Dental Cavitations: The Mouth’s Hidden Infections

Dental cavitations are known by many names: “cavitational osteonecrosis” or “ischemic osteonecrosis,” “ischemic bone disease” (IBD), “chronic ischemic jawbone disease” (CIBD), and so on. These are usually considered to be asymptomatic lesions, but there is also “neuralgia-inducing cavitational osteonecrosis” (NICO), which is commonly associated with severe facial pain, neuralgia, and headaches.

All of these terms describe essentially the same physical defect: holes or “cavities” found in the upper or lower jawbone. They form when the lack of proper blood supply creates an area composed of dead, decaying bone tissue and can be either an acute or chronic condition. Cavitations are found in extraction sites that have not healed properly, as well as around infected root canals and failed dental implants. They are the ultimate breeding ground for toxins that can lead to unexpected health issues.

Read the International Academy of Oral Medicine & Toxicology’s position paper on cavitations.

Dental cavitations can harbor many different types of microorganisms that create unfavorable conditions in the bone. If left untreated, these defects can fester over time and produce an array of toxins that can circulate to other parts of the body via the nerves, lymph, and blood. These systemic complications can affect other cells and organs in the body, too, resulting in inflammation, disease, and pain.

Importantly, not all cavitations exhibit obvious symptoms such as pain, redness, fever, or pus. Because of this, these defects can easily go undetected for many years. Often, they’re never discovered at all, as they’re not readily visible on conventional dental x-rays.

Recognizing Cavitations

Dental cavitations are not widely recognized or discussed much in conventional dentistry today simply because dentists generally are not educated about the condition in dental school. Yet it was first identified more than 100 years ago by G.V. Black, who is known as the “father of operative dentistry.” He called it a progressive disease that produced holes in the bone that ultimately could induce harmful, systemic side effects in the body. His treatment protocols included surgical debridement of the area to remove all unhealthy bone, abscesses, and cysts – protocols that remain the same to this day.
More recently, biochemist and toxicology expert Dr. Boyd Haley discovered that every cavitation tissue sample he tested contained toxins, which eventually compromise systemic health.

Unfortunately, this concept has not been embraced by the American Dental Association, and as of today, it is still met with some controversy regarding its very existence and effects. Perhaps in the near future cavitations will recapture the attention of dental scholars who will investigate these defects once again with open minds and a commitment to educate the entire dental profession on the proper way to diagnose and treat these bony defects for patients seeking relief from one or more of the symptoms listed below.

  • Facial pain
  • Breast pain
  • Ear problems
  • Jaw swelling
  • Thyroid problems
  • Neuropathy
  • Joint pains
  • Heart problems
    • Tinnitus
    • Skin problems
    • Chronic fatigue
    • Muscle pain
    • Systemic inflammation
    • Sinus problems
    • TMJ dysfunction
    • Digestive problems
      • Trigeminal neuralgia
      • Sleeping disorders
      • Phantom toothache
      • Atypical facial pain
      • Headaches and migraines
      • Bad Breath
      • Dry sockets
      • Lyme disease

        Cavitations & Lyme Disease

        One of the first places you’ll find Lyme disease is in the mouth. Some of the most common symptoms include a dry mouth, unexplained tooth sensitivity, inflamed gums, and even atypical facial pain and paralysis.

        Lyme disease is caused by a spirochete called Borrelia burgdorferi, which is transmitted by the bite of an infected blacklegged tick. This bacteria is commonly found in the oral cavity – and in cavitations.

        Learn more about oral health and Lyme.

        Diagnosing Cavitations

        First and foremost, diagnosing dental cavitations begins with an accurate and detailed medical history, in which we review symptoms, allergies, and any other medical concerns that you share with us.

        Although dental cavitations may be difficult to diagnose, using the proper x-ray equipment helps us see these lesions in much greater detail. Most conventional dental x-rays are 2-dimensional pictures taken of 3-dimensional objects. The x-ray flattens those objects into a picture that shows minimal detail. More accurate imaging is needed to identify potential areas of concern.

        A 3-dimensional CBCT scan is up to the job of identifying lesions in extraction sites, abscessed root canals, and failed implants. You can see the difference by comparing the two images below.

        2-dimensional panoramic scan

        3-dimensional cone beam scan

        The advanced technology of 3D imaging is one of the reasons why you hear more about dental cavitations these days. These once hidden infections are now visual realities that can be successfully treated for our patients.

        Another diagnostic option is a biopsy that can be sent for pathological review. Two types are currently available: tissue and DNA. Both are helpful in identifying which microorganisms are present in the cavitation site and helping to generate toxic exposures in the body.

        Before Cavitation Surgery

        Before a surgical procedure, it’s important to provide the body with a supplemental program that will support and promote a healing environment. In preparing for extractions, as well, I prefer the science-based formulations from Researched Nutritionals.

        What Cavitation Surgery Involves

        Getting the best surgical result starts with choosing the proper anesthetic. I routinely use either 3% Carbocaine (mepivacaine) or 4% Citanest Plain (prilocaine) to establish proper anesthesia without using a vasoconstrictor. Epinephrine, commonly found in lidocaine, constricts normal blood flow to the affected surgical site. Reduced blood flow reduces the oxygen potential and nutrients needed to support this environment’s healthy vital tissue.

        The surgical procedure for a former extraction site includes a thorough, mechanical debridement of the cavitational defect. Once the soft, dead tissue has been mechanically removed with a slow speed surgical bur, we use our Er:YAG laser to further disinfect and remove any remaining necrotic (dead) tissue in the surgical site and irrigate the area with copious amounts of ozonated water. Gaseous ozone is then administered at the site for further disinfection, followed by the placement of platelet rich fibrin (PRF). This procedure not only assists in tissue regeneration but also results in a healing time that is 3 to 5 times faster than normal. Science has repeatedly shown that using PRF also means less post-op pain and discomfort.

        Finally, once sutures have been placed to close the surgical site, the Nd:YAG laser is used for 1-3 minutes of photobiomodulation. This UV light therapy stimulates the mitochondria of the cells to help improve healing and reduce postoperative pain.

        Extracting a tooth requires the removal of the periodontal ligament (PDL) that connects it to the alveolar bone. If this isn’t done, it can become an obstacle for the cells that form the new bone to act on the tooth socket surfaces. We then use ozone and PRF in the manner described above.

        After Cavitation Surgery

        It is essential to provide the body with proper immune support following cavitational surgery. The immune system will be mounting an attack to kill whatever infection was released, so to give it a boost, we choose specific supplements to support your healing process.

        Of course, like any surgical procedure, cavitational surgery may not always provide successful results. Residual discomfort and minor swelling may persist for several months. But rather than just reopening the surgical site and retreating it, we can take a much more conservative approach using a simple device called an X-Tip. These can be used to make a small perforation into the cancellous bone and inject gaseous ozone into the original cavitational defect. Usually, 4 to 6 ozone injections are given over several months, at which point we re-evaluate the patient’s symptoms to assess the treatment’s effectiveness.


        Discovering these hidden infections and removing the toxic burden from the body is only the beginning to solving complex health issues. Protocols for detoxing the body and providing long-term immune support with supplements and pharmaceuticals should always be an important consideration during the healing phase.

        Ultimately, the best outcomes are usually accomplished by working together as a team with other health care providers who share similar philosophies and will provide their expertise and clinical experience to achieve the ultimate goal: optimal health and wellness for all patients!

        Read the International Academy of Oral Medicine & Toxicology’s position paper on cavitations.



        1. Windham B. Incidence levels and chronic health effects related to cavitations. (Article includes 80 scientific references)
        2. IAOMT Position Paper on Human Jawbone Osteonecrosis. Sept 21 2020. (Paper includes 48 scientific references)
        3. Levy TE. Oral Pathogens: A Common Cause of Chronic Disease. Journal of Orthomolecular Medicine. 2016;31(5):7-18.
        4. Neville BW, et al. Neuralgia-Inducing Cavitational Osteonecrosis. Oral and Maxillofacial Pathology. 2nd Edition: 746-748.
        5. Black GV. A Work on Special Dental Pathology. Chicago: Medico-Dental Co, 1915: 388-391.
        6. Haley B. Characterization and Identification of Chemical Toxicants from Cavitational Material and Infected Root Canalled Teeth: In Situ Testing of Teeth for Toxicity and Infection.  Proceedings of Annual meeting, International Academy of Oral Medicine and Toxicology; San Diego, California; 1997.

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