Cavitation Presentation: Ischemic Osteonecrosis of the Jaw – G.V. Block’s Forgotten Disease

Although these jaw bone infections are not easy to recognize on x-ray pictures, a large number of them have been diagnosed and they involve a subtype of Ischemic Osteonecrosis (IO), more frequently reported in the literature as NICO (Neuralgia-inducing Cavitational Osteonecrosis). 2,867 intramedullary biopsy samples taken from 1,333 facial pain patients has recently been reported. This includes pain relief of trigeminal neuralgia patients who have had these dead bone infected areas surgically removed.

The problem: Most dentists and oral surgeons are unaware of the presence of these infections until they have surgically eradicated the softened, dead bone in one of these areas and have received the biopsy report of its pathologic contents. G. V. Black, the foremost author of Dental pathology textbooks and Dean of the Dental School at Northwestern University, first reported the disease in 1915 as chronic osteitis. Little else was published until 1970. This disease appears to have been buried along with the root canal focal infection problem.

Similar disease areas in the other bones of the body have been labeled ischemic osteonecrosis, but those occurring in the mouth have been ignored by medical investigators. These mouth lesions also are felt to be an ischemia problem. However, there is reasonable evidence that many of them occur because infections from teeth are transferred into the periodontal membrane and the surrounding bony socket. Often, the healing process eradicates this infection after tooth extraction. However, in many cases this does not occur, and the bacteria involved in the original infection in the tooth remain, and cause these slow growing chronic infection holes in jaw bones.

X-ray pictures of such areas will be shown, along with the difficulty involved in making an x-ray diagnosis; other methods used to determine their presence; biopsy photographs of a trigeminal patient showing large cavitation area that was found to be an etiologic cause of this disease.

Cavitation jaw bone infections are also a focal infection cause of illness in other parts of the body.