Neuralgia-inducing cavitational osteonecrosis

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

* hopeful evidence
* Health fraud
* Trigeminal neuralgia
* Atypical trigeminal neuralgia

## Footnotes

1. ↑ 1.0 1.1 "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. March 1992. doi:10.1016/0030-4220(92)90127-C. PMID 1545963.
2. ↑ "Jawbone cavities and trigeminal and atypical facial neuralgias". Oral Surg. Oral Med. Oral Pathol. 48 (1): 3–20. July 1979. doi:10.1016/0030-4220(79)90229-9. PMID 287984.
3. ↑ "Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias". Oral Surg. Oral Med. Oral Pathol. 48 (4): 298–308. October 1979. 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. https://books.google.com/books?id=U3WyAFrXVfIC&pg=PA130.
5. ↑ 5.0 5.1 5.2 "AAE Position Statement on NICO lesions (Neuralgia-Inducing Cavitational Osteonecrosis)". AAE Research and Scientific Affairs Committee. http://www.aae.org/uploadedFiles/Patients/NICOlesionsnew.pdf.
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". http://articles.latimes.com/2006/jun/18/business/fi-teeth18/2.
8. ↑ "Long-term effects of jawbone curettage on the pain of facial neuralgia". J. Oral Maxillofac. Surg. 53 (4): 387–97; discussion 397–9. April 1995. 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'". https://quackwatch.org/related/cavitation/.
11. ↑ "Charlatans in dentistry: Ethics of the NICO wars". J Am Coll Dent 70 (3): 38–41. 2003. 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

* Gandhi, Yazad R.; Pal, U. S.; Singh, Nimisha (2012). "Neuralgia-inducing cavitational osteonecrosis in a patient seeking dental implants". National Journal of Maxillofacial Surgery 3 (1): 84–86. doi:10.4103/0975-5950.102173. PMID 23251067.

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