Dental Cavitations are a lesser known yet significant health issue that can lead to chronic conditions. Ischemic osteonecrosis of the Jaw, Fatty Degenerative osteonecrosis in Jawbone (FDOJ), Bone Marrow defects of the Jaw (BMDJ), Neuralgia-induced cavitational osteonecrosis (NICO) and even “Areas of impaired healing”- as more simply described by a Maxillo-Facial Radiologist- can all fall into this category.
Essentially, cavitations are areas of necrotic bone that may occur due to trauma, poor healing, improper dental procedures, and dry sockets. Although difficult to detect by conventional 2-D dental x-rays, they are more readily found with a 3-D CBCT, or Cone Beam. A trained Biological Dentist can see cavitations, and with proper software, can measure bone density differences to find the “pockets of necrosis or necrotic tissues areas”.
Originally discussed in the mid-19th Century; Dr. GV Black (the father of modern dentistry) described these jawbone cavitations as necrosis. Dr. Black suggested surgical “curettage of the unhealthy bone, tissues, cysts, and/or abscesses out of the cavitation”- This treatment is still the most popular today.
Because most people (and many conventional dentists) are unaware of what cavitations are, they may go undiagnosed for years. If left untreated, they can potentially lead to infection, chronic inflammation, toxin exposure and in some cases neuralgia.
Over 90% of cavitations are found after wisdom teeth extractions. They are also found around failed root canal extraction sites, traumatic injuries and dry sockets. Basically any area that has had incomplete healing, or loss of clotting factors. There are also a few documented reasons for cavitations to occur: Clotting disorders, uncontrolled diabetes and low Vitamin D levels.
Hundreds of studies on PubMed, going back 10 years, discuss cavitations from accredited researchers globally. Why then, do most conventional dentists and Oral Surgeons say “it doesn’t exist”? Great question!! For one, I do not assume, so I will just say: most are not up to date with the scientific research and/or clinical studies. This happens quite often in our profession…
In almost every cavitational surgery, I have found fat cells- which are not supposed to be in bone. Others have actual dead bone: grey/black friable and foul smelling tissue- adding insult to injury. These fat cells or cholesterol, are the body’s attempt to protect itself. At the sound of inflammation, our bodies send cholesterol cells to try and surround the source. In the last 10 years, new research on the delicate homeostasis of cholesterol and anti-inflammatory regulation has surfaced. In an otherwise healthy individual, intracellular cholesterol is released to “help” inflammation. Obviously this is a very simplistic explanation of a very delicate and balanced dynamic interplay between uptake, synthesis, storage and export mechanism of cholesterol. But the fact remains- fat cells in bone are “no bueno”; We want to get to the root cause and eliminate these necrotic areas- who wants dead bone in their bodies?
So how do Biological Dentists treat these cavitations? Once we see them, we cannot unsee them… Thanks to CBCT 3-D technology, we are able to plot them exactly. Usually a small, conservative incision is made directly over the plotted and measured area. When we find the hole- and IT IS A HOLE literally, we curettage the area to remove the dead and infected bone and periodontal ligament (PDL) that was left behind. Copious amounts of ozone and lasers are used to clean, disinfect, and decontaminate the defect. We also use a Piezo with diamond tips and ozone irrigation. Once this is complete, we graft the PRF (platelet rich fibrin) that is made from your own blood drawn at the beginning of treatment. PRF contains stem cells and growth factors that encourage the healing of the defect. We prefer to use PRF rather than cadaver or animal products in my office. Many times we add some natural supplements, and melatonin to aid in healing. After about 4-6 months, we can verify healing with a follow-up CBCT of the area. Almost every single patient reports some soreness to mild discomfort for the first few days following the treatment. The majority report a substantial difference in their general constitution. A very few of the largest cavitations, because of their degree of defect, will require a second treatment- but these are the exception, not the norm.
The problem with these areas of cavitations is that the bone has not healed properly; therefor there is no blood flow to the area which leads to the decay bone. Hence harmful bacteria and microbes have a place to accumulate. But no matter how “small” these “hidden” areas are, a trained Biological Dentist is able to read the areas and treat them to encourage proper healing, stimulate and promote new healthy bone growth.
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