Neuralgia-inducing cavitational osteonecrosis
Neuralgia-inducing cavitational osteonecrosis (NICO) is a controversial diagnosis whereby a putative jawbone cavitation causes chronic facial neuralgia. A cavitation is an area of dead bone; the painful nerve is said to result from the degenerating nerve. The condition is probably rare, if it does exist.
Signs and symptoms
The pain of NICO is said to be variable in extent, location and character. It may be intermittent, gradually progressive over time and the painful area may spread. The most common site is the lower jaw in the region of the molar teeth, although typically the teeth have already been removed from the area or there is a normal-appearing root canal treated tooth.
Also called Ratner's bone cavity, a neuralgia-inducing cavitational osteonecrosis was first described in dental literature by G V Black in 1920. Several decades later, oral pathologist Jerry E Bouquot took especial interest in NICO. Although osteonecrosis of the jaw—a jawbone cavitation—can be painless, NICO is specifically such associating with facial pain. The necrotic bone could be due to chronic low-grade infection, injury, abnormalities in clotting or blood supply, or drug treatment. NICO have been treated by surgically removing the dead bone, although recurrence has been common.
The diagnostic criteria for NICO are imprecise, and that the research offered to support it is flawed. The diagnosis is popular among holistic dentists. It has been rejected as quackery by some dentists and maxillofacial surgeons. In its position statement, dated 1996, the American Association of Endodontists asserted that although NICO occur and are treatable in toothless areas, NICO occurrence and treatment at endodontically treated teeth is generally implausible, that the diagnosis ought to be a last resort, and that routine extraction of endodontically treated teeth is misguided.
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