Jawbone Cavitations: The Overlooked Dental Condition Impacting Whole-Body Health

Hi everybody, I'm Dr. Sanda Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way. Welcome back to the Holistic Dentistry Show, the show where we dig deep into the connection between oral health and overall well-being. I'm your host, Dr. Sanda Moldovan, and today we're diving into a very important topic: jawbone cavitations. This is often misunderstood, and that's why I want to start a series on this podcast in order to shed light on jawbone cavitations. Specifically, we will explore the updated understanding of cavitations as outlined by the International Academy of Oral Medicine and Toxicology, or IAOMT. IAOMT recently published a position paper on cavitations where they researched many different articles. A few, uh, dentists and physicians were involved into creating this position paper is an update to a previous position paper. What exactly are cavitations? You've probably heard this term floating around in holistic dental circles, but it's not always clearly explained. At its core, a cavitation refers to an area of dead or dying bone tissue in the jaw, which occurs when the blood supply in that area has been disrupted. How can it be disrupted? Well, these areas can form after a tooth is removed or a root canal procedure, or sometimes even just due to an infection, a gum infection. While this condition has been talked about in dental history for over a century, modern science is only recently catching up to how big of a problem cavitations might be. How I heard about cavitations was actually at the Institute of Functional Medicine about 15 years ago. There was this physician on stage, and I'll never forget, as he was going through case presentation of his patients with complex chronic issues, such as chronic fatigue, brain fog, inflammation that is unexplained. And then he clearly stated it wasn't until the cavitations were done that my patient actually could heal from the rest of the issues that were going on. And here I am sitting in the classroom looking at the slides and I'm like, finished my residency in periodontics. At UCLA when I've never heard of jawbone cavitations. I'm like, what the heck are jawbone cavitations? So, when I started on the path of discovery, I went up to that physician and he directed me to one of the dentists that he was working with to learn about cavitations. This topic was fascinating to me, especially because I also want to help patients who have chronic fatigue and inflammation. I ended up going to Switzerland and spent some time with a doctor there that does a lot of cavitation procedures, and I learned a lot from him. After that, I started noticing that when I do cavitation procedures on my patients, they actually feel better. And the two main things that people get after cavitation surgery is the brain fog that is lifting So clearer thinking. And the second thing is more energy, more energy and less inflammation in their body. One of the reasons cavitations have gained more attention lately is the IAOMT's decision to give them a more scientifically accurate name. That name is chronic ischemic medullary disease of the jawbone. Or CINDJ. Why the change? Well, the IAOMT and a group of experts, including researchers, clinicians, pathologists, reviewed over 270 studies and found that the term cavitation didn't quite capture the complexity of the condition. Chronic ischemic medullary disease of the jawbone describes what's really happening: chronic ischemia, or lack of blood flow, in the bone marrow of the jaw. This leads to tissue death, also called osteonecrosis, which can result in a painful lesion and even systemic health issues. Now, you might be wondering, why is the jawbone so vulnerable? To this condition. The jawbone is particularly prone to trauma and infection because of how often we undergo dental surgery, like extractions of wisdom teeth, extractions of teeth maybe that had a gum infection or periodontal disease, teeth with deep cavities, and even root canals that have gone bad. A lot of you think, oh yeah, I'm gonna get a root canal and it's gonna last forever. Not true. Unfortunately, root canals are dead teeth. And it's usually only a matter of time before they get attacked by termites or basically microbes and they become soft and mushy. And then those areas where the teeth are removed in the jawbone don't heal properly. It can lead to cavitations. Historically, terms like neuralgia-inducing cavitation osteonecrosis or NICO were used to describe these painful conditions, especially in patients experiencing facial neuralgia. What is facial neuralgia? For example, they have shooting pain from usually sometimes the back of the jaw towards the ear all the way forward. And usually dentists cannot find anything wrong in that area. In fact, jawbone cavitations were first seriously explored in the 1860s. In 1867, Dr. H.R. Noel gave a presentation entitled A Lecture on Caries and Necrosis of the Bone at the Baltimore College of Dental Surgery. Then, 1901, jawbone cavitations were discussed at length by Dr. William Barrett in his textbook Oral Pathology and Practice, a textbook for the use of students in dental colleges and also a handbook for dental practitioners. But those people weren't the only one. J.V. Black, often referred to as the father of modern dentistry, included a section in his 1915 textbook Special Dental Pathology to describe the usual appearance and treatment of what he described as jawbone osteonecrosis. Now, I wanna clarify that we're not talking about jawbone osteonecrosis that is caused by, by bifosphonates, medication-induced jawbone osteonecrosis. That is a different kind of condition. We are talking about conditions that are due from, like, ischemia after removal of teeth or after, you know, root canal-treated teeth, or perhaps even gum infections. Interest in cavitations kind of faded until the late 20th century when modern imaging technology like cone beam CT scans helped us really see what was really going on. In these hidden areas of the jaw. In 1992, Dr. Bouchoir wrote a paper. He observed intraosseous inflammation in patients with chronic and severe facial pain. And he coined the term neuralgia-inducing cavitation osteonecrosis, or NICO. Although Bouchoir did not comment on the etiology of the disease. They concluded that it was probable that the lesion induced chronic facial neuralgia with unique local features, such as this inside the jawbone cavity formation, a longstanding bone necrosis with minimal healing. In a clinical study with patients with trigeminal facial neuralgia, Dr. Ratner also showed that almost all of the patients had cavities in the alveolar bone and jawbone. The cavity, sometimes more than 1 centimeter in diameter, were at the sites of previous tooth extractions and were generally not detectable by regular dental X-rays. Throughout the years, there's so many different terms that were given to cavitations. Dr. Lechner, who is one of the most published in terms of cavitation papers, coined the term NICO, neuralgia-inducing cavitation osteonecrosis. However, cavitations not always come with this facial neuralgia or nerve pain. Dr. Boucois called it chronic ischemic medullary disease of the jaw in a 2010 paper. And we're not talking just about adults here. There's actually been papers published on the juvenile mandibular chronic osteomyelitis that referred to children. Fatty degenerative osteonecrosis of the jaw is another name that was given by Lechner in 2017. We also have a term called chronic fibrosing osteomyelitis. Osteomyelitis basically just means bone infection. This was coined by Dr. Adams in 2014. Oral ulceration with bone sequestration. This was another name given. Chronic ischemic bone disease, also given by Bocqua, jawbone osteonecrosis. This was given, of course, by Block, and maxillofacial ischemic bone disease. So if you're searching for cavitation in the literature, sometimes not everything pops up because of all these different names that have been given over the years to these lesions inside the jawbone. So the whole goal of this position paper from IAOMT is to really solidify one simple term, which is basically the chronic ischemic medullary disease of the jawbone. The IMT's work has shown that cavitations are more than just a local problem. These dead areas of the jawbone don't just stay put. They can cause chronic inflammation and even impact your overall health. Some patients with undiagnosed cavitations suffer from chronic pain, neurological conditions, and systemic illnesses like chronic fatigue syndrome or even autoimmune disorders. Typically what I find in my patients with autoimmune disease, that once we remove the cavitations from the jawbones, their autoimmune condition stabilizes because what we're really doing is removing the burden of microbes from inside the jawbone off the immune system. Once the cavitations are treated. This is why IOMT and many holistic dentists take cavitation seriously, and including myself as a periodontist and integrative dentist. When traditional medical and dental treatments fail, cavitations might be the hidden culprit. So how do we diagnose cavitations? Definitely not with 2D x-rays. And you might be wondering, well, If they go to my dentist, can he identify them? Unfortunately not. Just like any training, all dentists need training in how to diagnose cavitations properly and of course how to treat it properly after that. The other problem we're encountering is that most dentists in the United States do not have home beam CT scan or a way to view the jaw in 3 dimensions. Standard dental x-rays often miss cavitations because they can be often too small or may be hidden, uh, by other, uh, structures of the face. That's why more advanced tools like cone beam CT scans, even thermography— sometimes we could see actually the focal inflammation in the bone through thermography— and acupuncture meridian assessments are becoming crucial in identifying these problem areas. When it comes to diagnosing jaw bone cavitations, traditional X-rays miss the marks. I wanna also talk about the Cavitow though, because some practitioners still use this device today. The Cavitow is an ultrasound-based device that was developed specifically to detect areas of low bone density. Which is often a sign of cavitation or osteonecrosis. It works by emitting sound waves into the bone and measuring how they travel through the tissue. Healthy bones allow sound waves to pass through at a consistent rate, while cavitated or necrotic bone creates this irregular patterns indicating potential areas of concern. In theory, this makes the Cavitow a useful tool for detecting cavitations. However, the Cavitow is not without its limitations. While it seems promising, in the early 2000s, the device struggled to gain widespread acceptance in mainstream dentistry due to the concerns of its reliability and reproducibility of the results. Many critics pointed out that the machine could produce false positives meaning it might identify cavitations where there is— there isn't actually any. As a result, its use has become more niche, and many practitioners like myself prefer the cone beam CT scan for a more definitive look at the jawbone. Still, there are some holistic dentists that continue to use the Cavitel, especially when other imaging methods are not available to them. So while the Cavitow has faded somewhat from mainstream, it's still an example how the research for better diagnostic tools in dentistry is ongoing. Technology like this helps bridge the gap in understanding the hidden aspects of oral health, especially when dealing with complex issues like cavitations. Once diagnosed, treatment options range from surgical curettage, where dead tissue is removed, to more integrative approaches using lasers and ozone, PRF, and even some bone grafting techniques. I will be discussing more about this in the next episode. Some practitioners report that over 75% of these lesions or cavitations are completely hollow or are filled with soft grayish-brown demineralized granulomatous tissue, often with yellow oily material, oil cysts found in the defective areas with surrounding normal bone anatomy. Others report the presence of cavitations having varying overlying cortical bone density that upon opening appear to have linings with fibrous black, brown, or sometimes even gray filamentous material. Still others report gross changes variously described as gritty, like sawdust, hollow cavities, and dry with occasional sclerotic tooth-like hardness of the cavity walls. What is this tooth-like hardness? Well, we think that the body actually forms a barrier. It's trying to enclose the microbial diversity that's actually going on in this necrotic bone area, and it starts to build these walls to block this from going systemic. Upon histological examination, these lesions appear similar to the necrosis that occurs in jawbones or other bones of the body and are histologically different though from osteomyelitis. And you can refer more to the position paper of IAOMT. You will find a link down below in the show notes. It's important to recognize that the connection between oral and systemic health is a growing area of research, and cavitations are a key piece puzzle in this systemic health. I cannot tell you how many patients we've been able to help that came to me with chronic fatigue, inflammation, brain fog, and after the treatment of cavitations, their physician was able to take over and help them heal. If you or someone you know has been struggling with unexplained chronic health issues, it might be worth investigating whether jawbone cavitations could be a factor. Thank you for joining me on today's episode of Holistic Dental Health. If you're intrigued by this topic or have any questions, feel free to reach out on our social media channels or leave us a comment. Don't forget to subscribe for more episodes exploring the intersection of oral health and whole body wellness. In the next episode, I will be continuing the cavitation talk, and we will be diving deeper in the science behind jawbone cavitations. Until next time, I'm Dr. Sanda Moldovanova Moldovanova, reminding you that a healthy mouth is a gateway to a healthier you. Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram @DrSandaMoldovan. This is Dr. Sanda Moldovan, and remember, your mouth is gateway to your health, so take care of it in the most natural and best way possible.