Why Some People Don't Heal After Cavitation Surgery- And How to Prepare the Right Way

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 in a natural way. Welcome to this week's episode on the Holistic Dentistry Show. I'm your host, Dr. Sanda Moldovan, periodontist and nutritionist. I want this to be a complete pre-surgery roadmap that I'm going to draw up for you in the next few minutes. How do we prepare our body for cavitation surgery? But in order to discuss how do we prepare our body, I want to talk about what is a cavitation and why does it matter? This is actually going to be a two-part series dedicated entirely to cavitation surgery. What is it? What your body needs before you go under. How to stack the odds so completely in your favor that your body heals faster than you thought possible. Whether your surgery is weeks away or you're just starting to explore this path, this episode is your preparation blueprint. So let's start at the beginning. A cavitation, short for cavitation osteonecrosis, is a pocket of dead or dying bone in the jaw, most often found where wisdom teeth or other root canal-treated teeth or dead teeth have been extracted and the bone never fully healed. These hollow, poorly vascularized lesions are sometimes called NICO lesions, neuralgia-inducing cavitation osteonecrosis. They harbor anaerobic bacteria, generate toxic byproducts, and communicate with your bloodstream and lymphatic system, which is why their effects are so far-reaching, contributing to chronic fatigue, brain fog, jaw pain, facial pain, and systemic immune burden. Here's what makes them so tricky. They are often invisible on a standard dental X-ray. The gold standard for diagnosis is a cone beam CT scan, which gives a 3-dimensional view of the jaw. If you haven't had one yet and you've had a missing tooth or wisdom teeth removed, that would be your first step. A cavitation is not just a dental issue. It is a whole body health challenge. And how well you prepare your body for surgery directly determines how well and how fast you heal after it. I hear so many patients blaming the previous doctor saying, oh, he didn't do a good job cleaning my cavitation. That's why I still have one, but it's time to take responsibility. Responsibility for our own health. It is not just in the hands of the doctor. It is also in your hands if you're going to undergo cavitation surgery. Make sure you prepare your body for healing. Step 1: Get your blood work done first. You cannot optimize what you cannot measure. Before you invest in a single supplement or change a single meal, get a comprehensive blood panel done. These are numbers you want in hand before your surgery date. And today there's just many different labs, even if you don't have a healthcare provider. For example, one of my favorite apps nowadays is Function Health, Function Health by Dr. Mark Hyman, and you can actually order a lab through there and get your results. And of course, an optimized path to health. Essential pre-surgery labs: vitamin D, so important in bone healing and reducing infection. The target rate is 60 to 80 nanograms per mL, even though Some patients are coming in saying, oh, my doctor told me it was normal. What exactly is normal? Well, unfortunately in medicine, 40 nanograms per ml is considered normal, but it's still suboptimal. Sometimes most labs flag 30 as normal, but for surgical healing, immune function, and bone regeneration, we need it to be between 60 and 80 nanograms per ml. Complete blood count checks red cells, white cells, and platelets. Oxygen delivery, immune response, and clotting capacity. Comprehensive metabolic panel: liver, kidney, electrolytes, and blood glucose. Your liver will process anesthesia. Your kidneys will clear metabolic waste, so it's super important that they are in optimum health. C-reactive protein, CRP, and ESR, markers of systemic inflammation. If elevated, your body is already fighting something, most likely even fighting cavitations. So it's important to increase the antioxidant level and the antioxidant supplementation. Ferritin and iron panel. Ferritin below 50 nanograms per mL signals poor oxygen delivery to healing tissues. This is a red flag. Thyroid panel. TSH, free T3, free T4. Thyroid function governs healing speed, immune response, and tolerance of surgical stress. That's why it's important that if you have hypothyroidism, you actually take the proper measures to have optimum thyroid hormone in your body. Magnesium, RBC form. Standard serum magnesium misses intracellular deficiency. Request a red blood cell magnesium test to really see if you're deficient. 80% of the population is actually deficient in magnesium. So I highly recommend that you take at least 500 milligrams of magnesium daily, and ideally either magnesium glycinate, threonate, or a combination of the two. Fasting blood glucose and HbA1c, super important. High blood sugar significantly delays wound healing. Fasting glucose should be under 100 mg/dL, and of course you can test this at home. HbA1c can also be tested at home. You can actually get a test from Amazon, especially if you have diabetes and you want to know where you're at. Sometimes we actually perform these tests in our office, especially if someone reports poor healing, but they haven't even been to a doctor in a very long time. HbA1c of over 5.6 indicates prediabetes, and of course we want this to be definitely under 5.6 for optimum healing. Take these results to a functional medicine practitioner if you can. Or follow the instructions on Function Health App. We're actually gonna post a Function Health link down below in the show notes if you're interested in becoming a member, and you can save $25 for the yearly membership. Standard reference ranges are calibrated for the average population, not for someone about to undergo surgery who needs optimum healing capacity. So keep this in mind. Now let's talk about Optimizing your vitamin D. Vitamin D is not really a vitamin, it's a prohormone that regulates over 200 genes. For cavitation healing specifically, you need adequate vitamin D for calcium and phosphorus absorption, for activating osteoblasts, the cells that build new bone, that is, and for keeping your immune system balanced so it can fight infection without triggering runaway inflammation. I had a patient the other day, his vitamin D was 18, and he had a massive infection around a a wisdom tooth, which I have to remove, and now we're asking for the body to deposit a lot of the minerals and the calcium in order to regenerate the bone. But if the vitamin D level of the body is low, this will not be undergoing its normal way. Basically, it— we will experience slower healing in patients with low vitamin D levels. If your level is below 40 nanograms per ml, work with your doctor on therapeutic supplementation. Typically 5,000 to 10,000 IUs of vitamin D3 daily, always paired with K1, K2, which directs calcium into the bone rather than into your arteries. Get retested after 8 to 12 weeks, and critically, start this at least 8 weeks before surgery. Vitamin D repletion takes time. Now, make sure you start the vitamin D optimization at minimum 8 weeks before surgery. However, A lot of times patients who are coming in, they don't feel well at all. So we don't want to wait 8 weeks to undergo cavitation surgery. In this case, it is okay to take one-time dose of 50,000 IUs prior to the procedure in order to quickly boost the vitamin D3 level, and then continue with 10,000 IUs vitamin D3. Now let's talk about your lymphatic system. We've got to get it moving. Your lymphatic system is your body's drainage and immune highway, and it has no pump. Unlike the heart pumping blood, lymph moves only through muscle contraction, breath, and manual stimulation. Walking stimulates the lymphatic system profoundly, which is one of the core reasons I recommend it consistently in my book, Heal Up. Before surgery, you want the system primed and flowing freely so that after the procedure, it can efficiently clear cellular debris, reduce swelling, and deliver immune cells directly to the healing side of your jaw. So some strategies of lymphatic activations are walking, as I mentioned. Even Hippocrates around 400 BC advocates walking as preventive medicine. Aim for at least 30 minutes daily. Almost anyone can do this. And now in your health app on your phone, it'll actually track your steps. A lot of physicians are now advocating for 10,000 steps a day. Rebounding, 10 minutes on a mini trampoline, is one of the most effective lymphatic movers available. I actually have a mini trampoline at home, and you don't have to take your feet off the base. So if you don't wanna walk or you're too tired to walk, just bounce on the trampoline while your feet are still in contact with the base. Some of the trampolines also come now with a bar, so you can hang onto the bar while you are bouncing. Dry brushing. Natural bristle brush strokes towards the heart before your shower. Another way to get the lymphatic system activated. Deep diaphragmatic breathing. Inhale fully, hold briefly, exhale completely. Creates a pressure gradient that physically pumps lymph through the body. Do this for 10 minutes. Hydrotherapy. Now, a lot of you have cold plunges and alternating 30 seconds cold, 30 seconds warm in the shower. Is sufficient, especially if you don't have a cold plunge. Repeated 3 times creates vascular pumping action of your lymph. If you know a good certified lymphatic massage therapist, you can do 2 to 3 sessions prior to surgery in order to get the lymphatic system moving. Another product that I like is a homeopathic called Aetherease. This homeopathic formula specifically indicated for stimulating lymphatic function and is particularly useful during the healing after surgery. Let's talk about hydration. It's really overlooked, and a lot of people are dehydrated. Your blood volume, lymph fluid, cellular detoxification, and virtually every enzymatic healing reaction in your body depends on adequate hydration. Yet the majority of people arrive to surgery mildly dehydrated, and that compromises anesthesia tolerance, tissue oxygenation and recovery speed. Oftentimes we draw blood for the PRF and we note that is actually very dark in color. It's not oxygenated. It's actually very rare for us to find oxygenated blood. So it is super important to drink good water. And in my book, Heal Up, you can actually find which water is right and which water give you the best hydration. The goal is half your body weight in ounces. Of water daily. If you weigh 150 pounds, that's 75 ounces spread throughout the day. Add electrolytes, or you can actually add 4 grams of sodium ascorbate, or both. You can add a pinch of quality sea salt. I like a product called Element as well. Or you can do coconut water, but just be careful with it because it does contain sugar, and you do not want to sip coconut water throughout the day as it may lead to cavities. Drink 16 ounces first in the morning before coffee or food, because usually when we wake up in the morning, we are dehydrated. That single habit of drinking 16 ounces of water first thing in the morning makes a meaningful difference in daily hydration status. During healing, the lymphatic system especially needs adequate water to flush out dead cells generated at the surgical site. So, Make sure you drink half your body weight in ounces of water daily, especially after surgery. Let's talk about sleep. This is your most powerful healing tool. Most surgeons won't tell you this, but the majority of tissue repair happens during sleep, specifically during deep, slow-wave, non-REM sleep, which makes up about 75% of your night. During this stage, growth hormone surges, immune cells mobilize, the glymphatic system flushes toxins from the brain, and cellular repair machinery runs at full capacity. Poor sleep before surgery means you're starting from a depleted state. I have a sleep optimization protocol that hopefully you can follow in order to improve your sleep. Aim for 7 to 8 solid hours every night of sleep. Especially non-negotiable during the pre-surgery period. Avoid caffeine after 2 PM. Turn off all blue light devices, phones, tablets, TVs, at least 60 minutes before bed. Keep your room cool. 65 to 68 degrees Fahrenheit is the sweet spot for deep sleep. Better yet, try a chili pad. I personally use one, and what it does, it actually starts to cool off my body once I fall asleep, so it can put me in that deep sleep state every night. Meditate or do breathing exercises before sleep to calm the nervous system. If it's hard for you to meditate, you can just count to 4, breathe in, and exhale to the count of 6. So slowly breathe in to the count of 4, slowly exhale to the count of 6. What this does, it will actually activate your vagus nerve to put you in a relaxed state. Magnesium glycinate, 200 to 400 milligrams before bed, promotes relaxation and improves sleep quality without dependency. Melatonin is also great to help you go to sleep. Start with 1 milligram per night. Melatonin is also a powerful antioxidant that supports healing. Acupuncture. I personally love acupuncture, especially when I'm stressed out and I can't sleep. It is clinically documented to improve sleep quality and worth scheduling in the weeks before surgery. CBD. The cannabinoids, if appropriate for you, can reduce nighttime anxiety and improve sleep onset. You can actually find CBD supplements in the form of capsules or in the form of oil. Avoid heavy meals within 3 hours of bedtime and exercise, because if you exercise or have heavy meals within 3 hours of bedtime, you will not be able to sleep due to the adrenaline running through your body. So with the sleep optimization protocol, I hope that you can find at least one or two things here that can improve the quality of sleep and the quality of your healing. I also want to spend some time to talk about nutrition, to give our body the raw materials that it needs. As I outline in my book, Heal Up, what you eat in the 4 to 6 weeks before surgery is a deposit into your healing bank account. You are literally building the raw materials your body will use to close that wound and regenerate the bone tissue. Protein first. Target 1 gram per pound of body weight daily. Protein provides the amino acids arginine, glutamine, glycine, proline that collagen is built from, and collagen is the scaffold of all wound healing. Research on food-restricted athletes showed significant drops in testosterone, spikes in cortisol, impaired physical performance, and increased fatigue, which is why strongly recommend against fasting around the surgical period. Complex carbohydrates are your friend here too. Brown rice, barley, beans, legumes, oats, and whole grains. Between 45 and 65% of calories should come from carbohydrates during healing. They provide sustained energy and are low glycemic, which is critical. High blood sugar significantly delays wound healing. Keep fasting blood sugar under 100 mg/dL. Beans are particularly valuable because you can puree them after oral surgery, after cavitation surgery, getting both protein and complex carbohydrates in an easy-to-eat form. And not just beans, you can do lentils as well as peas or split peas this way. Some supplements to add before surgery. Definitely vitamin C. Vitamin C in the form of sodium ascorbate, up to 8 grams a day and divided Doses starting 1 week before surgery. Sodium ascorbate is pH neutral and better tolerated than ascorbic acid. Vitamin C is essential for collagen synthesis, and as I mentioned above, collagen is important in bone healing as well as gum or soft tissue healing. Vitamin A, 25,000 IU per day, but remember, it's not for people that are pregnant. Studies Extensively for improving immune function. It is definitely knocked down by surgery, so make sure you load up on vitamin A. Bromelain, 1,000 milligrams per day on an empty stomach before surgery. Derived from pineapple, it reduces bruising, swelling, and pain. You only have to start bromelain really the day of surgery, not too far in advance. Vitamin C and vitamin A, however, stay on at least 1 week prior to surgery. Zinc, 15 to 30 milligrams and up to 50 if immune suppressed. Needed for DNA and protein synthesis, cell membrane stabilization, and tissue repair. Magnesium glycinate, 300 to 400 milligrams a day. Magnesium participates in thousands of enzyme reactions, including collagen production and tissue repair. B vitamins, especially B1 and B5. B vitamins are critical for collagen synthesis of gum tissue and bone at the cavitation site. Vitamins D3 and K2. As discussed, begin optimizing as soon as possible, ideally 8 weeks prior to surgery. Antioxidants. The best way to get antioxidants is from food, and of course you can have the colourful vegetables for a variety of antioxidants, but keep the fruit to a minimum. Antioxidants are essentials during the surgical stress period to neutralize oxidative damage. Now, there are some supplements to stop 7 to 10 days before surgery because they affect blood clotting and must be discontinued. For cavitation surgery, platelet-rich fibrin is collected the day of the procedure, and this is prepared and placed into the bone. If you take any of the blood thinning medications, then the PRF quality will not be as good. Supplements to stop 7 to 10 days before surgery are aspirin, ibuprofen, Motrin, Advil, and all such NSAIDs. Vitamin E above 400 IUs. Fish oil and omega-3 fatty acids, although they are great in anti-inflammatory inflammatory, because of their blood-thinning effect, you want to stop them 7 to 10 days before surgery. Garlic supplements, hawthorn berry, ginkgo biloba, high dose of turmeric or curcumin can actually thin out the blood and slow down healing. Remember, we heal through inflammation. Therefore, by interrupting the inflammation, the acute inflammation immediately following the surgery, we are actually interrupting the healing. That's why high-dose curcumin or turmeric is not advised prior to surgery. Now let's talk about exercise. I call this the wound healing accelerator. A landmark study published in the Journal of Gerontology in 2005 took 28 sedentary older adults and gave them all identical small skin wounds. The exercisers healed in an average of 29 days. While the sedentary group took 40. That is 11 extra days of recovery, just from exercise alone. So try to do any form of exercise, even if it's stationary. Exercise increases collagen production, reduces excessive scar tissue. One study showed fibrosis declined by 50% with regular exercise. It also enhances immune function and it increases blood flow and oxygen delivery to the skin and tissues. These are exactly the conditions you want going into surgery. You don't exercise much? Then just start with walking. If you've never exercised, check the guidelines from the American Heart Association or American College of Sports Medicine. They include guidance on when to do a cardiac stress test first before you begin any kind of vigorous exercise. If you're over 50, the platform of my friend Flipping 50 is a wonderful resource for women. If walking isn't accessible for you, swimming, water aerobics, upper extremity cycling, or rowing, or even bouncing on the trampoline all deliver similar benefits. The goal is consistent movement every day if possible. Now let's talk about mind-body preparation. I feel like this is crucial. This is consistently the most overlooked piece of surgical preparation. And the research is unambiguous. In Peggy Huddleston's book, Prepare for Surgery, Heal Faster, she documents the cascade of effects that anxiety and fear create in the body. When the sympathetic nervous system is dominant, stress hormones flood the system, heart rate accelerates, breathing becomes fast and shallow, And critically, immune function is suppressed. The very system you need most for healing gets shut down. In contrast, when you activate the parasympathetic nervous system through relaxation, the body releases a cascade of hormones that slow the heart, regulate breathing, and actively strengthen immune function. Studies at Beth Israel Medical Center, Emory University, and St. Thomas Hospital in London all demonstrated that patients given positive healing statements during general anesthesia recover faster, with less pain and fewer complications than control patients. So what does it look like in practice, this mind-body preparation? Well, research going back to the '50s, including work by gynecologist Dr. David Cheek, showed that patients could be traumatized by negative remarks made in the operating room while they were unconscious. In a 1959 study by Wolf and Millet, 1,500 patients given positive, Intraoperative Suggestions showed that 70% of adults and 100% of children needed no pain medication after surgery. That is extraordinary. Write out your healing statements and give them to your surgical team. Studies show that patients who receive positive suggestions reduced their morphine requirements by 23% in the first 24 hours postoperatively. Here is some example of effective healing statements: Following this operation, you will feel comfortable and you will heal very well. Following this operation, you will be hungry for healthy foods. You will be thirsty. Following this operation, you will wake up more energized than before. Very important to avoid any negative words in the healing statements, including the word "pain." The unconscious mind registers language Literally, keep every statement positive and forward-looking. For daily practice leading up to surgery, I recommend the apps like Calm, Insight Timer, The Tapping Solution, which uses EFT tapping to rapidly shift the nervous system into parasympathetic mode. Attitude matters too. As I say in my book, Heal Up, and as the science confirms, the serenity to accept where you are combined with a vision of where you're going creates measurable physiological changes that support healing. Spend 5 minutes daily visualizing a smooth surgery and a complete vibrant recovery. One more thing. If you smoke, stop now. Surgeons have known for decades that smokers experience significantly lower recovery. Multiple studies in orthopedic and oral surgery confirm delayed healing, more pain, and increased complications in smokers. If you smoke, stopping even just weeks before surgery measurably improves your outcomes. This is one of the highest leverage changes you can make. So that is your episode 1 preparation blueprint. Get your labs done. Optimize your vitamin D. Move your lymphatic system. Hydrate deeply. Sleep like healing is your full-time job because right now it is. Nourish your body with protein, complex carbs, and the right supplements. Exercise and prepare your mind. You are not just going into surgery, you are going into prepared, armed, and ready. In the next episode, we cover exactly what happens after the procedure, how to protect the surgical site, reduce swelling, support bone regeneration, and come through this with your health transformed. Until then, heal up. 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 the gateway to your health, so take care of it in the most natural and best way possible.