Osteonecrotic/Dental Cavitations Areas

What is a dental cavitation?

A cavitation is a jawbone abnormality typically found in the bone around previously extracted teeth, and most commonly where a wisdom tooth was extracted.

Following the extraction, the body doesn’t heal properly and the bone doesn’t fill the empty space like it should, due to a number of factors discussed below. This low density porous bone allows the bacteria that were there around the infected tooth to continue breeding.

A dental cavitation may appear on cbct scan as a hole in the bone or as a “ghost tooth” or an area of decreased bone density where the bone hasn’t “grown back” due to impaired blood flow (ischemia) to the area.

These pathological changes are usually triggered by a combination of systemic and local factors, such as reduced blood supply due to the vasoconstrictive action of local anaesthetic, especially where nerve blocks have been given.

There are a number of potential triggers (top 12 from a list of >60):

1. Infection & trauma
2. Estrogen therapy or pregnancy
3. Corticosteroid therapy
4. Autoimmune disease /RA
5. Malnutrition (starvation/anorexia)
6. Anemia & blood clotting disorders
7. Alcoholism & cigarette smoking
8. Frequent hyperbaric changes
9. Radiation & chemotherapy for cancer Rx
10. Metastatic cancer
11. Bisphosphonates – given for the treatment of osteoporosis
12. Hypothyroidism (deficiency of thyroid or growth hormone).

How is dental cavitation diagnosed?

Dental cavitation infections are diagnosed primarily with a 3D CBCT Conebeam Scan, which is the current international diagnostic tool  used to identify jaw bone abnormalities by examining each cross-section millimeter by millimeter of the affected infected jaw cavitation area in all directions – not possible with conventional 2D xrays or panelipse xrays.

Often patients who have previously had thermography will come to our practice because something was “picked up” – so serving as a pre-diagnostic tool that can help identify areas of ischemia in the jaws and lymphatic abnormalities, which can lead patients to explore whether they actually have dental cavitations.

Why do Dental Cavitations develop? The Aetiology of Ischemic Bone Disease

Lets break down the name to simplify it:

Ischaemic = Lack of blood supply to a part of the body resulting in tissue damage/death/lack of healing – due to the lack of oxygen and nutrients.
bone = in this case present in the jaw bone around an extraction site
disease = bacteria not cleared out by the dentist/surgeon, are left behind, so compromising the immune system and colonizing the extraction site, feasting on existing cellular structure,  further destroying bone and blood supply to the surrounding bone.

Where do the bacteria come from?

There are several sources:

1. Tooth extractions: for a tooth to be removed,it usually has an infection, thus bacteria are present at this site.During tooth extraction/surgery (fully or partially erupted wisdom teeth included), the tooth is merely removed with no attempt to clear the infected periodontal ligament or surrounding infected bone. The dentist/surgeon merely stitches the socket close, allowing the bacteria left behind to multiply and spread further.  These bacteria can incubate for years, potentially releasing toxic infection residue [bacterial debris and tissue waste (necrotic cells)] into the blood, circulating through the circulatory system and ultimately negatively impacting all the cells of the body. This of course, means that the immune system will be constantly engaged in an attempt to isolate, destroy and prevent these bacteria from spreading to adjacent teeth and bone nor into the body. Thus over time, the immune system becomes exhausted, especially where there are several areas of infection in the jaw. Remember inflammation in the jaw means inflammation in the body = disease.
2. Infections around Root Canal treated teeth: Root-canaled teeth do not have an active blood supply, hence why they are considered by many as “necrotic teeth”.  Conventional root canal therapy of teeth teaches dentists to clean and fill the canal 1mm short of the apex (tip) of the root. The problem with this protocol is that bacteria have most often penetrated into the surrounding  bone, forming the typical halo around the tip of the root seen on xray when an abscess is diagnosed. Thus this area of bacterial activity is not typically addressed in root canal therapy, so being left behind, allowing bacteria to continue breeding and as with extraction sites discussed above, leave the body dealing with an ongoing infection while running down the immune system. Because there is no nerve tissue within the tooth (as it had died off during infection and been removed by the dentist), there are no active pain receptors which means that individuals do not typically experience any pain or discomfort until the infection is so large that it can spread to the adjacent teeth, tissues, bone or drain into the sinuses in the case of teeth in the upper jaw. In fact, many of our patients will report years and years of sinus issues or post nasal drip or stomach reflux, spending extensive funds on ENT’s and gastroenterologists, with no relief because the root cause is in fact, their infected root canal treated tooth. 
3. Overuse of Local Anaesthetic containing epinephrine: epinephrine is a vasoconstrictor and therefore reduces blood supply to the anesthetized area during surgery – but also reduces the much needed blood flow into the area for healing and tissue regeneration, so preventing cavitation lesions. This is even more significant where nerve blocks are given, and hence why cavitation areas are more common in the lower jaw (inferior alveolar nerve block). By using shorter acting anaesthetics with lower toxic byproduct creation and avoiding the use of vasocontrictors like epinephrine, biological dentists are to prevent ischaemia of the tooth extraction site.
4. Infection & Lowered Immune System: the longer the infections exist in the jaw, the more compromised the immune system becomes as it works non-stop to keep the area isolated and controlled. With time the immune system weakens, allowing other opportunistic pathogens like viruses, parasites and fungi to add to the bacterial loaded infection. During such cases, it has been documented that bacteria from within the cavitation site, may produce strong chemical compounds that are highly neurotoxic, and which can then combine with chemicals or heavy metals, such as mercury, and form even more potent toxins. Over time, these neurotoxins can be released into the bloodstream, where they wreak havoc within the body.
5. Link between Low Vitamin D Levels & an effective Immune System: Vitamin D plays a crucial role in controlling both the innate and adaptive immune responses, and its deficiency is linked to increased autoimmunity and susceptibility to infections. Thus testing and monitoring the individual’s levels of vitamin D before tooth extractions or clearing of osteonecrotic areas, is essential in ensuring a better outcome i.e. better healing and reduced risk of osteonecrosis. Interesting, studies show that the Borrelia virus (seen in Lyme disease), tends to live and proliferate locally in the in the areas of cavitations, which have no ability to fight these infections as the immune system is not able to reach the areas of ischemia due to limited blood flow.

Diagnosing Jaw Cavitations

Although cavitations can go undetected for years (especially since traditional dentists and many maxillofacial surgeons, are not trained to look out or diagnose them), in an otherwise healthy individuals, the most common reason biological dentists find these necrotic areas is because patients have, in their journey to seek answers to their chronic ailment, have come across an awake functional/integrative medicine doctor or their own research which opens their eyes to the role of these festering pools as part of the root cause of their condition.

3D cone beam cbct scans are the best way to diagnose cavitations by someone with an experienced eye for cavitation areas. Also taking a thorough history both medical wrt any conditions present, as well as dental wrt teeth removed, how they were removed, any post op symptoms or infections, condition of the tooth removed, who removed it, etc

If you suspect that your wisdom teeth were not cleared properly or that you may have a cavitation area or an infected root treated tooth you would like to remove biologically, refer to our accredited practitioner list: https://saabp.co.za/biological-practitioners/ for biological dentists who can assist you; or contact us via email: admin@saabp.co.za or call us on 027 21 438 1710