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'''Neuralgia-inducing cavitational osteonecrosis (NICO)''' is a jawbone cavitation that causes chronic facial [[neuralgia]]. The cavitation is an area of [[necrosis|dead bone]], and the painful nerve is theorized to result from the degenerating nerve.<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|url=}}</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|url=}}</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|url=}}</ref> Although some experts acknowledge that NICO can occur, their frequency, causation, and diagnosis have remained controversial, and the diagnosis has been marginalized.
'''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"/>
==Controversy==


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"/> Although [[osteonecrosis]] within the jawbone—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,<ref name="pmid1545963"/> injury, abnormalities in clotting or blood supply,<ref name="AAE position statement"/> or drug treatment.<ref>Landesberg R, Woo V, Cremers S, Cozin M, Marolt D, Vunjak-Novakovic G, Kousteni S & Raghavan S, [https://www.ncbi.nlm.nih.gov/pubmed/21291478 "Potential pathophysiological mechanisms in osteonecrosis of the jaw"], ''Ann N Y Acad Sci'', 2011 Feb;'''1218''':62–79.</ref> NICO have been treated by [[curettage|surgically removing the dead bone]], although recurrence has been common.<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|url=http://linkinghub.elsevier.com/retrieve/pii/0278-2391(95)90708-4}}</ref>
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>

⚫
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>


⚫
Opponents of the NICO concept have argued that diagnostic criteria are imprecise, and that 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 |url=http://linkinghub.elsevier.com/retrieve/pii/S0278-2391(00)36564-8}}</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 |doi= |url=}}</ref><ref>Stephen Barrett, [https://www.quackwatch.org/01QuackeryRelatedTopics/cavitation.html "A critical look at cavitational osteopathosis, NICO, and 'biological dentistry'"], Quackwatch, 4 Apr 2010.</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 |doi= |url=}}</ref><ref>Sciubba JJ, [https://www.ncbi.nlm.nih.gov/pubmed/19371400 "Neuralgia-inducing cavitational osteonecrosis: A status report"], ''Oral Diseases'', 2009 Jul;'''15'''(5):309–12.</ref><ref>IAOMT, [https://iaomt.org/iaomt-position-paper-jawbone-osteonecrosis "IAOMT position paper on jawbone osteonecrosis"], International Academy of Oral Medicine & Toxicology, 27 Jul 2014.</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|accessdate=8 May 2013}}</ref> More recently, German dentist Johann Lechner and immunologist Volker von Baehr, referring to Bouquot's work, have reported [[basic research]] supporting such jawbone pathology as well as systemic consequences.<ref>Lechner J & von Baehr V, [https://www.ncbi.nlm.nih.gov/pubmed/26170877 "Peripheral neuropathic facial/trigeminal pain and RANTES/CCL5 in jawbone cavitation"], ''Evid Based Complement Alternat Med'', 2015;'''2015''':582520.</ref>
==See also==
==See also==
⚫
* [[Trigeminal neuralgia]]
* [[Atypical trigeminal neuralgia]]
* [[Atypical trigeminal neuralgia]]
* [[Osteonecrosis of the jaw]]
* [[Health fraud]]
⚫
* [[Trigeminal neuralgia]]


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

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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