By Michael G. Rehme, DDS, CCN
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.
Originally posted April 7, 2009