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Anne H, Autoimmune disease sufferer
This article accompanies a two-part video Dental Cavitations below (18 mins total).
Jaw cavitations form when a tooth extraction site fails to heal properly. Such sites may not demonstrate any overt signs of being a problem; however experts estimate that they may be a primary cause of a wide range of chronic, serious and degenerative diseases.
The two unwanted consequences of a tooth extraction are a dry or infected socket and a cavitation and these terms are explained below.
Dry or infected sockets
If a blood clot either fails to form after an extraction or subsequently becomes dislodged, then a 'dry' or infected socket will ensue. Here, the exposed bone becomes packed with bacteria and food and areas of infection form in a superficial osteomyelitis and portions of the bone may die in a form of osteonecrosis.
This can be very painful, the socket may smell or taste bad, and the individual affected may feel generally unwell, have a temperature and possibly some swelling. The dentist will usually clean the area out, insert a soothing pack and may prescribe antibiotics.
Eventually the socket will at least appear to heal, but fills in from the base and sides in what is known as healing by secondary intention rather than by healing into a blood clot which is known as healing by primary intention. This can result in very slow healing and may also be associated with sloughing of portions of dead bone which may continue to appear for some months after the extraction and which many patients may mistake as being fragments of tooth. These may be shed naturally or may require removal by the dentist.
The formation of a cavitation
The other problem that can occur further to an extraction (not precluded by the development of a dry socket) is that a cavitation can form. These form when the periodontal ligament that suspends the teeth in the jawbone is not removed. This membrane then serves as a barrier to effective healing preventing the entry of the immature cells into the blood clot that enables effective healing.
In addition, the membrane itself decomposes becoming necrotic and harbouring bacteria and some have likened this to failing to remove the afterbirth after a baby is born. The bacteria involved are mostly thought to be derived from the normal flora of the mouth. However, even the cleanest mouth is heavily infected and although these bacteria largely cause no harm in the environment of a healthy mouth, when permitted entry to the depths of an extraction socket, they morph into their anaerobic forms.
In response to the infection, white blood cells enter the affected area and can mutate developing multiple nuclei. In the attempt by the immune system to destroy the pathogens these cells can also create collateral destruction of the bone. The pus that forms can then spread via the circulation and this further impairs the blood flow which causes areas of devitalised bone to be sequestered and create chronic infection.
This process leads to the development of a hole or cavitation deep within the bone. The problem is that the socket usually apparently heals with the gum growing over the extraction site and a thin layer of surface bone forming. The normal signs of infection such as redness, swelling, pain or running a temperature may also all be absent so that not only are these lesions hidden from view, but there is often no overt sign that there is a problem.
However, although infection plays a role in the development of cavitations, many feel that the problem is essentially caused by poor circulation to the area. This results in both a lack of the nutrients and oxygen required for healing and also in compromised removal of toxins from the region.
Cavitations can also spread through and around adjacent structures such as adjacent teeth, blood vessels, nerves, veins and other extraction sites and can grow to become quite large.
In addition to extractions, root canal treatments are also recognised to introduce bacteria deep within the bone as the canals within the teeth are instrumented and cleaned. And this procedure may also cause a localised osteomyelitis or osteonecrosis around the tips of the roots of the teeth.
Cavitations: Foci of infection
One of the problems posed by cavitations is that they can act as a focus of infection which means that the toxins that they produce and the microorganisms that they harbour can enter the circulation and affect distant body parts. Although focus of infection theory has fallen from favour in allopathic medicine, many natural health practitioners and holistic dentists feel that there is a lot of merit in the concept.
The toxins that cavitations produce may also account for subsequent chronic pain including neuralgia and headaches, and for chronic disorders such as sinusitis, arthritis, fibromyalgia, back pain, multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS). Specialist practitioners treating cavitations report cures of disparate conditions including, blindness, autoimmune disease, tinnitus, fibromyalgia, and the disappearance of cancerous tumours.
Cavitations: Blockage of meridian flows
The second big issue with cavitations is that they can adversely affect the energy meridians that flow through the teeth and jaws. This is a two-way process so that an underlying weakness in an energy meridian may account for why poor healing occurred after an extraction or even why the tooth decayed in the first place.
Equally, the presence of a cavitation or any other pathology on the meridian pathway can cause poor function of the affected organs or systems served by the meridian. For example, the development of a cavitation after extraction of a wisdom tooth may adversely affect the heart, small intestine and hormone production and cavitations forming further to extraction of the first or second molar teeth may cause problems with the large intestine or lung.
The incidence of cavitation formation
Some specialist practitioners estimate that up to 90% of routine extractions may result in the formation of cavitations, and the further back in the mouth the extraction, the more likely they are to occur. They are also estimated to affect half the population with the majority of those affected having multiple cavitation lesions.
Of all sites, lower wisdom tooth extraction sites form cavitations the most frequently. This may be because the area was often necrotic and infected prior to extraction, the bone in this region particularly dense and also because the extraction usually involves a surgical procedure involving removal of bone.
However, because of their obscurity and the lack of practitioner familiarity with cavitations, these holes in the jawbone routinely evade detection. Sufferers may frequently have failed to respond to conventional and even alternative treatments and this effect will not be eliminated until the cause is identified and adequately treated.
Detection and treatment of cavitations
Cavitations are difficult to detect using the usual methods such as examination or x-rays. Visually, the gum has healed and there may be no overt signs of redness or swelling over the extraction site
When it comes to x-ray detection of cavitations, the signs are either absent or subtle and easily missed. This is because a change in bone density will not be apparent on x-ray until there is at least a 30% loss of bone. With proper healing the outline of the condensed bone surrounding the roots of the extracted tooth should have disappeared within 2 years of the extraction. If a faint outline can still be detected on x-ray after this time, this may indicate the presence of a cavitation. There may also be a subtle change of bone texture or signs of destruction of the compact bone surrounding the inferior dental nerve in the lower jaw.
Although scanning using a CAT or MRI scan can reveal cavitations it is expensive, exposes the individual to significant radiation, and is usually interpreted by a radiologist who is probably not especially familiar with the concept of cavitations and who may miss the signs.
The most reliable method of detecting jaw cavitations involves the use of a device known as a Cavitat which uses an ultrasonic scan combined with computer software to produce a 3 dimensional image of the jaw bone. Relatively few dental practitioners own and operate these devices. In addition to cavitations and soft spots, it can also detect areas of hypercalcification which may also indicate an issue with healing.
The US Food and Drug Administration recently approved the Cavitat as an ".. adjunct device to determine low bone density and dessicated bone". In order to receive this stamp of approval from the FDA, the company submitted 4,000 case studies and the device demonstrated a success rate in excess of 94% in detecting problem areas.
However, a campaign by critics subsequently forced the company out of business although some dentists may still own and operate such equipment. The newer cone beam tomography being introduced into some dental practices which gives a 3D images of the hard tissues may also reveal the presence of cavitations.
Other means of detection include electrodermal screening to measure energy flows through the energy meridians and the more low tech method of using kinesiological muscle testing to localise problems in the mouth relating to energy flows.
When it comes to treatment, anything short of surgical removal of the dead bone, periodontal ligament and infected area is destined to fail. This surgery creates a clean field and a blood clot into which bone cells can regenerate producing healing.
While dentists dealing with this issue report quite high cure rates, there is also a strong tendency for the cavitations to recur later. This may be because of underlying problems with poor oxygenation of the area and some advise the use of hyperbaric oxygen before and after surgery to increase oxygen levels in the tissues.
Local anaesthesia and the formation of cavitations
Some think that the formation of cavitations may be due in part to the type of local anaesthetic and injection that dentists routinely employ. Anaesthetics typically contain a vasoconstrictor such as adrenaline (epinephrine) and this serves to retain the anaesthetic in the region long enough to be effective and also to prevent haemorrhage during surgery or extraction. However, this constriction of the blood vessels may ultimately contribute to creating both dry sockets and cavitations.
Certain regions are more vulnerable to bone infection and necrosis due to the particulars of their blood supply and the lower jaw or mandible is one of these regions. Whereas the upper jaw is fairly porous and has an extensive blood supply because it is part of the skull, the lower jaw or mandible is a separate, movable bone with just one artery that enters either side of the jaw near the joint.
This means that teeth in the upper jaw can be anaesthetised by means of an anaesthetic deposited locally known as an infiltration injection. But in the lower jaw a block injection (inferior alveolar or inferior dental block) is typically used whereby the anaesthetic is deposited adjacent to the main arterial and nerve supply where it enters the jaw bone. This may compromise the initial formation of a blood clot in the first few hours causing more problems after lower tooth extractions.
Other causes of cavitations
Other factors that predispose towards poor healing include:
The use of corticosteroid drugs such as prednisolone or dexamethasone
The use of bisphosphonate drugs which are used to treat osteoporosis and some cancers
The use of oestrogen-based drugs such as the contraceptive pill or HRT
Underlying medical conditions such as diabetes mellitus, cancer, Paget’s disease or Cushing's syndrome
Poor oral hygiene
The presence of mercury from dental amalgam fillings in the jaw bone which can be particularly high around the ends of the roots of teeth that have amalgam cores underlying bridges or crowns made of gold or porcelain-fused-to-metal. The presence of mercury in this vulnerable area may kill the bone cells by starving them of oxygen and being a heavy metal, mercury literally settles in the base of each body compartment concentrating in the lower jaw.
Nutritional deficiencies may also be a factor in poor healing and it is possible that all of us are effectively deficient since our native diet is estimated to have contained ten times the minerals and vitamins of our modern diet.
Cavitations: The way forward?
The division of the body into parts rather than viewing it as a cohesive whole is never more apparent than when it comes to the division between dentistry and medicine. Typically dentists have concerned themselves almost exclusively with care of the mouth and teeth and ignore or cannot see the implications of their treatments upon general health. And doctors regard the mouth as the province of dentists and show little interest in its health or restorative status.
This means that important causative links are being overlooked daily by dentists and doctors all over the globe and that much preventable suffering ensues as a consequence.
Although cavitations were first described by G V Black, the father of modern dentistry, nearly two hundred years ago and they have been recognised by both physicians and dentists for centuries as a cause of systemic health problems, mainstream dentistry including the American Dental Association (ADA) currently refuses to accept that they exist. And, until something becomes accepted dental school teaching, it will in effect, not exist for the vast majority of dentists.
So if you suffer from chronic health problems that could date back to a tooth extraction and particularly if you recall having an infected or 'dry' socket or the extraction was of a wisdom tooth, it might be worth exploring the possibility that some of your problems may relate to this overlooked but serious cause.
However, be warned that your dentist will most probably not even be aware of the problem and you may need to seek out a specialist dental practitioner. Also, be aware that if you require an extraction, a little prevention can go a long way by seeking out someone knowledgeable about this issue.
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Dental cavitations: Article summary
This article accompanies a two-part video which examines the problem of dental cavitations also sometimes referred to as Neuralgia-Inducing Cavitational Osteonecrotic lesions or NICOs. These are holes that form within the bone after tooth extractions that can act as a focus of infection for the rest of the body and that contain a mixture of necrotic and infected bone. The causes, detection and treatment are discussed.
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The Natural Recovery Plan Newsletter September 2011 Issue 20. Copyright Alison Adams 2011. All rights reserved Dr Alison Adams Dentist, Naturopath, Author and Online Health Coach www.thenaturalrecoveryplan.com