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Cavitations

 

 

 

 

A cavitation refers to a toxin-containing hole in the jawbone, often at the site of a previously extracted tooth. Cavitations have many scientific names such as ischemic osteonecrosis, chronic non-superative osteomyelitis, and neuralgia inducing cavitational osteonecrosis (NICO). This is not so much an infection in the bone, as a necrosis or gangrene (dead tissue) in the bone marrow, as a result of impaired blood flow (ischemia). A cavitation often develops because of incomplete healing after routine extraction. The contents of cavitations are always necrotic, dead or dying material. The microscopic picture looks the same as gangrene! If a gangrenous extremity is not amputated, the rest of the body will sicken and die, due to a high concentration of anaerobic bacterial toxins.

Incomplete healing of a cavitation is promoted by a number of factors, including the following:

* Failure to completely remove the periodontal ligament lining the tooth socket that holds the tooth to the bone

* Physically large surgical excavations, such as with impacted wisdom teeth, where the resulting holes can be expected to be larger than usual and more new bone is required to fill the holes

* Failure to clean out the infected adjacent bone and periodontal ligaments seen in the extraction of root canal treated and abscessed teeth

* Failure to remove condensing osteitis, the reactive bone formation that attempts to wall off infection, usually involving the periodontal ligament as well

* Poor systemic healing support from a compromised immune system

* Poor nutrition and a weak thyroid gland.

* Failure to allow the formation of a complete blood clot at the excavation site; too early dislodgment of a clot after extraction; also bleeding

* Smoking

* Antibiotic therapy

* Chronic osteoporosis of the jawbone

* Systemic and adjacent toxicity from other dental toxins and other sources

* Pre-existing periodontal disease, in addition to any other factor that would also promote periodontal disease

One of the primary factors in cavitation formation seems to be that the initial extraction does not include the thorough removal of the periodontal ligament from the socket after the tooth is removed. Unfortunately, this inadequate socket cleaning is the routine procedure with most extractions. Cavitation formation after tooth extraction is the rule and not the exception; yet, the condition is still largely unknown to most of dentistry, and underestimated by those who are aware of it. A cavitation can be expected to form when the socket lining separating the tooth from the bone is not thoroughly removed. A thorough removal of the ligament requires that a portion of the bony socket be removed as well.

 

One purpose of this ligament is to give a certain amount of natural shock absorption to the tooth. Without it, chewing would be much like riding on rims rather than tires. When the periodontal ligament is not thoroughly removed from the socket after the extraction, the surrounding bone receives no notification that the tooth is gone. The continued presence of any portion of the ligament gives the biological message to the surrounding jawbone that all is well, and no new bone growth is needed. Bone cells are not going to start new growth and then migrate through a barrier naturally designed to limit such growth. The jawbone determines that if the ligament is still there, the tooth must be there as well.

Since the periodontal ligament does not extend to the upper edge of the extraction site, new bone growth activity will not be inhibited at the top of the socket, and a characteristic thin cap of bone will eventually extend over the extraction hole. Larger cavitations often have only a cap of gingival, or gum tissue, over them. Even the thin overlying cap of bone does not form in these cases. In routine dental extraction, portions of the periodontal ligament will sometimes remain more strongly attached to the tooth than the bone and be removed along with the tooth. When partially removed in this fashion, the spotty absence of the ligament will permit equally spotty growth of bone, resulting in the wide variety of cavitation shapes and sizes.

Even when large wisdom teeth are removed surgically from impacted sites with extensive excavation, cavitations are nearly always present. When the excavated hole is large enough, cavitation formation can be anticipated, even if most, or all, of the periodontal ligament is removed, since so much more new bone growth is needed to completely fill the hole. Condensing osteitis must be completely removed to give the opportunity for complete healing. Solid, healthy bone must be reached to allow the normal regeneration of bone. When infection or necrosis remain throughout the socket and adjacent bone, with or without condensing osteitis, healing will rarely ever be completed.

Blood clot formation, with its gradual retraction over time as the surrounding tissue heals in, is nature's way of promoting proper healing throughout the body, not just in the mouth. When a nicely formed blood clot fills the socket, healing gets a good start. But when it is dislodged early, or adjacent periodontal disease or smoking causes too rapid a retraction, a dry socket is the result, and cavitation formation can then be anticipated.

Preexisting diseases, such as osteoporosis with poor bone structure in the jawbone before the extraction, can clearly promote the formation of cavitations. Bleeding disorders, which would directly impair the formation of the important blood clot, can also be promoting factors. Periodontal disease can also serve to more easily infect the freshly extracted sites and bathe them in the toxins produced by the anaerobic bacteria trapped in the diseased gums. The presence of local and systemic toxins will also impair the healing process anywhere in the body. The presence of toxins such as heavy metals will chronically disrupt the calcium/phosphorus balance in the body, promoting the continuous mobilization of calcium from the bone into the tissues and into the urine. Any healing bone needs more bioavailable calcium, not its removal.

The procedure to clean a cavitation has often involved use of a blind approach, due to a lack of reliable diagnostic tools. Consequently, dentists have missed smaller and unusually located cavitations. Even a larger cavitation could be missed by the wrong angle of attack by failing to explore the one cusp site that had cavitated. Cavitations will also interconnect and form channels in the jawbone.

An explored channel might be counted as only one cavitation when it actually developed from more than one unhealed extraction site. Many smaller cavitations will never be found because the operator may not opt to explore a smaller area between the teeth on either side of the old extraction site. Larger cavitations can extend below the mandibular nerve. Such large cavitations allow the toxins more access to the rest of the body by utilizing the mandibular and other nerve channels. Most dentists seem to convince themselves that if a cavitation cannot be seen on x-ray, it must not be there. However, a cavitation characteristically cannot be seen on x-ray. While some cavitations can be clearly visualized on a panoramic x-ray, by those who are trained to identify them, the vast majority of cavitations, even large ones, will be completely missed on a careful examination of the x-rays.

Only a cavitation that has formed with additional calcification around a well-defined border will be visualized on X-ray. The cavitation officially forms when healing at the top is complete. The healing over on top allows the rapid development of an oxygen-deprived, or anaerobic, state in the hole. Native mouth bacteria produce highly toxic metabolic by-products when deprived of oxygen. Bacteria that are normally harmless to man when oxygen is present form a deadly toxin when oxygen is removed. An example of deadly toxins forming when oxygen is absent is the botulism toxin, resulting from vacuum-packed foods, sealed with bacteria present. Some toxins found at cavitation sites are up to 1,000 times more toxic than botulism in their effects on enzymes systems.

Antibiotics will not help the individual poisoned with botulism, nor will they help the cavitation patients, as the problem stems primarily from bacterial toxins, not bacteria. Only a rapid neutralization of a large toxin dose will save the patient. Toxins in both cavitations and root canal filled teeth rapidly kill vital human enzymes at the lowest imaginable concentrations. Cavitation toxicity tends to be cumulative. The more cavitations you have, the more toxicity is present. Cavitations also may make other diseases worse. They will make it more difficult for a compromised immune system to ever completely recover. The immune system characteristically tolerates all stresses fairly well until it collapses relatively suddenly. It will compensate as long as possible, then very suddenly its defenses will no longer be effective. Cavitations might not be the cause of an illness, but they can easily be the factor that prevents recovery from it.

Sonic Imaging

There is a new technology that has been developed that can image the jawbone using unfocused ultrasound that provides a color-coded three dimensional representation of the density of the bone and shows loss of bone or ischemic dying bone tissue that is usually not seen on x-ray imaging. This technology, called a Cavitat, has been approved by the FDA and is now available. It has an incredibly high accuracy record in the findings of a correctly performed scan. This can be done chair-side at a dental facility so equipped. Check out the Cavitat website at www.dentalhelp.org. They have references for dentists who have cavitat devices, as well as other educational materials, etc.

Treatment

Surgery is often necessary to properly and thoroughly clean out a cavitation site, for there is no other way to remove dead bone. The key to bone healing and regeneration is through removal of necrosis and support of the thyroid gland, especially by using detoxified iodine. Neither injections into the bone with homeopathic remedies or laser light treatments will work to stop the progressive necrosis. If necrotic tissue is not thoroughly removed, the necrosis will spread and cause more destruction to the bone, nerves and blood vessels. This kills teeth in the process, for they are cut off from their blood supply. After cleaning out the necrotic bone, healing can then take place and new bone cells will fill in the cavitations. Unfortunately, there are only a handful of dental surgeons today who do a proper job of thoroughly cleaning out the diseased bone tissue.

Dr. Wesley Shankland has written a very comprehensive book for individuals who suffer with TMJ and related disorders. TMJ: Its Many Faces, 2nd Edition, published by Anadem Publishing, has drawn on Dr. Shankland's experience of over 23 years of treating patients from all over North America and around the world. These patients have seen, on average, six other health professionals prior to seeing Dr. Shankland. While many of these patients have been told that their TMJ problem is a result of stress, Dr. Shankland has found that nearly 100% of these patients do have physiological and/or anatomical reasons for their pain. This book discusses how the patient can become actively involved in his or her treatment. Included are complete instructions and diagrams of exercises. Lifestyle changes are outlined and a chart of dietary modifications are contained within the book. An entire chapter is devoted to choosing and evaluating a TMJ doctor.

 

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