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'''Neuralgia-inducing cavitational osteonecrosis (NICO)''' refers to presence of cavitations in jaw bones ([[human mandible|mandible]] and/or [[maxilla]]) in conjunction with chronic facial [[neuralgia]]. The concept implies direct and causal relationship between the bone pathology (cavitations) and pain itself. Pain in this setting is commonly described as atypical facial neuralgia and is chronic in nature. Cavitations represent areas of necrotic (dead) bone.<ref name="pmid287984">{{cite journal |author=Ratner EJ, Person P, Kleinman DJ, Shklar G, Socransky SS |title=Jawbone cavities and trigeminal and atypical facial neuralgias |journal=Oral Surg. Oral Med. Oral Pathol. |volume=48 |issue=1 |pages=3–20 |date=July 1979 |pmid=287984 |doi= 10.1016/0030-4220(79)90229-9|url=}}</ref><ref name="pmid291856">{{cite journal |author=Roberts AM, Person P |title=Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias |journal=Oral Surg. Oral Med. Oral Pathol. |volume=48 |issue=4 |pages=298–308 |date=October 1979 |pmid=291856 |doi= 10.1016/0030-4220(79)90027-6|url=}}</ref><ref name="pmid1545963">{{cite journal |author=Bouquot JE, Roberts AM, Person P, Christian J |title=Neuralgia-inducing cavitational osteonecrosis (NICO). Osteomyelitis in 224 jawbone samples from patients with facial neuralgia |journal=Oral Surg. Oral Med. Oral Pathol. |volume=73 |issue=3 |pages=307–19; discussion 319–20 |date=March 1992 |pmid=1545963 |doi= 10.1016/0030-4220(92)90127-C|url=}}</ref>
'''Neuralgia-inducing cavitational osteonecrosis''' ('''NICO''') is a diagnosis whereby a putative jawbone [[Cavitation (bone)|cavitation]] causes chronic facial [[neuralgia]]; this is different from [[osteonecrosis of the jaw]].<ref name="pmid1545963"/> In NICO the pain is said to result from the degenerating nerve ("neuralagia").<ref name="pmid287984">{{cite journal |vauthors=Ratner EJ, Person P, Kleinman DJ, Shklar G, Socransky SS |title=Jawbone cavities and trigeminal and atypical facial neuralgias |journal=Oral Surg. Oral Med. Oral Pathol. |volume=48 |issue=1 |pages=3–20 |date=July 1979 |pmid=287984 |doi= 10.1016/0030-4220(79)90229-9}}</ref><ref name="pmid291856">{{cite journal |vauthors=Roberts AM, Person P |title=Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias |journal=Oral Surg. Oral Med. Oral Pathol. |volume=48 |issue=4 |pages=298–308 |date=October 1979 |pmid=291856 |doi= 10.1016/0030-4220(79)90027-6}}</ref><ref name="pmid1545963">{{cite journal |vauthors=Bouquot JE, Roberts AM, Person P, Christian J |title=Neuralgia-inducing cavitational osteonecrosis (NICO). Osteomyelitis in 224 jawbone samples from patients with facial neuralgia |journal=Oral Surg. Oral Med. Oral Pathol. |volume=73 |issue=3 |pages=307–19; discussion 319–20 |date=March 1992 |pmid=1545963 |doi= 10.1016/0030-4220(92)90127-C}}</ref> The condition is probably rare, if it does exist.<ref name="Scully2013">{{cite book|last1=Scully|first1=Crispian|title=Oral and maxillofacial medicine: the basis of diagnosis and treatment|date=2013|publisher=Churchill Livingstone/Elsevier|location=Edinburgh|isbn=978-0-7020-4948-4|page=130|edition=3rd|url=https://books.google.com/books?id=U3WyAFrXVfIC&pg=PA130}}</ref>


Also called Ratner's bone cavity, a neuralgia-inducing cavitational osteonecrosis was first described in dental literature by G V Black in 1920.<ref name="AAE position statement"/> Several decades later, oral pathologist Jerry E Bouquot took especial interest in NICO.<ref name="AAE position statement"/>
==Suggested Causes and Treatment==


The diagnostic criteria for NICO are imprecise, and the research offered to support it is flawed.<ref name="pmid10981982">{{cite journal |author=Zuniga JR |title=Challenging the neuralgia-inducing cavitational osteonecrosis concept |journal=J. Oral Maxillofac. Surg. |volume=58 |issue=9 |pages=1021–8 |date=September 2000 |pmid=10981982 |doi=10.1053/joms.2000.8745 }}</ref> The diagnosis is popular among [[holistic dentistry|holistic dentists]]<ref>{{cite web|last1=Yi|first1=Daniel|title=Roots of a Dental Controversy|url=http://articles.latimes.com/2006/jun/18/business/fi-teeth18/2|archive-url=https://web.archive.org/web/20150221053755/http://articles.latimes.com/2006/jun/18/business/fi-teeth18/2|url-status=dead|archive-date=21 February 2015|website=Los Angeles Times|access-date=25 June 2017|date=18 June 2006}}</ref> who attempt to treat NICO by surgically removing the dead bone they say is causing the pain.<ref name="pmid7699492">{{cite journal |vauthors=Bouquot JE, Christian J |title=Long-term effects of jawbone curettage on the pain of facial neuralgia |journal=J. Oral Maxillofac. Surg. |volume=53 |issue=4 |pages=387–97; discussion 397–9 |date=April 1995 |pmid=7699492 |doi= 10.1016/0278-2391(95)90708-4}}</ref>
The cause of NICO is allegedly [[avascular]] [[osteonecrosis]] (AO) (also known as [[ischemic]] osteonecrosis). This bone ischemia would result from a chronic low-grade [[infection]],<ref name="pmid1545963"/> or, in more modern versions of the theory, susceptibility to [[thrombosis]].<ref name="pmid8621985">{{cite journal |vauthors=Gruppo R, Glueck CJ, McMahon RE, etal |title=The pathophysiology of alveolar osteonecrosis of the jaw: anticardiolipin antibodies, thrombophilia, and hypofibrinolysis |journal=J. Lab. Clin. Med. |volume=127 |issue=5 |pages=481–8 |date=May 1996 |pmid=8621985 |doi= 10.1016/S0022-2143(96)90065-7|url=http://linkinghub.elsevier.com/retrieve/pii/S0022-2143(96)90065-7}}</ref><ref name="pmid9390643">{{cite journal |author=Glueck CJ, McMahon RE, Bouquot JE, Triplett D, Gruppo R, Wang P |title=Heterozygosity for the Leiden mutation of the factor V gene, a common pathoetiology for osteonecrosis of the jaw, with thrombophilia augmented by exogenous estrogens |journal=J. Lab. Clin. Med. |volume=130 |issue=5 |pages=540–3 |date=November 1997 |pmid=9390643 |doi= 10.1016/S0022-2143(97)90132-3|url=http://linkinghub.elsevier.com/retrieve/pii/S0022-2143(97)90132-3}}</ref>


It has been rejected as [[quackery]] by some dentists and [[maxillofacial surgeon]]s.<ref name="pmid14977370">{{cite journal |author=Follmar KE |title=Taking a stand against fraud and quackery in dentistry |journal=J Am Coll Dent |volume=70 |issue=3 |pages=4–5 |year=2003 |pmid=14977370 }}</ref><ref>{{cite web |last1=Kreidler |first1=Marc |title=Cavitational Osteopathosis, Bouquot, NICO, and 'Biological Dentistry' |url=https://quackwatch.org/related/cavitation/ |website=Quackwatch |date=18 May 2019 }}</ref><ref name="pmid14977380">{{cite journal |vauthors=Bouquot JE, McMahon RE |title=Charlatans in dentistry: Ethics of the NICO wars |journal=J Am Coll Dent |volume=70 |issue=3 |pages=38–41 |year=2003 |pmid=14977380 }}</ref><ref>{{cite journal |last1=Sciubba |first1=JJ |title=Neuralgia-inducing cavitational osteonecrosis: a status report |journal=Oral Diseases |date=July 2009 |volume=15 |issue=5 |pages=309–12 |doi=10.1111/j.1601-0825.2009.01532.x |pmid=19371400 }}</ref> 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.<ref name="AAE position statement">{{cite web|title=AAE Position Statement on NICO lesions (Neuralgia-Inducing Cavitational Osteonecrosis)|url=http://www.aae.org/uploadedFiles/Patients/NICOlesionsnew.pdf|publisher=AAE Research and Scientific Affairs Committee|access-date=8 May 2013|archive-url=https://web.archive.org/web/20160305164026/http://www.aae.org/uploadedfiles/patients/nicolesionsnew.pdf|archive-date=5 March 2016|url-status=dead}}</ref>
According to some opinions, the suggested treatment for NICO involves oral surgery consisting of [[decortication]] and [[debridement]] of bone via [[curettage]] to remove dead bone tissue. However, this suggestion is based only on a poorly defined trend in one retrospective study, which appeared in 1995 and which was referenced - in [[PubMed]]-listed publications - only three times in the following 21 years.<ref name="pmid7699492">{{cite journal |author=Bouquot JE, Christian J |title=Long-term effects of jawbone curettage on the pain of facial neuralgia |journal=J. Oral Maxillofac. Surg. |volume=53 |issue=4 |pages=387–97; discussion 397–9 |date=April 1995 |pmid=7699492 |doi= 10.1016/0278-2391(95)90708-4|url=http://linkinghub.elsevier.com/retrieve/pii/0278-2391(95)90708-4}}</ref>

===[[American Association of Endodontists|AAE]] Position Statement===


In 1996, the Research and Scientific Affairs Committee of the American Association of Endodontists prepared the following statement to address issues raised by some endodontic patients:

:''The NICO lesion (Neuralgia-Inducing Cavitational Osteonecrosis, also known as Ratner’s bone cavity) was first described in the dental literature in 1920 by G.V. Black. The lesion consists of ischemic osteonecrosis found in the jaws of patients with symptoms of [[atypical facial pain]] or trigeminal neuralgia. Research has shown the lesions to be difficult to diagnose. The lesion will sometimes present very subtle radiographic changes often detectable only by a technetium scan or with multiple periapical radiographs. The overlying soft tissues show no changes. Many etiologies for NICO have been suggested, but none have been substantiated through research. According to noted oral pathologist Dr. J.E. Bouquot, the typical NICO case occurs as facial pain many years after an extraction or an infection in the area. Odontogenic infections and minor trauma have been suggested as initiators, and correlations to clotting or vascular abnormalities have been made based on anecdotal associations. No scientific studies have demonstrated a causative relationship between endodontic therapy and the formation of NICO. The recommended treatment for NICO is decortication and curettage of the bony tissues. While this practice has produced relief of pain in some cases, NICO has a strong tendency to recur and to develop in other jawbone sites. Most affected sites with a postoperative NICO diagnosis have been in edentulous areas. However, some patients with long, frustrating histories of pain associated with endodontically treated teeth have been presented the treatment option of tooth extraction followed by periapical curettage in an attempt to alleviate pain. The American Association of Endodontists cannot condone this practice when NICO is suspected. Because of the lack of clear etiological data, a NICO diagnosis should be considered only as a last resort when all possible local odontogenic causes for facial pain have been eliminated. If a NICO lesion is suspected in relation to an endodontically treated tooth, if possible, periradicular surgery and curettage should be attempted, not extraction. In addition, the practice of recommending the extraction of endodontically treated teeth for the prevention of NICO, or any other disease, is unethical and should be reported immediately to the appropriate state board of dentistry.''<ref name="AAE position statement">{{cite web|title=AAE Position Statement on NICO lesions (Neuralgia-Inducing Cavitational Osteonecrosis)|url=http://www.aae.org/uploadedFiles/Patients/NICOlesionsnew.pdf|publisher=AAE Research and Scientific Affairs Committee|accessdate=8 May 2013}}</ref>

===Controversy===
NICO remains a controversial diagnostic entity. The opponents argue that the concept can currently not be accepted because precise diagnostic criteria are lacking and there is no supporting [[evidence-based medicine|scientific evidence]] that does not suffer from [[methodological]] flaws.<ref name="pmid10981982">{{cite journal |author=Zuniga JR |title=Challenging the neuralgia-inducing cavitational osteonecrosis concept |journal=J. Oral Maxillofac. Surg. |volume=58 |issue=9 |pages=1021–8 |date=September 2000 |pmid=10981982 |doi=10.1053/joms.2000.8745 |url=http://linkinghub.elsevier.com/retrieve/pii/S0278-2391(00)36564-8}}</ref> It has been rejected as [[quackery]] by some but not all [[dentists]] and [[maxillofacial surgeon]]s.<ref name="pmid14977370">{{cite journal |author=Follmar KE |title=Taking a stand against fraud and quackery in dentistry |journal=J Am Coll Dent |volume=70 |issue=3 |pages=4–5 |year=2003 |pmid=14977370 |doi= |url=}}</ref><ref name="pmid14977380">{{cite journal |author=Bouquot JE, McMahon RE |title=Charlatans in dentistry: ethics of the NICO wars |journal=J Am Coll Dent |volume=70 |issue=3 |pages=38–41 |year=2003 |pmid=14977380 |doi= |url=}}</ref>


==See also==
==See also==
⚫
* [[Atypical trigeminal neuralgia]]
* [[Health fraud]]
* [[Trigeminal neuralgia]]
* [[Trigeminal neuralgia]]
⚫
* [[Atypical trigeminal neuralgia]]
* [[Osteonecrosis of the jaw]]


==Footnotes==
==Footnotes==
{{Reflist}}
{{Reflist|2}}


==External links==
==Further reading==
*{{cite journal |last1=Gandhi |first1=Yazad R. |last2=Pal |first2=U. S. |last3=Singh |first3=Nimisha |title=Neuralgia-inducing cavitational osteonecrosis in a patient seeking dental implants |journal=National Journal of Maxillofacial Surgery |date=2012 |volume=3 |issue=1 |pages=84–86 |doi=10.4103/0975-5950.102173 |pmid=23251067 |pmc=3513818 |doi-access=free }}
* [http://www.quackwatch.org/01QuackeryRelatedTopics/cavitation.html Cavitational Osteopathosis, NICO, and Biological Dentistry] - from [[Quackwatch]]


{{DEFAULTSORT:Neuralgia-Inducing Cavitational Osteonecrosis}}
{{DEFAULTSORT:Neuralgia-Inducing Cavitational Osteonecrosis}}

[[Category:Fringe science]]
[[Category:Fringe science]]
[[Category:Medical controversies]]
[[Category:Medical controversies]]

Latest revision as of 03:40, 18 March 2024

Neuralgia-inducing cavitational osteonecrosis (NICO) is a diagnosis whereby a putative jawbone cavitation causes chronic facial neuralgia; this is different from osteonecrosis of the jaw.[1] In NICO the pain is said to result from the degenerating nerve ("neuralagia").[2][3][1] The condition is probably rare, if it does exist.[4]

Also called Ratner's bone cavity, a neuralgia-inducing cavitational osteonecrosis was first described in dental literature by G V Black in 1920.[5] Several decades later, oral pathologist Jerry E Bouquot took especial interest in NICO.[5]

The diagnostic criteria for NICO are imprecise, and the research offered to support it is flawed.[6] The diagnosis is popular among holistic dentists[7] who attempt to treat NICO by surgically removing the dead bone they say is causing the pain.[8]

It has been rejected as quackery by some dentists and maxillofacial surgeons.[9][10][11][12] 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.[5]

See also

[edit]

Footnotes

[edit]
  1. ^ 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. doi:10.1016/0030-4220(92)90127-C. PMID 1545963.
  2. ^ 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. doi:10.1016/0030-4220(79)90229-9. PMID 287984.
  3. ^ 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. doi:10.1016/0030-4220(79)90027-6. PMID 291856.
  4. ^ Scully, Crispian (2013). Oral and maxillofacial medicine: the basis of diagnosis and treatment (3rd ed.). Edinburgh: Churchill Livingstone/Elsevier. p. 130. ISBN 978-0-7020-4948-4.
  5. ^ a b c "AAE Position Statement on NICO lesions (Neuralgia-Inducing Cavitational Osteonecrosis)" (PDF). AAE Research and Scientific Affairs Committee. Archived from the original (PDF) on 5 March 2016. Retrieved 8 May 2013.
  6. ^ Zuniga JR (September 2000). "Challenging the neuralgia-inducing cavitational osteonecrosis concept". J. Oral Maxillofac. Surg. 58 (9): 1021–8. doi:10.1053/joms.2000.8745. PMID 10981982.
  7. ^ Yi, Daniel (18 June 2006). "Roots of a Dental Controversy". Los Angeles Times. Archived from the original on 21 February 2015. Retrieved 25 June 2017.
  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. doi:10.1016/0278-2391(95)90708-4. PMID 7699492.
  9. ^ Follmar KE (2003). "Taking a stand against fraud and quackery in dentistry". J Am Coll Dent. 70 (3): 4–5. PMID 14977370.
  10. ^ Kreidler, Marc (18 May 2019). "Cavitational Osteopathosis, Bouquot, NICO, and 'Biological Dentistry'". Quackwatch.
  11. ^ Bouquot JE, McMahon RE (2003). "Charlatans in dentistry: Ethics of the NICO wars". J Am Coll Dent. 70 (3): 38–41. PMID 14977380.
  12. ^ Sciubba, JJ (July 2009). "Neuralgia-inducing cavitational osteonecrosis: a status report". Oral Diseases. 15 (5): 309–12. doi:10.1111/j.1601-0825.2009.01532.x. PMID 19371400.

Further reading

[edit]
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