Neuralgia-inducing cavitational osteonecrosis
Neuralgia-inducing cavitational osteonecrosis (NICO) is a jawbone cavitation that causes chronic facial neuralgia. The cavitation is an area of dead bone, and the painful nerve is theorized to result from the degenerating nerve.[1][2][3] Although some experts acknowledge that NICO can occur, their frequency, causation, and diagnosis have remained controversial, and the diagnosis has been marginalized.
Controversy
Also called Ratner's bone cavity, a neuralgia-inducing cavitational osteonecrosis was first described in dental literature by G V Black in 1920.[4] Several decades later, oral pathologist Jerry E Bouquot took especial interest in NICO.[4] 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,[3] injury, abnormalities in clotting or blood supply,[4] or drug treatment.[5] NICO have been treated by surgically removing the dead bone, although recurrence has been common.[6]
Opponents of the NICO concept have argued that diagnostic criteria are imprecise, and that the research offered to support it is flawed.[7] It has been rejected as quackery by some dentists and maxillofacial surgeons.[8][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.[4] 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.[13]
See also
Footnotes
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ Follmar KE (2003). "Taking a stand against fraud and quackery in dentistry". J Am Coll Dent. 70 (3): 4–5. PMID 14977370.
- ^ Stephen Barrett, "A critical look at cavitational osteopathosis, NICO, and 'biological dentistry'", Quackwatch, 4 Apr 2010.
- ^ Bouquot JE, McMahon RE (2003). "Charlatans in dentistry: Ethics of the NICO wars". J Am Coll Dent. 70 (3): 38–41. PMID 14977380.
- ^ Sciubba JJ, "Neuralgia-inducing cavitational osteonecrosis: A status report", Oral Diseases, 2009 Jul;15(5):309–12.
- ^ IAOMT, "IAOMT position paper on jawbone osteonecrosis", International Academy of Oral Medicine & Toxicology, 27 Jul 2014.
- ^ Lechner J & von Baehr V, "Peripheral neuropathic facial/trigeminal pain and RANTES/CCL5 in jawbone cavitation", Evid Based Complement Alternat Med, 2015;2015:582520.