Although most people have never heard of cavitations, they’ve been known in the dental world since the 1860s. Even one of the most towering figures in the profession, GV Black – nicknamed “the father of modern dentistry” – wrote about them in his 1915 textbook on dental pathology.
Yet many dentists today seem largely unaware of the condition, save when it’s caused by bisphosphonates, a common osteoporosis drug. Biological dentists are the exception.
We’ve long been aware of this type of hidden infection that often develops after tooth extractions. They may also be found around infected root canals and failed dental implants.
The cavitation itself is an area of dead and decaying bone, usually concealed by healthy looking gum tissue. It’s the ultimate breeding ground for toxins that can lead to unexpected health issues.
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.
The good news is that successful treatment may help resolve “seemingly unrelated chronic inflammatory conditions” elsewhere in the body, as well as in the mouth. As the International Academy of Oral Medicine & Toxicology notes in an updated position paper they released last month,
Whether systemic illnesses are of an autoimmune nature or inflammation occurring otherwise, significant improvements have been reported, including improvement in cancer. The symptom complex associated with these lesions is highly individualized and therefore not generalizable or easily recognizable. Therefore, the IAOMT is of the mindset that when a patient is diagnosed with jawbone cavitations with or without associated localized pain, and also has other systemic illness previously not attributed to jawbone cavitations, the patient needs further evaluation to determine if the illness is associated with, or is a consequence of the disease.
When it is, surgical cleaning and disinfection of the sites is generally called for, along with other treatments to eradicate the infection and support the proper healing of the site, as well as more general detoxification therapies to address the systemic impact of cavitations.
Here in our office, that includes ozone and laser sterilization of the cavitation site(s), the use of platelet rich fibrin (PRF) to support faster and better healing, and photobiomodulation to reduce post-op discomfort and further accelerate the healing process. (You’ll find all the details of our cavitational surgery protocol here.)
The whole IAOMT paper is worth a read, offering an excellent overview of the nature of cavitations, risk factors, and treatment guidance for dentists. (Read the paper now.) It also makes the case for a more specific and accurate name for the condition: Chronic Ischemic Medullary Disease of the Jawbone (CIMDJ).
CIMDJ describes a bone condition characterized by the death of cellular components of cancellous bone, secondary to an interruption of the blood supply.
Of course, new names take a while to catch on. Some of the other names you might run across in the meantime include neuralgia inducing cavitational osteonecrosis (NICO), fatty degenerative osteonecrosis of jawbone (FDOJ), and chronic ischemic bone disease (CIBD), just to name a few. (“Ischemic” refers to the condition of not having enough blood, while “osteonecrosis” literally translates to “bone death.”)
All refer to the same kind of hidden infection – an infection that can and should be treated for the sake of oral and whole body health alike.