Cavitations

In other words, a lot of things can go wrong with extractions and infected, failing root canals. That is why it is important to properly support the body when doing these procedures and during the healing phase.

Dr. Evans can't tell you how many times she has been told by patients that simple oral hygiene instructions were not given after an extraction was performed. This is so basic yet so important. If the site is not kept clean, you may very well get a cavitation, which is basically a hole in your jaw that is filled with some combination of bacteria, pus, or dead bone cells.

Any acute condition is bad, but a chronic infection that the body cannot eliminate is bad as well. The immune system has to deal with it 24/7, and it can wear the immune system down over time.

As an example of what can happen with a cavitation, Dr. Evans recalls a patient who presented with pain in her ears and jaw, sore and inflamed lymph glands under her jaw, a history of wisdom teeth extractions, and a history of fevers and immune issues.

She had been on multiple antibiotic regimens, had multiple blood tests done, cultures, and a biopsy of her lymph glands done. When nothing helped or could be found causing the problems she was experiencing, the final recommendation was to do a spinal tap. That's where she drew the line and said no more aggressive tests that showed nothing.

When she refused the spinal tap, it was suggested that maybe she should go to a dentist. That is when Dr. Evans saw her. It seemed that her symptoms could be dental related, so Dr. Evans took an image called a panorex that shows all the bone of the jaws and the teeth.

What Dr. Evans found was a black hole in her jaw where the wisdom tooth had been. There was the problem, literally in black and white. It was a hole in her jaw created after a wisdom tooth was extracted that never healed correctly and had remained ever since. When Dr. Evans queried the patient, she remembered that the extractions were difficult and there was a lot of pain afterward. The right diagnosis was a NICO lesion, or cavitation for short. (For a definition please see below.)

The right treatment for a cavitation is to surgically remove it by cutting through the fingernail thick cortical plate with a small round bur, removing the dead, infected tissue manually, and placing a suture to seal it again. In some cases a biological bone graft may be indicated.

As you can see, the cure for the problem is surgical, but it does not have to be aggressive or risky. There is no other way to get the dead tissue out of the jaw. As with any procedure, the proper support is necessary (please see the support necessary after an extraction, as they are the same).

A NICO lesion is short for Neuralgia-Inducing Cavitational Osteonecrosis. The lesion is characterized by insufficient blood flow and bone death in the jaws of patients with symptoms of atypical facial pain or nerve pain. It was first described in the dental literature in 1920 by G.V. Black, and soon after Dr. Price did his, at the time, revolutionary research showing systemic effects of infected teeth. This research is still cited in books and is well known even today.