Treating Jaw Bone Cavitations: The Latest Approaches

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. I'm your host, Dr. Sanda Moldovan, and today we're continuing on the series of cavitations. In our last episodes, we explored what cavitations are and why the IAOMT has redefined them as chronic ischemic medullary disease of the jawbones, or CINDJ. We also covered how to best diagnose cavitations. Today, we're going to take a deeper look into the science behind these jawbone cavitations. How do they form? What exactly is happening inside the bone? And why are they so difficult to diagnose? Let's start with the basics. Jawbone cavitation, or chronic ischemic medullary a disease of the jawbone, occurs when blood supply of the cancellous bone, which is actually inside the jawbone, is interrupted. Without proper blood flow, bone cells begin to die, a process known as osteonecrosis. Over time, this can lead to the formation of hollow spaces or dead zones inside the bone. These cavitated areas don't always heal properly. Especially after trauma like a tooth extraction or oral surgery. But it's not just about the dead bone. In cavitated areas, the body tries to respond to the lack of healing by sending inflammatory cells to the site. This chronic low-grade inflammation often leads to the release of cytokines. Which are proteins involved in the body's immune response. Why is the body sending cytokines in the site? Well, because also microbes are involved. We also believe that when an extraction is done, there's a slight opening in the gum area and sometimes a big opening depending on the surgical technique involved, and oral bacteria can easily go inside and populate the bone. Sometimes you will have patients saying, "Oh, I got a dry socket." Well, what is exactly a dry socket? It is an area that has no blood supply and bacteria from the mouth has gone inside and populated the bone area. It is a very painful condition that some patients can experience after they have, let's say, a wisdom tooth removed. Or any other tooth for that matter. More so around root canal-treated teeth, if these are to be removed, typically what I find and what we see as surgeons is that the bone around that root canal-treated tooth is actually devoid of blood. So it's super important that we remove the bone until we get a nice, healthy bleeding site. Let's go back to cytokines. Studies, including those cited by the IAOMT position paper, and the link will be below in the show notes, have shown that these cytokines are often found at significantly higher levels in jawbone cavitations when compared to healthy ones. This continuous inflammation can impact not only just the local jawbone, but may also contribute to systemic health issues such as chronic pain, chronic fatigue, and even autoimmune disorders. Because of the inflammatory nature of jawbone cavitations, in a paper in 2017, Lechner and Behr have investigated the possible relationship between cytokines, and the disease. One cytokine of particular interest is called RANTES, regulated upon activation normal T-cell expressed and secreted. This particular cytokine called RANTES, as well as fibroblast growth factor, FGF2, is expressed in greater amounts in cavitational lesions. In patients with CIMDJ or cavitation. What they found in this 2017 paper is that the level of RANTES are more than 25 times greater in those with disease. And RANTES are strong inflammation that is causing a site of cavitation. 25 times compared to healthy bone. Studies have shown Moranthese to be implicated in many other systemic illnesses, not just jawbone cavitations, such as arthritis, chronic fatigue syndrome, atopic dermatitis, nephritis, colitis, alopecia, thyroid disorders, and the promotion of multiple sclerosis and Parkinson's disease. RANTES has been shown to cause acceleration of tumor growth as well. So it is not good to have excessive levels of RANTES in your body. The excessive levels of RANTES and FGF2 in cavitation lesions have been compared and linked to the levels observed in other systemic illnesses like hermiotropic Lateral sclerosis, ALS, multiple sclerosis, MS, rheumatoid arthritis, and even breast cancer. Dr. Lechner also looked at breast cancer patients and did a study where he actually looked at the inflammatory cytokines after cavitation in breast cancer patients. And after cavitations, the markers went down in every patient. Indeed, the levels of these messengers detected in the jawbones are higher than in the serum, than cerebral spinal fluid of ALS and MS patients. So what's going on at the cellular level in these cavitations? The IAOMT highlights something called fatty degenerative osteonecrosis, Fatigue of the Jawbone, or FDOJ, a term that describes a specific type of jawbone lesion where fatty tissues replaces healthy bone cells. This process not only leads to structural issues in the jaw, but can also impact the body's immune response. The presence of these fatty tissues where bone needs to be is one of the reasons why cavitations can be slow to heal. —when prone to chronic inflammation. Interestingly, scientists have also discovered that cavitations often form in sites of previous tooth extractions. When a tooth is removed, the socket is supposed to fill with new bone tissue, but sometimes, whether due to infection, poor surgical technique, or underlying systemic issues, that bone doesn't regenerate properly. Leaving a cavitation behind. So cigarette smoking, for example, is another risk factor that may cause someone to develop a cavitation after extraction. Other risk factors are vitamin D3 deficiency, calcium deficiency, osteomalacia, thrombocoagulopathies, antiphospholipid syndrome, cemental tears, cancer, dengue fever, sickle cell anemia, anemia in general, and reduced immune function. This is from Table 3 in the position paper of IAOMT, which link you can find below. Up to 80% of patients have a problem with excessive production of blood clots in their vessels. And I'm talking about 80% of patients who develop cavitations. This excessive blood clot production is not normally revealed in the routine blood testing. Bone is particularly susceptible to this problem of hypercoagulation. And It's a problem, especially when it's trying to heal. This hypercoagulation problem might be suggested by a family history of stroke, heart attacks at an early age, less than 55 years of age, hip replacement or arthritis at an early age, deep vein thrombosis, pulmonary emboli, blood clots in lungs, retinal vein thrombosis, and recurrent miscarriages. But extractions are not the only way that we can get cavitations. Root canal procedures are designed to save a tooth by removing infected pulp and sealing the tooth. However, some studies suggest that root canal-treated teeth may harbor toxins or become breeding grounds for bacteria. Which can contribute to systemic health problems. This bacteria that builds inside the tooth eventually spills in the jawbone, and when we look in a CT scan, we can actually see cysts or hollow bone areas right at the tip of the root of root canal-treated teeth. One of the main concerns about root canal-treated teeth is that they may leave behind undetected infections. According to a study by Dr. Boyd Haley, root canal-treated teeth can be home to anaerobic bacteria, which thrive in the oxygen-deprived environment inside the sealed tooth. These bacteria can produce potent toxins such as thioethers and mercaptans, which have been shown to be harmful to human cells in laboratory testing. Haley's research revealed that many root canal-treated teeth tested positive to these toxins, which are thought to contribute to chronic health conditions like heart disease, arthritis, even certain neurological disorders. In addition to Haley's research, the work of Weston Price is often cited in this debate. Dr. Price was a pioneer in the field of holistic dentistry, conducted extensive research in the early 20th century documenting how bacteria from root canals could travel to other parts of the body, and lead to systemic infections. His work was dismissed by mainstream dentistry for many years, but modern studies are revisiting the biocompatibility of root canal treated teeth, especially in the context of patients suffering from unexplained chronic illnesses. Another interesting study comes from the Journal of Clinical and Experimental Dentistry, where researchers found that Periapical lesions, those that form around the root of a root canal-treated tooth, often harbor chronic infection. These lesions can go unnoticed for years because they don't always cause pain, and they're not detectable usually on two-dimensional regular dental x-rays. But yet they can lead to systemic inflammation, which contributes to a whole host other health issues, including cardiovascular diseases and autoimmune reactions. In cases like this, cavitations may develop near or around root canal-treated teeth, further complicating the situation. This brings us to another interesting aspect of cavitations: their potential to impact overall health. Biological dentists and the IAOMT have been at the forefront of studying the link between jawbone cavitations and chronic systemic conditions. Fibromyalgia, chronic fatigue syndrome, and even autoimmune issues have been connected to cavitations, although research is still ongoing to fully understand these relationships. So what does it all mean to you? The science behind cavitation is still evolving, but one thing is clear: these lesions are real. They can have a significant impact on both oral and overall health. If you've been suffering from chronic pain, whether in your head, in your jaw, or in your body, or unexplained systemic issues, it may be worth considering whether cavitations could be the underlying cause. Well, as we mentioned, cavitations form when blood flow to a section of bone is cut off, leading to necrosis. In the case of root canals, some studies suggest that the procedure itself or bacterial toxins released from sealed tooth could contribute to local ischemia, cutting off the blood flow. So oftentimes I actually biopsy for microbes. Not just pathology. Whenever I do cavitation procedures, the biopsy never comes back sterile. We find a multitude of bacteria, typically anywhere from 2 to 20+. We find about 60 to 70% of the time parasites, certain viruses, and Even though we don't have yet a good lab to test for mold, I do believe that some areas that we scoop out that look black could be, uh, mold-related lesions. That's it for today's deep dive into the science of jawbone cavitations. Thanks for tuning in to the Holistic Dentistry Show. If you found this episode helpful or want to learn more about cavitations, Stay tuned for the next episode where I will be talking about how to treat jawbone cavitations and what do we know today as the best methods. Until next time, I'm Dr. Sanda Moldovanova reminding you that a healthy mouth is the gateway to a healthy body.

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 @drsandamoldovanovan. This is Dr. Sanda Moldovan, and remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.