CAVITATIONS - (from Issue #1 of Cavitations Plus Quarterly newsletter)
by Karen Evans, EdD

Everyone knows what a cavity is, but cavitations are much less well-known. Both words come from the same root word, "hole." A cavity is a hole in the tooth, whereas, a cavitation is a hole in the bone that cannot be detected through visual inspection. The term "cavitation" was coined in 1930 by a well-known orthopedic researcher to describe a disease process in which the lack of blood supply to an area of bone resulted in a hole or "hollowed out" portion of the jawbone or other bones in the body. This process was also described in 1915 by G.V. Black as a progressive disease of the jawbone which kills the bone cells and produces large hollowed out areas of bony tissue or a soft mass enclosing particles of necrotic (dead) bone. He was intrigued by the unique ability of this disease to produce extensive jawbone destruction without causing redness, swelling of the overlying tissues or increasing the patient's body temperature. This "avascular" disease is one in which the progressive impairment of blood supply to the marrow of the bone essentially produces small "heart attacks" (infarcts) in the jawbone, thus resulting in osteonecrosis (bone death). It is possible that a biofilm form of the bacteria, which is antibiotic resistant, adheres to the inside of the capillary walls and that its toxins and by-products, combining with other cellular material, are responsible for the infarct-producing clots. Black suggested that surgically removing this dead bony tissue was necessary to promote healing of the jawbone.

In the last decade, the term "cavitation" has been used not only to describe lesions appearing as empty holes, but also various types of lesions in the jawbone, found through tissue analysis to be ischemic (lacking in oxygen), necrotic (dead), osteomyelitic (bone infected) and toxic. These lesions are often located in old extraction sites and under or near the roots of root canal teeth, avital (dead) teeth, and wisdom teeth. Sometimes they seem to spread extensively from these locations throughout the jawbone and may penetrate the sinuses or totally encompass the inferior alveolar (jaw) nerve.

Recent research by Dr. Boyd Haley shows that ALL cavitation tissue samples tested contain toxins which significantly inhibit one or more of the five basic body enzymes necessary in the energy production cycle. These small chemical toxins, metabolic waste products (most likely from anaerobic bacteria), may produce significant systemic effects, as well as play an important role in the localized disease process which negatively affects the blood supply in the jawbone. There are indications that when these toxins combine with chemicals or heavy metals, such as fluoride or mercury, more potent toxins may be formed. Research from Germany indicates that the jawbone (especially the wisdom teeth sites) may be a holding tank for heavy metals. Clinical experience indicates that it is sometimes difficult for some patients to successfully detoxify mercury from the body until after cavitations, as well as fillings containing mercury, are removed.

The term NICO, Neuralgia-Inducing Cavitational Osteonecrosis, has also been used when severe facial pain, neuralgia, headache, or phantom toothache accompany this disease. Although the presence of cavitations is a common occurrence, only a small percentage of individuals with them suffer from the pain component included in the description of NICO lesions. Even if pain symptoms or localized jawbone symptoms are not present, systemic symptoms can be extensive. The intense concern expressed by several researchers and physicians earlier this century about the damaging systemic influences of these lesions has likewise become a concern of contemporary dentists, physicians and researchers who have examined this information.

Bob Jones, the inventor of the CAVITATtm (an ultrasound instrument designed to detect and image cavitations) found cavitations of various sizes and severity in approximately 94% of several thousand wisdom tooth sites scanned. He also found cavitations under or located near 100% of root canal teeth scanned in both males and females of various ages from several different geographical areas of the United States.

There are several possible initiating, predisposing and risk factors that may be associated with cavitations. It is likely that the combination of these factors present in a particular individual in a particular jawbone area will influence the occurrence, type, size, progression and growth pattern of a lesion.

One of the major initiating factors is likely dental trauma which includes physical, bacterial and toxic components as listed below:

Predisposing factors include clotting disorders such as thrombophilia, hypofibrinolysis or others (which may be undiagnosed); age - evidence suggests that as many as 11% of older individuals may have major or complete blockage of arteries feeding the jaws; radiation or chemotherapy for cancer; rheumatoid arthritis; lymphoma; bone dysplasia; variable atmospheric pressures in occupation; osteoporosis; lupus; sickle cell disease; homocystinemia; Gaucher's disease; hyperlipidemia; hemodialysis, antiphospholipid antibody syndrome; inactivity (bedridden, paraplegic); gout and deficiency of thyroid or growth hormone.

Risk factors that may be responsible for ischemic osteonecrosis (cavitations) include corticosteroid use, pregnancy, estrogen use, alcoholism, cigarette smoking and pancreatitis.

One source of data indicates that 45% of all jawbone cavitations are located in the third molar (wisdom teeth) sites. These areas are particularly predisposed because they contain small terminal vessels (microvasculature), and osteonecrosis is a disease of such vessels. Injections for dental procedures are often given near these areas. If the local anesthetic used contains a vasoconstrictor (often epinephrine), it may shut down the blood supply to the bone in these areas. For this reason, the exclusive use of non-vasoconstricting anesthetics is indicated.

The recommended treatment of cavitations at the present time remains the same as that proposed by G.V. Black: surgical debridement (scraping clean) of the areas to remove all unhealthy bone and all pathology such as abscesses, cysts, etc. It is not sufficient to "punch" a small hole in the bone, drill a little and rinse it out. In fact, this, and the practice of injecting these lesions with homeopathics and other substances, instead of debriding them, may very well increase the severity instead of lessening it.

After the unhealthy bone is removed, the treatment goal is bone regeneration. Successful bone regeneration, up to this point in time, has depended a great deal on the healing capacity of the individual's body and the treatment or elimination of predisposing and risk factors, which is not always possible. Lack of healing or reoccurrence of a lesion and the need for re-treatment is always a possibility, no matter how well the surgery is performed. There are very few dentists as yet who are trained in effectively diagnosing and treating these lesions. Those who are not so trained are not qualified to diagnose this condition, nor to confidently assure the patient that (s)he does not have a cavitation.

Prevention of cavitations involves the elimination or appropriate modification of initiating, predisposing and risk factors. There are new instruments, products and technological applications which may improve prevention and treatment procedures and enhance the bone regeneration process. Many questions are yet to be answered, and more research is needed to perfect the prevention, diagnosis and treatment of cavitations, but our knowledge is increasing daily. Most importantly, many individuals are experiencing relief from local and systemic symptoms, diseases and pain as a result of the surgical treatment of cavitations.