sites of previous extractions, and the pathology was as Black had already described. Such cavities would be subjected to curettage and, upon complete healing with new bone, the pain syndromes would frequently subside.

Other symptoms associated with these boney defects include: deep bone pain and pressure; a sour, bitter taste which often causes gagging and bad breath; sharp, shooting pain from the jaws which can elude a doctor’s diagnostic attempts; chronic maxillary sinusitis, congestion and pain; a history of large dental fillings followed by pain, root canal therapy, and ultimately, removal of the tooth; difficult tooth extraction, including wisdom teeth, several years earlier; post-operative complications, especially the development of a dry socket.

If you’re faced with a situation that requires the removal of a tooth, remember to follow the biological approach. Explain your concerns about cavitations. Ask your dentist to “carefully and thoroughly” remove the periodontal ligament. Hopefully they’ll follow your instructions. If not, you might want to find a biological dentist who understands the importance of this simple yet critical step.

It’s your mouth and it’s your health that’s at stake. Being an educated patient now may prevent you from experiencing years of unexplained pain, discomfort or compromised health conditions later in life.

About Dr. Michael Rehme, DDS, CCN

Dr. Michael Rehme, DDS, CCN is one of the few Biological (Holistic) Dentists in St. Louis, MO and the U.S. that are Certified Clinical Nutritionists (CCN). He practices Biological Dentistry that includes mercury free, tooth colored fillings; healthy dental materials; balancing body chemistry; and nutritional therapy. For articles and information about Biological Dentistry (also referred to as Holistic Dentistry) and patient success stories visit www.toothbody.com or call his office 314-997-2550. Attend a free monthly presentation and discussion by Dr. Rehme on Biological Dentistry the third Tuesday each month at 6:30 pm and his dentistry office in St. Louis. Please call to verify the date.

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11 Responses to Unexplained Dental Pain Explained: Tooth Extractions, Cavitations and the Periodontal Ligament

  1. Rebecca Hull February 15, 2015 at 12:04 pm #

    How do i find a biological oral surgeon who will reopen a site with cavitation and help me to get the healing that is not occurring after an infected root candled tooth was extracted?
    I’m on the east coast in MA.


    • Office February 23, 2015 at 2:23 pm #

      Thanks for your query, Rebecca! A biological dentist should first be consulted to properly diagnose the cavitation. He or she can then refer you to an oral surgeon who can appropriately clean the site.

      All three of the major professional societies of biological and holistic dentists have online directories that can guide you to a local practitioner:


    • Leonore Alaniz June 20, 2016 at 2:39 pm #

      Go to Groton Dental, Rebecca. They seem to be the only professionals whp follow the above protocol. I can testify to it, and am very happywith the results. Furthermore, remval of Ligament allows a bone graft. I had it done even tthough i will not have an implant on that spot. My bone reformed at the place, because the grf created a matrix for my OWN bone to regrow onto. THAT is pretty neat in itself. Leonore

    • Grge H July 3, 2018 at 12:54 am #

      Where may I find a biological oral surgeon in Montana. I am in Lewistown, MT and am aware I may have to travel to procure the treatment I am looking for.

      • Office July 5, 2018 at 3:38 pm #

        The IAOMT lists several current member dentists in Montana. You can learn more about them here: https://iaomt.org/for-patients/search/region/montana/

        If they don’t do oral surgery themselves, they may be able to refer you to an oral surgeon aware of biological dental concerns.

  2. Maryellen November 10, 2016 at 12:48 pm #

    I really need help!! I had my bottom teeth all removed because of complications from bridges years ago.(thought it was the right thing to do). I have had pIn in my jaw and chin for over two years now and I have a knot in my chin. I have went back to explain my pain and concern and nothing has been done. I keep having infections coming out in my face but have know history of acne. The infection had now spread all over myself and comes out in different places from time to time. I have been to regular doctors many many times and just get antibiotics and sent on my way. This has changed my life and I’m severely depressed and don’t want to leave the house . It’s painful . Everyone has me believing it’s all and my head and I need to stop touching my face. I know I’m not just loosing my mind it’s real. Who can I get to understand my concerns before it’s to late and travels to my brain .??

    • Office November 11, 2016 at 11:44 am #

      The place to start is with a complete evaluation by a well-trained biological dentist – someone who can take the big picture view of your health situation, current and past, and assess the role that your dental conditions may be playing in it. (If it’s not dentally related, they should be able to refer you to a qualified integrative physician for further help.)

      If you’re in the St. Louis area or can travel here, please give us a call at the office. We’d be glad to speak with you. Our number is (314) 997-2550.

      Additionally, the three major professional organizations for biological dentists all have searchable online directories:


  3. Sarah March 18, 2017 at 8:37 pm #

    Hi Dr. Rehme,
    I am scheduled in May 2017 to get some of my silver/mercury amalgrams removed by a biological dentist. He also is referring me to an oral surgeon who will remove my root canal. I’m assuming this surgeon will remove the peridontal ligament and clean the bone so that there is no infection remaining. Is there a way to find an oral surgeon who believes in the Hal Huggins approach to removing a root canal?

    • Office March 22, 2017 at 1:45 pm #

      The best way to find what you are looking for is to call the offices and inquire.

  4. Liane June 15, 2017 at 5:07 pm #

    I removed a bottom wisdom tooth now the hole is yellow inside and i get a sour bitter salt taste that comes from the hole and bad breath. The pain has gotten worse. What should i do?

    • Office June 16, 2017 at 12:12 pm #

      We can’t offer specific advice, unfortunately, but it definitely sounds like something to get checked out by a dentist sooner rather than later. If you’re in the St. Louis area, give our front desk a call: (314) 997-2550. If you’re outside the area and need to find a biological dentist closer to home, you may find one through one of the three main professional associations for biological and holistic dentists:


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