Save at-risk bone the minimally invasive way

Dr. Gerry Curatola
"What Are Cavitations And How To Treat Them."

A biologic approach to jaw cavitations

The human body faces numerous health risks that are not immediately identifiable or noticeable. For example, most people are familiar with the dangers of high blood pressure, which generally cannot be felt, but which are nonetheless liable to take fatal forms. Yet few people pause to give thought to the health-threatening conditions that may be lurking inside their own mouths.

A lack of concern for worst-case dental scenarios is understandable, as it may be attributable to lack of information. However, that may be on the verge of changing.

With decades of combined experience and expertise, the renowned Rejuvenation Dentistry® team wants to make the world more aware of the bone disorder known as “cavitations.” As the word itself remains unfamiliar to most people, the need for this is plainly evident.

jaw bone model

What is a cavitation?

To begin with, it is important to define terms. Your natural inclination, especially when put in mind of the dentist, may be to connect “cavitations” to the similar-sounding “cavities.” But this would be a mistake. As explained in the National Journal of Maxillofacial Surgery, cavities and cavitations both involve holes. A cavity is, of course, a hole in one’s tooth. A cavitation, on the other hand, is a hole in bone. Thus, to say that the latter hole is a deeper problem would be true in a very literal sense. The journal goes on: “Unlike most tooth cavities, bone cavitations cannot be detected by simply looking at the bone, and even using X-rays, many cavitations are missed.” Interestingly, the term is not even a century old, having been coined in 1930 by an orthopedic researcher seeking to explain the blood-flow problems caused by a hole in the jawbone. The same process was addressed as early as 1915 by pioneering dentist Dr. G. V. Black, who observed a case in which blood vessels in the jawbone were blocked, leading ultimately to “dead bone.” As these historical notes indicate, the issues posed by cavitations are more severe than those traditionally associated with cavities. It comes as no surprise that, eventually, the condition acquired a more medical term: NICO (Neuralgia-Inducing Cavitational Osteonecrosis).
This is the jaw-based variation of osteonecrosis—also known by several other names, including avascular necrosis (AVN)—which can affect any bone in the body (but especially the hips and knees). The National Institute of Arthritis and Musculoskeletal and Skin Diseases defines osteonecrosis as “a bone disease. It results from the loss of blood supply to the bone. Without blood, the bone tissue dies. This causes the bone to collapse. It may also cause the joints that surround the bone to collapse.” Causes are not always known, but may include certain medicines, medical procedures, long-term alcohol use, injury or increased bone pressure. Risk factors more specifically associated with jawbone-based osteonecrosis include gum disease, heavy smoking, and low oral doses of bisphosphonates, which are used in the prevention or treatment of osteoporosis. It is important to note, however, that research into the causes of dental cavitations is still ongoing and possibly quite far from being fully understood. Some explanations might even be considered controversial. However, the underlying problem remains clear. Put as simply as possible, a loss of blood supply to a patient’s jawbone has taken place.
jaw bone loss graphic

Understanding the problem

Significantly, cavitations of the jaw may or may not cause pain. Unfortunately, this raises the possibility of a patient suffering from a very regrettable oral condition for years without even knowing it. And this, in turn, brings us back to the uncomfortable reality that many forms of visual observation, including X-rays, will not necessarily reveal a patient’s cavitations. All of which is made especially troubling by the potential ramifications of suffering from them. The problem is not just dead bone; it is what forms around it. The absence of healthy tissue facilitates the accumulation of bacteria, fungi, and parasites. The area of bone subject to cavitation gives rise to a kind of dental cesspool of unwanted microbial invaders. And as anyone who has ever spoken with a dentist knows all too well, our mouths already harbor enough of those as it is!

Equally troubling is the ease with which jawbone cavitations can occur. Common but nonetheless extensive dental procedures—think root canals and tooth extractions—can cause trauma that gives rise to cavitations. In fact, according to the American College of Rheumatology, most instances follow dental extractions.

Making matters worse, there are links between osteonecrosis—including dental cavitations—and other serious forms of disease. These include: heart disease, autoimmune diseases, HIV infection, sickle cell, pancreatitis, Gaucher’s disease, and others. It is also associated with radiation-based cancer treatment.

Now that you understand the problem, you are likely asking yourself: What can be done to address it?


As always, prevention begins at home, with a strict regimen of daily brushing and flossing, plus regular visits to our office. However, in some cases, this may not be enough. After all, what if cavitations have already set in? What if a patient did everything he or she could to maintain oral health, only to suffer from cavitations as an unintended result of a separate procedure? Or, perhaps worst of all, what if osteonecrosis of the jaw simply happens, seemingly out of the blue, for no discernible reason? For many patients, the answers to these puzzling questions may lie in a potentially revolutionary new kind of dentistry. To see the philosophy in practice, look no further than New York City’s Rejuvenation Dentistry. As a business model, it seems simple enough. The dental services available here include everything one might expect—restorative work such as basic crowns and bridges, implant procedures, preventative care, and so forth. But digging a little deeper, one quickly realizes that this is not your typical dentist’s office. Rather, Rejuvenation Dentistry is a practice where removal of mercury from a patient’s teeth is seen as being just as important as more traditional procedures. Mercury is a fixture of many metal fillings, but science has linked it to numerous disturbances of psychological and physical well-being (including memory loss and personality changes). If this reminds you of cavitations, perhaps it should. The fact that so many people go through life afflicted by serious unknown maladies is disturbing, but only when you assume their conditions can’t change. This brings us back to the work of Dr. Gerry Curatola, the practice’s founder and guiding force. “Traditionally, dentists have focused on restorative aspects and really taking care of the mouth as a separate entity, and I see oral health as being on the front line of a patient’s wellness,” he says in an introductory video.


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Rejuvenation Dentistry


The practice’s integrative approach is called “holistic dentistry.” It takes into consideration a patient’s emotional well-being, diet, and other personal factors that pertain to the bigger physical picture. A healthier patient is a happier patient, and vice-versa. “This the kind of true integration that brings together beauty, wellness, restorative dentistry, and healthy living,” Dr. Curatola adds.


At this point, it should be noted that the word “holistic” has acquired an unfairly negative connotation. Many people will be put in mind of crystals and potions being employed for questionable New Age-style healing purposes. However, to treat a subject holistically is simply to consider the relationship between its interconnected parts. When viewed in this light, it makes little sense to approach dental problems except holistically (even at the most basic level of taking into account the connection between mind and body). This has serious implications for jawbone osteonecrosis, as dental professionals today search for & successfully utilize—the latest solutions to the problems with which Dr. Black grappled more than 100 years ago. Crucially, these not need be invasive. Using what Dr. Curatola calls “bio-compatible technology,” laser-based healing kills pathogens and makes it possible for a dental osteonecrosis patient’s bone tissue to regenerate. In the process, the laser greatly reduces or eliminates discomfort, bleeding, and healing time. These exciting new possibilities are becoming a reality thanks to products from manufacturers like BIOLASE, which makes all-tissue and soft-tissue lasers for dental professionals. For patients, this marks an especially welcome contrast to treatments that require surgical removal of bone. Meanwhile, with increasingly high-tech and relatively painless treatments for cavitations and other problems, those scary dentist drills from old movies will surely become a thing of the past.
dental implant model


Of course, cavitations remain a serious condition—a kind of “silent killer” that goes undiagnosed in far too many people. But while the problem may always exist, its scope and severity can only decrease as more and more patients take an all-encompassing approach to combatting it. In the case of jawbone osteonecrosis, this “all-of-the-above” philosophy begins with ever-increasing awareness, takes shape in the form of vigilant care, and finds empathetic advocacy in the hands of our most forward-thinking dental practitioners.
dental patient smiling
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