Neuralgia-inducing cavitational osteonecrosis

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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.[1][2][3] The condition is probably rare, if it does exist.[4]

Signs and symptoms[edit]

The pain of NICO is said to be variable in extent, location and character.[5] It may be intermittent, gradually progressive over time and the painful area may spread.[5] The most common site is the lower jaw in the region of the molar teeth,[5] although typically the teeth have already been removed from the area or there is a normal-appearing root canal treated tooth.[5]


Also called Ratner's bone cavity, a neuralgia-inducing cavitational osteonecrosis was first described in dental literature by G V Black in 1920.[6] Several decades later, oral pathologist Jerry E Bouquot took especial interest in NICO.[6] 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,[3] injury, abnormalities in clotting or blood supply,[6] or drug treatment.[7] NICO have been treated by surgically removing the dead bone, although recurrence has been common.[8]

The diagnostic criteria for NICO are imprecise, and that the research offered to support it is flawed.[9] The diagnosis is popular among holistic dentists.[10] It has been rejected as quackery by some dentists and maxillofacial surgeons.[11][12][13][14] 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.[6]

See also[edit]


  1. ^ Ratner EJ, Person P, Kleinman DJ, Shklar G, Socransky SS (July 1979). "Jawbone cavities and trigeminal and atypical facial neuralgias". Oral Surg. Oral Med. Oral Pathol. 48 (1): 3–20. PMID 287984. doi:10.1016/0030-4220(79)90229-9. 
  2. ^ Roberts AM, Person P (October 1979). "Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias". Oral Surg. Oral Med. Oral Pathol. 48 (4): 298–308. PMID 291856. doi:10.1016/0030-4220(79)90027-6. 
  3. ^ a b Bouquot JE, Roberts AM, Person P, Christian J (March 1992). "Neuralgia-inducing cavitational osteonecrosis (NICO). Osteomyelitis in 224 jawbone samples from patients with facial neuralgia". Oral Surg. Oral Med. Oral Pathol. 73 (3): 307–19; discussion 319–20. PMID 1545963. doi:10.1016/0030-4220(92)90127-C. 
  4. ^ Scully, Crispian (2013). Oral and maxillofacial medicine: the basis of diagnosis and treatment (3rd ed.). Edinburgh: Churchill Livingstone/Elsevier. p. 130. ISBN 9780702049484. 
  5. ^ a b c d MS Greenberg; M Glick; JA Ship (2008). Burket's oral medicine (11th ed.). Hamilton, Ont.: BC Decker. p. 270. ISBN 9781550093452. 
  6. ^ a b c d "AAE Position Statement on NICO lesions (Neuralgia-Inducing Cavitational Osteonecrosis)" (PDF). AAE Research and Scientific Affairs Committee. Retrieved 8 May 2013. 
  7. ^ Landesberg R, Woo V, Cremers S, Cozin M, Marolt D, Vunjak-Novakovic G, Kousteni S & Raghavan S, "Potential pathophysiological mechanisms in osteonecrosis of the jaw", Ann N Y Acad Sci, 2011 Feb;1218:62–79.
  8. ^ Bouquot JE, Christian J (April 1995). "Long-term effects of jawbone curettage on the pain of facial neuralgia". J. Oral Maxillofac. Surg. 53 (4): 387–97; discussion 397–9. PMID 7699492. doi:10.1016/0278-2391(95)90708-4. 
  9. ^ Zuniga JR (September 2000). "Challenging the neuralgia-inducing cavitational osteonecrosis concept". J. Oral Maxillofac. Surg. 58 (9): 1021–8. PMID 10981982. doi:10.1053/joms.2000.8745. 
  10. ^ Yi, Daniel (18 June 2006). "Roots of a Dental Controversy". Los Angeles Times. Retrieved 25 June 2017. 
  11. ^ Follmar KE (2003). "Taking a stand against fraud and quackery in dentistry". J Am Coll Dent. 70 (3): 4–5. PMID 14977370. 
  12. ^ Stephen Barrett, "A critical look at cavitational osteopathosis, NICO, and 'biological dentistry'", Quackwatch, 4 Apr 2010.
  13. ^ Bouquot JE, McMahon RE (2003). "Charlatans in dentistry: Ethics of the NICO wars". J Am Coll Dent. 70 (3): 38–41. PMID 14977380. 
  14. ^ Sciubba JJ, "Neuralgia-inducing cavitational osteonecrosis: A status report", Oral Diseases, 2009 Jul;15(5):309–12.

External links[edit]