| NICO Guest speaker Anna Marie Pitroliere Recap by: Don Jeffries Nico is a medical condition that is quite uncommon and is not a well known disease throughout the medical profession. Several years ago, it was conceived in the Dental field. However, to this day, it is not well known even among dentists and it is a rare event to come across other medical personnel who may be familiar with the disease, which is called Neuralgia-Inducing Cavitational Osteonecrosis, other wise known as NICO. Anna Marie talks about NICO which are holes in the jaw bone, these cavitations cause TN like symptoms and can be very toxic. My experience is that I was having severe facial pain after I had to have two teeth removed two years ago. I had the X-Rays, MRI’s, CAT scans and they couldn’t find anything wrong. A neurologist came in and he couldn’t find out what was causing this pain and burning sensation was. So I went to Cedars Sinai Where they examined me, put me through exercises, cold sprays on the jaw, an injection into the jaw and the muscles that were spasmodic in my jaw. After this the pain started coming down. The pain never left, but it has subsided.With NICO’s there is no swelling of the gum, no redness, there is nothing that shows. These cavitation’s cause TN like symptoms. Just like TN, they may go for years with no symptoms then a puff of wind, brushing your teeth, causes a shooting pin, headaches, pressure, and neck aches. So what we have found out through the research of Dr. Wesley Shankland DDS, MA., Ph.D., who deals with all kinds of facial pain. He gives lectures with a man, Mr. Bob Jones, who had the same problems and came up with the idea for the cavitat machine. Cavitation’s can be very toxic which can affect the nerves in the face and other parts of the body.One of the things they do is clean out the cavities and biopsy the bone. When they do this you will lose the teeth. There is no way to get in to clean out the bone without pulling the teeth. A lot of people have had a lot of success with cleaning out the bone. Sometimes they will cut out the bone and do a bone graft. When doing this, you still must lose your teeth. There is no way to have a bone graft without losing your teeth. Then you can have implants put in with a healthy bone. When the bone dies, there is no blood circulating, and this can cause neuralgia (nerve pain) which is the same as trigeminal nerve pain. To check this out, you need to go to one of three or four dentists in California that specialize in this type of work. And there are only about three machines (cavitation machines) that take these panoramic pictures that are needed to help identify the problem. Many cases are perpetuated by infection or initiated by infection, however, the clinical and histopathologic (Tissue) characteristics of NICO are only superficially similar to osteomyelitis. In the jaws, minor trauma such as extraction’s, endodontic surgery, and periodontal surgery are common initiators of intraosseous ischemia, but only in people already susceptible because of an underlying (often undiagnosed) clotting disorder, embolic or other vascular abnormality. It has been found that 94% of NICO patients who failed to improve after their initial surgery had one or more of the following coagulation disorders: High levels of plasminogen activator inhibitor Low levels of stimulated tissue plasminogen activator Low levels of Protein C or Protein S (thrombophilia) Resistance to activated Protein C High levels of lipoprotein A Elevated levels of anticardiolipin - antibodies (associated w/ thrombophilia (blood clot) and damaged endothelial (center) cells). NICO has been documented in patients ranging from 18 years old to 94 years old, in both males and females. Patients usually are between the ages of 35 - 64 (71%) and are female (75%). The bone sites that are most involved, from most prevalent to least prevalent, are mandibular molars, maxillary molars, and maxillary cuspids/lateral incisors. The third molar sites represent 45% of all jawbone involvement. It has been considered that the disease smolders quietly for years or decades prior to the onset of symptoms, however many cases become painful immediately after jaw surgery, endodontic therapy or crown preparation. Ischemia is painful and the pain in the jaws is usually more intense (neuralgia-like) than intraosseous (bone) ischemia (blood flow -anemia)) of other bones. The jaws are the only bones with large sensory nerves within them. With NICO, these nerves are surrounded by ischemic necrotic (diseased tissue) tissues for long periods of time, often decades. When the pain is present, it is normally much like atypical facial neuralgia or trigeminal neuralgia and the typical NICO patient has had this pain for about 6 years before NICO is diagnosed. The pain appears to be of a slowly progressive nature, the ischemic (blood flow) process with increasing pain and increasing areas of activity. One-third of patients have more than one quadrant involved and 10% have lesions in all four quadrants, but not necessarily at the same time. Antibiotics may temporarily lessen the associated pain of NICO in cases with low-grade infection, however they are not likely to produce a cure. The abnormal intrabony tissues usually must be removed surgically through decortication and curretage. Once this abnormal tissue is removed, the bony defect often heals and the intense facial pain decreases dramatically or disappears completely. One third of NICO patients, however, experience minimal or no pain relief and 3% have experienced increased pain. The use of various anti-clotting therapies may be of great benefit in the future. NICO has a strong tendency to recur and/or to develop in additional jawbone sites, often requiring multiple repetitions of the same surgical procedure. Thirty percent of affected patients experience local recurrence of jaw or facial pain, usually of a different type than the original pain. One- third develop additional NICO lesions elsewhere in the jaws. Wesley Shankland II, DDS, M.A., PhD Dr. Byung Sun Yoo Director, TMJ & Facial Pain Center 2425 3rd Ave. 6011 Cleveland Ave. San Diego, CA 92101 Columbus, OH 43231 619-231-1624 www.drshankland. com www.cavitat.com Books: Let The Truth Be known Dr. A.J. Zakarian DDS TMJ It’s many faces 3504 4th Ave.Face The Pain San Diego, CA Root Canal Cover-up 619-296-6899 Return to Home Page |