Neuralgia-inducing cavitational osteonecrosis – What is it?

This is the fourth in a series of 7 posts about orofacial pain with difficult to diagnosis or unusual origin.

1. Cracked tooth syndrome
2. Trigeminal neuralgia
3. Atypical odontalgia
4. Neuralgia-inducing cavitational osteonecrosis or NICO AAE  JADA from UIC Epstein June 2011
5. Referred pain
6. Myofascial pain
7. Burning Mouth Syndrome

Neuralgia-inducing cavitational osteonecrosis Etiology and Symptoms

A low-grade, nonsuppurative, radiographically invisible osteomyelitis of the jaws with pain similar to trigeminal neuralgia.  If that sounds like a bunch of words made up for some scientist somewhere to sound smart, you may be right.  There is not total agreement that this is an actual condition.  It may be unknown or misdiagnosed form of neuralgia.  Those that do believe this condition exists theorize that it is caused by blood constriction to small areas in the bone or bone marrow resulting in small infections.  4/5 patients that are diagnosed with NICO have underlying coagulation problems and some believe this is a requirement for the diagnosis.  The location of the pain is nearly impossible for the patient to locate and by the time a NICO diagnosis is made a patient usually has had multiple root canals followed by extractions.  The dental treatments and antibiotics sometimes temporarily relieve the pain but it always returns.

Neuralgia-inducing cavitational osteonecrosis Treatment

There is no recommended treatment for this condition.  It may be that these are neuralgia cases that current science does not understand and we are just grasping for a reason as to why this is happening (this seems likely to me).  For more on chronic pain check out my TMD and chronic pain blog.